Refer to
Psychological Medicine and Older Adults Directorate
Southwark Community Mental Health Team
Ground Floor, Marina House
63-65 Denmark Hill
London, SE5 8RS
Tel: 020 3228 2240/6920
Email: SouthwarkMHOADTeam@slam.nhs.uk
http://www.slam.nhs.uk
Date: 01/11/2024
PRIVATE AND CONFIDENTIAL
Named or duty GP
Silverlock Medical Centre
2 Verney Way
London
SE16 3HA
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬____________________________________________________________
MEDICAL REVIEW
Re: Name: Mervalee Myers | DOB: 19/05/1959 | NHS No: 625 090 0543
Address: 16A-16B Alma Grove, London, SE1 5PY
Diagnosis F29 Unspecified non-organic psychosis
Current Psychotropic Medication Nil
Relevant Physical Health History/Medication Compressive left common peroneal nerve palsy (2024, resolved)
Lumbar back pain
Type 2 diabetes mellitus (2018)
High cholesterol (2022)
I met with Ms Myers in clinic at Marina House today alongside her allocated care coordinator, Hawa Oweh (CPN).
Background
Ms Myers is a 65-year-old female, not previously known to the Southwark Older Adult CMHT, however previously under working age mental health services. Ms Myers was referred to our team by Dennis Kamara, a mental health nurse in primary care. He requested for an assessment of diagnosis and treatment options, with information that Ms Myers has a long history of low mood and anxiety with some previous underlying trauma and recent stressors including her housing association taking her to court and ongoing disputes with her neighbours.
The following information about Ms Myers’s mental health background is taken from available electronic mental health records.
Ms Myers’ mental health records date back to 2017 where there is a Merlin report from police with concern about Ms Myers struggling with her mental health following a tribunal, with also a mention of her receiving previous support from the Maudsley. This however doesn’t appear to have been followed by input from secondary mental health care. In 2021 there are a number of contacts with the crisis line and referrals to CMHT (working age), outlining concerns about low mood, anxiety and suicidal thoughts for the past 7 years since her mother passed away. Other contributory factors noted included the death of a neighbour the previous year and being charged with criminal damage and attending court in April 2021. Ms Myers had also spoken about the death of her brother and developing depression and an eating disorder as a result of discrimination at work. Another referral to CMHT in 2021 reportedly from Southwark council outlined concerns of Ms Myers feeling police were being sent to kill her. There was also a phone call from a mental health practitioner from the University of East London (student wellbeing service) expressing concerns about Ms Myers’ mental health and possible bizarre and paranoid behaviour.
In 2022 Ms Myers was assessed following a GP referral by the Southwark Assessment & Liaison Team. This assessment noted mental health difficulties appearing to commence in 2014 when Ms Myers was reportedly persecuted in her place of work, having worked as an early year’s practitioner. It was reported that Ms Myers was being accused by her nursery in Southwark of being ‘uncooperative, rude and confrontational’, and was under investigation, and then left due to ill health. Following this, she received 12 sessions of Cognitive Behavioural Therapy (CBT) at the Maudsley. Following this, Ms Myers had reported not being able to gain paid employment, but had worked voluntarily in mental health research, been involved in various organisations and online podcasts, and was also featured in a book about Windrush. Ms Myers had reported an incident of the police in 2021 attending her home and beating her, and that she now has a criminal record and has been turned down for jobs due to her criminal record check (CRB). She had reported feeling she has been targeted by certain people she used to work with and there was a pattern. The impression of this review was that there was not any clear evidence of depression or psychosis, that past events have been very stressful and that Ms Myers could benefit from further talking therapy. She was then referred to IAPT.
In 2023 and going into 2024 there were a number of referrals to CMHT, due to concerns about Ms Myers’ mental health. There was reference of Ms Myers’ housing association seeking legal action due to antisocial behaviour. In December 2023 Ms Myers was reported to have called 111 herself reporting feeling hopeless about the threat of eviction from her home and having ongoing issues with her neighbours. In March 2023 Ms Myers was brought to A&E by the London Ambulance Service reporting worsening mental health. No evidence of thought disorder or psychosis observed and GP was advised to review Ms Myers and consider a referral to mental health services.
