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Psychiatric assessment of a young man (14HDC01268)
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14HDC01268, 20 October
Psychiatrist ~ District health
board ~ Risk assessment ~ Management plan ~ Mental health ~ Right
A man, aged 20 years at the time of these events, presented to
the Emergency Department (ED) at a public hospital complaining of
testicular pain. The man had no significant mental health history.
On assessment, no source for the testicular pain was found, and the
impression was "Anxiety and depressed mood - suicidal ideation." An
acute mental health review was requested.
The man was assessed first by two community psychiatric nurses
who assessed the man's risk to himself as low‒moderate and risk to
others as low and requested an urgent psychiatric assessment "for
possible ward admission."
A psychiatrist completed the assessment. His impression was that
of "Major Depression". His management plan was for the man to
return home with his parents (who were present at the assessment)
and to return for a further assessment the following morning.
The following morning the man, accompanied by his father,
attended a further assessment with the psychiatrist. During the
assessment the psychiatrist had difficulty engaging with the man.
At the completion of his assessment, the psychiatrist concluded
that the man was experiencing a major depressive disorder, with no
imminent risk of self-harm.
The psychiatrist made the decision to discharge the man with
suggested follow-up with his GP for his testicular pain, and
consideration for counselling in the community. The man returned
home with his father. He subsequently left the house and was later
involved in an incident that resulted in injuries causing his
It was held that the psychiatrist did not provide services to
the man with reasonable care and skill, and, accordingly, breached
Right 4(1) by failing to:
- ascertain and take into account the parents' opinions on risk
and their views on the proposed management plan at the initial
- assess the man's level of risk adequately at the second
- admit the man, either voluntarily or compulsorily under the
Mental Health (Compulsory Assessment and Treatment) Act 1992 and,
having decided not to admit the man, failing to offer him ongoing
specialist follow-up, or to provide clear, specific guidelines to
the man's GP; and
- provide sufficient information to the man's father about his
son's condition, and not discussing the proposed management plan
adequately or providing clear information about that management
plan during the second assessment.
The psychiatrist was also criticised for not documenting the
formulation of his risk assessment adequately in the clinical
The district health board was found not to have breached the
It was recommended that the psychiatrist undertake further
training on communication with patients, that he undertake further
professional development in relation to clinical assessment, and
that he provide a letter of apology to the family for his breach of
In accordance with the recommendation of the provisional
opinion, the DHB agreed to undertake a review of all patients seen
and discharged by mental health services during a one-month period,
looking at short-term outcome, to assess whether risk assessments
have been assigned appropriately.