Sunday, 6 December 2015

Political violence and mental health

A brief note in the context of the recent Leytonstone stabbing (5/12/15): commentary on social media predictably has started to suggest that the perpetrator may have had 'mental health issues' (to use a common example of the terms used). This is not helpful and further stigmatises people with mental health problems. Most people with mental health problems do not commit violent crime. People who offend in general might indeed have some sort of personality disorder (as the prison statistics show) or substance misuse problem but the effect of these specific mental disorders in the relevant circumstances is usually just disinhibition of behaviour, disruption of emotional regulation and a reduction in the threshold for aggression, and this may be true even where psychotic or affective disorders are a factor.

However the motivations and thought processes that engendered the hostility in the first place may well be subjectively rational when viewed from particular political or religious viewpoints. It is dangerous therefore to conflate the 'mental health' aspect with the 'motivational' aspect of these events and simply write perpetrators off as being 'mentally ill' . Most homicides result in convictions of murder and punishment with custodial sentences, rather than diminished responsibility manslaughter verdicts and psychiatric hospital disposals. It is dangerous to take a view where people who disagree with government policies or have strong religious/political views and react aggressively are deemed 'mentally unwell' or 'delusional' in a broad sense, as if this is enough to entirely account for the violent behaviour. It might be convenient but it will not solve the problem, and mental health input will not change a lifetime of religio-political indoctrination, marginalisation, social disenfranchisement, disagreement with foreign policy, perceived victimisation or whatever else it is that contributes to the attitudes behind the behaviour.

Thursday, 20 November 2014

Medical Innovation Bill

I attended a dinner last night at which one of the topics discussed was Lord Saatchi's proposed 'Medical Innovation Bill'.

I am not convinced of the necessity of this Bill and am confused by how it will interact with existing medical law. The particular issue that troubles me is the Bill's seemingly contradictory position on the Bolam test and 'negligence'.  I am not fully reassured by the analysis at

To my understanding, defending negligence alleged in  relation to therapeutically motivated actions would in part be reliant upon demonstration of a Bolam -satisfactory level of peer expert support of those actions; the support of a 'responsible body of medical opinion'. However this Bill would now assert that departure from the 'existing range of accepted medical treatments for a condition' will not be negligent  'if the decision to do so is taken responsibly' (s1(2), Medical Innovation Bill). The Bill defines making a decision 'responsibly' in this context, as simply being to have obtained and taken into account the 'views of one or more appropriately qualified doctors in relation to the proposed treatment'

Section 2 of the Bill would provide that

'Nothing in section 1 affects any rule of the common law to the effect that a  departure from the existing range of accepted medical treatments for a  condition is not negligent if supported by a responsible body of medical  opinion.'

My concern is that this Bill would allow that any treatment however experimental or 'innovative' , given to a patient by a doctor would be legally defensible as long as the approval of at least one other expert doctor is obtained - even if a larger 'body' of expert medical professionals would not have advised that treatment. Can one individual expert now constitute a 'body' for the purposes of Bolam and negligence?

If anyone can actually answer the question of how one would innovate 'responsibly' yet remain Bolam compliant and defensible were it to go wrong, I would be keen to read views.

Wednesday, 9 October 2013

Depression and inflammation

Just a quick link to a case report I published recently - the association might appear a bit tenuous, with various other explanations to account for the observation some might say, but still it describes an interesting finding in keeping with the current evidence about the neuroimmunology of depression, and might generate some further research into mirtazapine's mode of action.

Wednesday, 17 July 2013

What went wrong?

Granted nobody has been proven guilty yet, but how sad if the following charges were to be proven true;

The suspects include "Jae-don Fearon, 20" - and the reason it would be especially sad would be that it was not so long ago that the same (presumably), then-teenage Jae-Don was active as a campaigner against gun-crime following the shooting of his father

and indeed lauded as an  "exceptional teenager"

Interesting change of attitude to violence, if the allegations are found to be true - well I thought so anyway.

Saturday, 13 October 2012

Jimmy Savile and Broadmoor

I cannot fathom why someone like Jimmy Savile was given a personal set of keys and unsupervised access to wards and patients in Broadmoor Hospital - regardless of whether or not the allegations are true.

What other medical specialty would allow someone with no healthcare training whatsoever that degree of access to vulnerable patients? What a pathetic failure of the services of the time.

Would be interesting to know what the forensic consultants thought about it all at the time. I cannot imagine any sound-minded consultant approving of someone entirely unrelated to medicine other than through financial affiliations and voluntary work having such influence in the management of a maximum-security psychiatric hospital, and accessing their patients.

Friday, 2 April 2010

Mephedrone claims another victim

So Eric Carlin becomes yet another casualty of the government's stupid attitude to drugs;

resigning on 1/4/2010 over pressure on the ACMD to rush a decision regarding the classification of mephedrone - despite the lack of any real research into its pharmacology, long or even medium-term effects, and the lack of appropriate consideration given to what extent a 'ban' will actually effect any significant harm reduction in the future.

In fact some evidence seems to suggest that decriminalisation is a more useful strategy than than simplistic reactionary prohibition in terms of harm reduction . The most well known example is decriminalisation of personal possession of all drugs in Portugal:-,8599,1893946,00.html

The Cato Institute report on drug decriminalisation in Portugal showed:-

"that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well".

Furthermore the new laws, which will come into effect in a few weeks, are "expected" to target other "substituted cathinones" as well. This should have implications for 'khat' usage (from which cathinones are derived), which is very common in the UK amongst Ethiopian and Somali immigrants. Khat usage is so mainstream amongst these populations that to criminalise its use is effectively to criminalise an entire ethnic minority. I have no idea how the government will fairly enforce this legislation in practice.

Monday, 1 February 2010

A reply from the foreign office

Received this today.

01 February 2010

Dear Dr Alikhan

Thank you for your email about Mr Akmal Shaikh, who was executed in China on 29 December, 2009.
The UK condemns in the strongest terms the execution of Akmal Shaikh and Ministers and officials worked tirelessly to try and prevent it. We made 27separate high level representations to the Chinese authorities, including by the Prime Minister and Foreign Secretary who were both personally involved in this case.
We deeply regret that our concerns , and in particular those surrounding mental health issues, were not taken into consideration despite repeated calls by the Prime Minister, Government Ministers, Members of the Opposition and the European Union.
The UK respects China’s right to bring those responsible for drug smuggling to justice. But the UK is completely opposed to the use of the death penalty in all circumstances and will continue to work on its abolition worldwide.
At this time our thoughts are with Mr Shaikh’s family and friends. We continue to offer them all the support we can.

Yours sincerely,

Mary Withall
Mary Withall | Assistant Desk Officer| Country Casework Team|Consular Directorate | WH4.3| Foreign and Commonwealth Office | London SW1A 2AH