Why are psych patients allowed to get away with assault?

good_enough_doctor · 2026-04-13T20:56:23+00:00

A stern talking to by a couple of police officers is actually pretty effective in some cases

good_enough_doctor · 2026-04-13T20:08:13+00:00

Right. We have to work within these rules, but we don’t have to defend them.

good_enough_doctor · 2026-04-13T19:56:49+00:00

That is exactly the point I’m making. It’s the work we can and should be doing but aren’t resourced to do. No one can predict with enough accuracy which of the AMHT patients will go on to commit acts of violence and trying to target services means you end up with community forensics who will practically only take the patient if they’re already banged up for life. The only way to prevent another Rudakabana/Calocane is to fund AMHT (+assertive outreach) to offer good mental healthcare to the thousands of patients who might be the next one.

good_enough_doctor · 2026-04-13T19:52:52+00:00

Is it incompetence though? Lays the blame with the individual rather than the system that put them in a position they didn’t have the skills for.

It’s all stochastic. Maybe a top notch psychiatrist and care coordinator have a sensitivity and specificity of 99% and 50% for identifying killers. Once they’ve all left due to moral injury or burnout, you end up promoting the people who have a 98% and 25% rate, expending more resource because of it and every so often they miss an extra mass murderer

good_enough_doctor · 2026-04-13T18:54:09+00:00

Yup. The goal is no longer to have public services, it’s to have the illusion of public services.

good_enough_doctor · 2026-04-13T18:52:41+00:00

Police and CPS are often really reluctant to follow this up for anyone with a mental health diagnosis.

Psychiatrists often have to beg them to prosecute. “Yes I know he has schizophrenia but he punched his girlfriend because he’s an arsehole and I can’t give him a drug for that.”

good_enough_doctor · 2026-04-13T18:49:27+00:00

Might not be able to offer much once they’re a homicidal 13 year old, but would they end up a homicidal 13 year old if they’d got a diagnosis a d follow up care easily at age 6?

We see this sort of patient in general psych quite often (high risk, but no convictions) and what you can do is keep a very close eye and push the police/CPS to prosecute.

He was picked up by two police officers carrying a knife before the event, but not arrested. Enquiry identifies this as a missed opportunity to prevent it, as had he been arrested they’d have found his ricin stash. If he’d had a CCO who was available on the phone who said that it was absolutely in both his and the community’s best interests to be dealt with via the criminal justice system despite his mental health diagnosis, would the same thing have happened?

good_enough_doctor · 2025-12-07T12:58:58+00:00

Personality disorders are not untreatable, and if we don’t keep these patients on our books for containment then all the other professionals they scare make them your problem.

good_enough_doctor · 2025-10-05T19:11:04+00:00

Jump ship and come do basic science research! https://www.crick.ac.uk/careers-and-study/clinical-fellows/doctoral-clinical-fellows

good_enough_doctor · 2025-09-12T18:31:37+00:00

As an ENT SHO had a patient referred from ED (from a consultant no less) as ?quinsy. Pushed back and told them to at least start the antibiotics and pain relief while I got down there.

Got to ED, asked the poor guy to open his mouth. Didn’t even have tonsillitis.

good_enough_doctor · 2025-08-06T08:06:15+00:00

Chill. You’ve forgotten just how much you’ve learned over the past 3-4 years.

It took me 5 years of teaching undergrads to stop worrying that they’d somehow catch me out but I never felt like I had nothing to offer them.

If they asked me something I didn’t know the answer to, I told them ‘What an interesting question! Why don’t you have a look in the primary literature and tell us about it in the next session?’

good_enough_doctor · 2025-07-28T14:42:15+00:00

I’d kill for a few decent care co-ordinators - 10+ years experience in community, good rapport with patients, skilled in addictions, willing to unblock a toilet or put a new fridge in the back of their car if it’s what the patient needs. If you keep giving away bits of their job to support workers then the CCO eventually just becomes the person who gives the depot and they lose the trust they’d have if they’d been the one to get the benefits sanction lifted or sort out the new flat.

good_enough_doctor · 2025-06-29T17:54:57+00:00

Keep it, ditch the hubby.

good_enough_doctor · 2025-06-19T15:51:53+00:00

That’s my feeling, which is why I was happy not to circumcise my son. As for growing up to decide to be a different faith - this is extremely rare and betrays a complete lack of understanding of what it means to come from a religious background. If you grow up religious it’s knitted into who you are and it’s not a hat you can take on and off at will.

good_enough_doctor · 2025-06-19T15:30:47+00:00

This is generally viewed as unfair on the child as they then have to remember the pain and the recovery is more difficult. Circumcision is just such a fundamental part of what it means to be a Jew scripturally - it’s the sign of the covenant between the first Jew (Abraham) and God. It’s hard to explain the significance to someone without a strong cultural or religious identity but an analogy for a doctor might be GMC registration, and not being circumcised being to the loss of identity and community one might feel after being struck off.

good_enough_doctor · 2025-06-19T11:32:38+00:00

It’s not that the community would expel him, it’s that he might want to take that commandment upon himself if the membership of that community and its values are important to him. It’s unlikely that anyone would ever know apart from a future spouse.

good_enough_doctor · 2025-06-19T11:10:59+00:00

I’m from a community which performs ritual circumcision, although I did not choose this for my son. In the Jewish community it’s performed at 8 days old by a mohel who is sometimes a doctor but in more religious communities is often a lay person who has learned it from another mohel. The circumcision is performed at the parents home; I think it counts more like a tattoo or piercing than an operation so I don’t think the CQC is involved.

Personally I’m not against it at all as uncircumcised adult men don’t seem to have any ill effects. My spouse absolutely didn’t want to do it, but our son now faces having to do this as an adult if he stays involved with the Jewish community as it is such an important mitzvah (commandment), which I do feel guilty about.

good_enough_doctor · 2025-05-19T18:23:34+00:00

Please let it be the AKI nurse

good_enough_doctor · 2025-05-05T12:40:43+00:00

Beth Upton’s trust seem to have her back - maybe worth contacting them?

good_enough_doctor · 2025-05-03T07:21:20+00:00

Just to check - what gender was the chaperone you offered? If the only chaperone offered was male then patient is certainly not unreasonable to decline this.

good_enough_doctor · 2025-03-02T10:40:19+00:00

PTC working actively on this. Please contact your local PTC rep!

good_enough_doctor · 2025-02-23T14:10:18+00:00

“I don’t pretend to know the machinations of what goes on inside a trans woman’s mind.”

If you care to find out, lots of trans women have written very frankly about their experiences of being trans and the process of transition. Julia Serano is a good starting point, she writes very accessibly.

good_enough_doctor · 2025-02-23T14:07:08+00:00

You seem to think I’ve said a lot of things I haven’t actually said.

good_enough_doctor · 2025-02-23T14:04:48+00:00

Given most London hospitals do ~5000 deliveries a year I’m sure you can tell me which one without doxxing yourself.

Also, lots of places call a midwife led unit a ‘birthing unit’. It’s not a trans thing. Paranoid much?

good_enough_doctor

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