RE: LH Karly. Ratcliffe@ [Karly.Ratcliffe@] Sent: 31 August 2012 10:40 To: Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION Y TRUST) Dr Nairac,
Thank you for your email. It is great to see-that Li is finally opening up about his self harm and this really is a step forward in the right direction for him. Regarding Li’s Education, this is being dealt with accordingly and the relevant steps are being made. Li has been kept up-to date with this. Kind Regards, Karly Ratcliffe Social Worker Children in Care Team St Peters House, Broadstairs
LH Nairac Bertrand (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST) . Sent: 30 August 2012 17:57 To: [email protected]; Karly.Ratcliffe@ Ce: Johnson Niall (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST) Importance: High Attachments:30.08.12 attachment.doc (37 KB)
i. Please refer to the attachment 2. Please can Ms Mackelden forward the full address of Verona House, and the new GP’s details by return email? 30.08.12 attachment re LH From: Dr Nairac, Consultant Psychiatrist, Orchard House Kent CT10 2TT To: stacey. mackelden@; Karly.Ratcliffe@
Dear Colleagues Re: Li Harris DOB 30.11.96 Thank you to Ms Mackelden for bringing Li to see me this afternoon. Also present was Mr N Johnson, CPN Orchard House.
1. Li has settled well at Verona House. He presented with manageable anxiety as well as appropriate talk and congruent feelings. He is much better than he was before I (and some others !) had to be cruel in order to be kind. He was able to talk about everything (including the previous taboo subject) and it seems that he was grateful and appreciative. Li is currently well catered for at his placement, where minimal self-harm occurred in the early stages. Such ongoing self-harm as may still happen “appears to be limited to very superficial scratching of the (top) of the forearm. Regarding previous(ly taboo) self-damage, Li told me that I had been right regarding its onset (Redacted by author – Reason “The Thing”). He expanded, adding that he was 9 years old when first (Redacted by author – Reason “The Thing”) also at the time there was big stress to do with mother’s erstwhile boyfriend and he used to feel guilty. Since then he rersorted to the procedure at times of particular. stress and I suggested that, with the passage of time, the factor of endorphin addiction was likely to have contributed to the urge to repeat the behaviour (endorphins = natural internal painkiller substances, like morphine, which are released by the body when there is pain. « Addiction » to those accounts in part for the phenomenon of repeated self-harm and compulsive jogging !) Li also wanted me to know that (some) bleeding earlier this year was. as a result of not fresh, further self- injury, but (Redacted by author – Reason “The Thing”) He still did not begrudge me for the bossiness etc to which I resorted earlier in the Summer; something had to change — and it has. Li is still mostly numb regarding the loss of the Thomsons after 4 years. Li is particularly keen to catch up with about 3 months of late course work and to reintegrate the mainstream school. He thinks that, otherwise, it could be difficult for him to have access to necessary facilities — e.g. photography & music facilities. In addition, there is the issue of self- esteem. He had already thought. that a meeting with relevant professionals was required and i second this
Regarding medication. Li is unsure whether his tablets makes a difference. Ms Mackeldeen did not notice much difference when Li was without medication for 6 days in the earlier stages of his placement at Verona House (this arose because of some reported failure on the part of staff at KMAH). Subsequently she thought that there was a positive effect of Equasym XL 40mg. Equally, when pressed, she was in agrement that Li was currently more on a mood disorder (« bi-polar-ish ») than an ADHD spectrum. Management:
1. Urgent: Please can Ms Mackelden forward the full address of Verona House, and the new GP’s details by return email?
2. Regarding continuity of CAMHS care: I shall review Li at intervals — he knows that I would see him more often if I had the time. He may have to settle for several times a year rather than several times a month. It is. important that he should make all possible use of his key worker, who was chosen for him by Ms Mackelden. I trust that Verona House will keep me informed of any major development between appointments, and by email, please. It would not be appropriate for Li’s case to be transferred to his locality CAMHS clinic (Georges Turle House) at this stage.
3. Regarding medication : I have advised a trial off all medication — with a repeat prescription being issued next week (and collected at Orchard House), nevertheless, so that there need be no delay in resuming medication should it appear to be necessary.
4, Regarding education: I would ask Ms Ratcliffe to arrange a meeting with Ms Mackelden, the ‘Pilgrims’ Education officer, Mr R Sancto from Hereson/Ellington Schoo! and me.
5. Regarding the loss of the previous carers: Li will consider my offer to facilitate any meeting to help the grief process in respect of the previous — placement, including mending some feelings. Naturally, this would need to be agreed with the previous carers and, indeed, with the legal guardian.
6. NEXT APPOINTMENT: on Friday 28th September at 2 pm, at Orchard House. Yours faithfully a Dr BL Nairac MRCPsych Consultant Psychiatrist
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