REPORT OF AN INDEPENDENT INQUIRY ... - Hundred Families

20. On 15th April 1992, Dr Feldman wrote to the Homeless Persons Unit at the London Borough of
Newham in the following terms:
“Chandran Sukumaran suffers from manic depressive psychoses (sic). Provided he takes his
Lithium, which acts as a prophylactic, he is perfectly well at all times. However, if he fails to
comply then he has quite severe breakdowns which require hospital medication. To this end
we are treating with Lithium Carbonate, which he should take daily. He should have a
Lithium level assessment done every three months and I am finding it very hard to persuade
him to attend outpatients for this to be done. His prognosis depends on whether he complies
with medication and whether he can set up a stable life style in the community. It is essential
that he has a resonable (sic) home environment as part of his successful rehabilitation in the
community.”
21. On 23rd June 1992, Chandran did go to see Dr Feldman. In her letter to Dr Alagrajah, she
expressed her amazement that he had come to see her. He was taking 800mg of Lithium
Carbonate but insisting he wanted this dosage reduced to 400mg. Dr Feldman agreed to this
reduction, considering it was better than his not taking any medication. He then failed to attend
appointments on 25th September 1992 and 1st December 1992. After the second occasion, he
was not sent another appointment.
22. Dr Feldman said that the policy at that time was to give patients two outpatient appointments. If
the patient failed to attend both appointments, he/she was referred back to the relevant GP with
a letter inviting the GP to re-refer the patient if necessary.
23. Dr Feldman also said that it was very much left to general practitioners to take on board the
advice given in a patient’s Discharge Summary and to act on it. Talking of the service in the early
1990s, she said:
“There was no what I call running after people. It was a fragmented service where people did
the most minimalist things and you were lucky if they even received an appointment. I
wouldn’t have said it was a robust service. ... It was the lack of resources and the lack of
togetherness and the lack of morale and all the things that Cinderella services have, which we
were.”
24. Chandran told us that he went to some of his outpatient appointments and then stopped going to
them. His explanation for doing this was he was:
“so young and they kept putting injections into me. It was loads of medication and I just
swallowed it. I had a lot of side effects and I didn’t like the side effects. ... I never understood
my illness and no one explained it to me.”
Comment
The nature of the care Chandran describes himself as receiving is characteristic of an overstretched
traditional service at that time. Chandran did not feel he was a partner in his care
package or recovery.
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