DR RAJ PERSAUD MIND GAMES

It is easy to forget that one of the key reasons the NHS was established was to assist in protecting the very weakest and most vulnerable in our society. At times you have to question whether it really serves that purpose any more.

I had a patient who developed a severe mental illness and was admitted.

The patient also happened to have been a witness to an extremely serious crime.

The court case arrived for the trial of the alleged perpetrator, and the police were keen for my patient to testify; it was apparently vital to securing a conviction.

However, the patient was too unwell and unwilling to go to court, so I protested my client was not fit to plead.

But the police were not too pleased with this assessment and wanted a second opinion. The patient declined to consent to a second opinion.

The police were having none of this and strode on to the ward and managed to persuade the patient to consent to a second opinion. The key point here is that, as I understand it, the police are not allowed to interview the vulnerable, as in the severely mentally ill, without their consent and without the consent of the consultant psychiatrist, who is the responsible medical officer.

Yet the ward staff blithely let the police gain access to the patient without protecting their clients adequately.

Certainly the police can be a bit relentless, and in some senses they are just doing their job. Yet I believe while they must do theirs, we must also do ours, and that is to protect our patients.

This is not the first time in my experience that wards have not sought to properly protect their patients from outside agencies. Often this is because the staff are not aware of who they can stop coming on to the wards. I am sure policemen brandishing their badges can be a rather intimidating proposition.

The simple solution is for wards to call consultants and check it is OK with them before letting others have access to the patient. Their tendency to take it upon themselves to make this decision is redolent of a general decline in the authority of the consultant. Consultants feel non-medical staff want more autonomy but do not want the consequent responsibility.

Dr Raj Persaud is consultant psychiatrist at South London and Maudsley trust and Gresham professor for public understanding of psychiatry.