In September 2024 Ms Myers was referred to the Southwark Older Adult CMHT by Dennis Kamara, mental health nurse in primary care. There were concerns related to her behaviour and posting references to suicide in her social media. Ms Myers was seen by Dennis in primary care alongside her son Kevin who had travelled from Jamaica where he lives. There were reported issues with housing, neighbours and family. She has lived in her current address for 23 years and has been having issues with neighbours banging her door and making malicious complaints about her to the police. The housing association has reportedly taken an injunction against her and she is at risk of eviction and the case is currently in court. Her son had reported the reason for this being Ms Myers putting up inappropriate material online about the council and refusing to take it down. Her son had mentioned Ms Myers storing urine for months to throw it at her employer’s property and putting up comments on social media about feeling suicidal, which Ms Myers admitted to, however, stated she would never do this due to her Christian faith. There was also concern from Ms Myers about a camera being placed in the shared communal doorway by her neighbours, that it initially faced towards the street however now has been turned directly at her. She had reportedly denied feeling the neighbours watch her when she is in her flat however, the only issue is when she is coming through the communal front door.
Recent progress
Ms Myers was initially assessed by our team on 08/10/24 at home by Joseph Mukuba, Community Psychiatric Nurse. Following this, I decided to assess Ms Myers myself to help come to a psychiatric diagnosis and consider treatment options.
I have subsequently reviewed Ms Myers in clinic on 16/10/24. During this assessment Ms Myers described to me in detail her background history to date, including the trauma in her upbringing (physical abuse from mother, father dying when she was a young age), and her first marriage to a controlling husband resulting in domestic violence. Ms Myers talked about losing her mother 10 years ago, and around the same time being forced out of working as a nursery nurse and following this receiving therapy. Ms Myers talked about the issues with her neighbours persecuting her, which have worsened over the years, and her recent bereavement of her husband a few months ago.
On 23/10/24 Ms Myers contacted 111 and LAS due to feeling in ‘crisis’ after her grandniece left having stayed with her without saying goodbye. I visited Ms Myers at home on the 25/10/24. During this visit, Ms Myers described in more detail the persecution she reports experiencing from her neighbours, whom she believes are trying to kill her, leading to her feeling unsafe at home. She reported since her husband passed away, she has been more careful in locking her front door and that if she didn’t do that ‘I would be dead’. Ms Myers showed me the doorbell camera her neighbour set up on the outside of the shared front door, and how she believes the neighbour is using this to monitor her coming in and out of her home. Ms Myers talked about her neighbour kicking on her front door every day to provoke her and her belief that her neighbours want to try to provoke her into confronting them, which would then give them an excuse to harm and kill her. Ms Myers has explained to me how she believes other neighbours are also siding against her and that she also feels under threat from the police and housing association, all working together against her.
Neuroradiology
CT head 26/03/24: nil concerns
On review
I summarised the purpose of review to complete the assessment following the referral to our team from Dennis Kamara, primary care mental health nurse.
I asked Ms Myers how she has been since we last met. She talked about the housing association not coming yet to fix her toilet seat, as well as the mould on her kitchen door and the damp in her windowsill. She reported attending her drumming group and doing a performance and spoke positively about this. She brought up about her neighbours continuing to try to provoke her since we last met. Ms Myers spoke about the neighbours ‘stomping’ on the floor loudly to provoke her. Ms Myers agreed that she believed the neighbours were trying to kill her. I recalled her previous statement to me that she believed the neighbours were trying to provoke her so that she would in turn confront them, and this would give them the excuse to try to kill her. Ms Myers accepted this is what she believed. She stated she would not attack them herself and is trying to keep to herself. Ms Myers said recently she stayed at a friend’s house overnight as she didn’t feel safe to return home. I asked about the camera. Ms Myers continued to report that she believed the camera on the doorbell was there to monitor her movements. She said she is trying not to think about this. She stated being more frustrated about her doorbell always being rung.
