What ‘lessons’ will be learned from the Amy el-Keria case?

Picture of Amy el-Keria, a young white girl with shoulder-length dark hair, wearing white top with black stripes, standing in front of a stage curtain and singing into a microphone.
Amy el-Keria

Yesterday the Priory Group, which owns a number of private mental-health units in the UK which treat patients on contracts from the NHS as well as their ‘flagship’ private unit in Roehampton, was fined £300,000 over the death of a 14-year-old girl, Amy el-Keria, in their hospital in Ticehurst, East Sussex, in November 2012. Amy, who had a recent history of self-harm and suicide attempts, was found hanged in her room which was assessed by an untrained staff member to have “medium risks” with a number of ligature points, an assessment which was not followed up. The court heard that staff did not promptly call 999 or a doctor and were not trained in CPR, that the hospital’s lift was too small to accommodate the ambulance service’s stretcher and that nobody from the hospital accompanied Amy in the ambulance. The company had an operating profit of £2m in 2017 and claimed that the most recent Care Quality Commission (CQC) report, published in January, had rated the hospital as ‘good’. Inquest, which supported the family, released this statement. (Jess Thom, AKA Tourettes Hero, has published a number of articles on Amy, whom she knew, starting with this one.)

Priory Group is one of the biggest private healthcare operators in the UK and its units have featured in a number of the cases I have followed over the past few years. These included the stories of Claire Dyer and Claire Greaves, both of whom were in secure units operated by Partnerships in Care before and after Priory took them over in December 2016. The abuses that go on in these places were summarised in a previous post. I currently follow a lady whose teenage daughter, who has Asperger’s-type autism and was admitted informally to another company’s unit last summer, was transferred to a “low-secure” unit in south-east London in February. This essentially has a “lowest common denominator” approach to eliminating self-harm, removing everything that could possibly ever be used for that purpose, right down to pens and pencils (the unit’s school has an art class, but they are only allowed to paint with their fingers!). She has no access to music or any electronics (there is a TV, but they are not allowed to hold the remote control). The bathing and toileting area is open to view by anyone who might peer into the room.

Not all of these things are down to self-harm prevention; some stem from forensic restrictions, although in some cases there is justification for removing someone from the Internet for the benefit of their mental health. But there is no justification in imposing these restrictions on everyone in a unit, not all of whom have committed crimes (if any of them have) and not all of whom are at immediate risk for self-harm or suicide, for months at a time. Some of the things deemed to be “means of self-harm” are also the means of having a life, after all. People write stories, songs, poems, letters. In one case, an iPad was necessary so that the person in the secure unit could talk with her deaf sister using sign language; this was withheld for weeks. Ironically, some of these things are what people do to take their mind off their situation and they may lessen their urges to harm themselves; this case highlights the futility of some of the restrictions these units impose.

The criticism of Priory’s care in the case of Amy el-Keria was that she had the means to harm herself despite the known risks. The danger is that, fearing financial repercussions, the companies that run these units will simply impose restrictions on all their patients which might not be necessary and will make life more miserable for everyone. I noticed a similar thing after the inquest into the death of Nico Reed, who had cerebral palsy and died in an NHS-run care home (the same trust whose negligence led to the death of Connor Sparrowhawk in 2013) and one of the immediate factors was the failure to check on him every 20 minutes; however, his family also said that, when moved to this facility, the physiotherapy which had kept him healthy throughout his childhood disappeared, they mislaid the book that he needed to communicate and when they visited, he appeared withdrawn and scared which he never previously had done. His family were putting plans in place to bring him home when he died. It should not get to the point where it is necessary to check on someone every 20 minutes when they are trying to sleep; how then can someone get uninterrupted rest?

These things are sometimes necessary, at peak crisis points, to protect someone at risk of a medical crisis or self-harm, but they should not be used on a blanket basis for prolonged periods. The regimes in these units are already often miserable and needlessly restrictive; a new tranche of restrictions will make them less effective at resolving people’s mental health problems and act as a deterrent to them from seeking help in the event of a future crisis. The mother of the girl mentioned earlier tweeted the other day that she already regretted asking for help as there is no way of getting her daughter out of the clutches of these people once admitted, even if voluntarily. The way of life (it should not be a ‘regime’, a term generally used to refer to prison or a dictatorship and has associations with oppression) on a ward should not be dictated by a company’s need to minimise its liabilities but should be therapeutic first and foremost.

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