Ms Myers made a statement about never wanting to ‘give up’. I enquired about whether she experiences suicidal thoughts. Ms Myers stated this has been misconstrued and referenced a poster or piece of literature she was pictured in, that had the quote about people being unemployed, being at risk of suicide, and said this quote was then attached to her. Ms Myers did admit to having last had a suicidal thought in August this year, when her son was visiting her and she talked about her door being kicked. She didn’t report having experienced any plans or intent to act on this. Ms Myers stated there was no chance that she would come to harm via her own means. She has previously stated her Christian faith as a protective factor.
I summarised to Ms Myers what she had explained to me over the last 3 meetings leading to my opinion about her mental health diagnosis. This included Ms Myers’ description of her earlier life and trauma she experienced, the domestic violence in her first marriage which led to her separating and being saved by the housing situation, the loss of her mother 10 years ago around the same time as stopping working as a nursery nurse. Then over recent years with the increasingly difficult situation with her neighbours, beliefs that they are provoking her by monitoring her movements, trying to kill her and banging on her door, leading to her receiving a possession order which may potentially result in her being evicted and a possible custodial sentence due to being in contempt of court. Then more recently the stress of losing her husband. I explained to Ms Myers my impression that as a result of the build up of stress over these years that her beliefs and experiences about the neighbours could be explained by her being unwell with paranoia and psychosis. I explained that this is a condition that we could provide treatment for, including both antipsychotic medication, and psychosocial support, including psychology for psychosis. Ms Myers said in response to this that she had experienced some paranoia in the past. She said she accepted this was my explanation of opinion about her mental health. Ms Myers said she was willing to try medication if it would help. Ms Myers explained she had recently been to her new GP for vaccinations and blood tests, I advised I would check the results of these and then give her a call next week to see whether she would like to go ahead with starting antipsychotic medication. She agreed to this and accepted a patient information leaflet about risperidone. She confirmed having our contact numbers in case needing to get in touch in between appointments. Hawa confirmed she would make an appointment with Ms Myers when she had started on her medication to monitor how she is doing. We also discussed social activities and community groups, Ms Myers knew of Time & Talents and didn’t want to attend there, however appeared keener in Blackfriars.
Mental state examination
Ms Myers presented on time, she was well kempt, wearing a diabetes charity t-shirt, engaged well, reasonable rapport established, maintained eye contact, speech slightly pressured however, interruptible and voice not raised, mood reported as well and objectively appeared euthymic with reactive affect. Mild thought disorder evident with circumstantial responses. Describing persecutory delusional thoughts about neighbours trying to kill her and monitoring her movements. No reported auditory hallucinations and didn’t appear to be responding to unseen stimuli. Appeared well orientated to time and place. Insight partial however took on board opinion about diagnosis and agreed to consider treatment options explained.
Care Plan
- I have provided written information for Ms Myers for an antipsychotic medication – risperidone. I advised I will check Ms Myer’s most recent blood tests with her GP and call her following this to see whether she would like to start risperidone or not.
- I will send this assessment letter to Mrs Myers, and she is then able to share this with her solicitor for her current court case.
- Ms Myers is assigned a care coordinator in our team – Hawa Oweh, CPN – who will monitor Ms Myers’ mental state and risks and support with psychosocial interventions.
- Hawa Oweh has agreed to make contact with the housing association to support Ms Myers with fixing her toilet seat and other house matters needing repair.
- Ms Myers confirmed having contact numbers for people to call, including the Samaritans, our team number during working hours (0203 228 2240) and the SLAM crisis line out of hours (0800 731 2864).
Yours sincerely,
Dr Phil Gregory
Signed Electronically
Consultant Psychiatrist
Cc:
GP
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