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Running Commentary: Medical Status 15.34 pm UK-Time hours) 13 May 2022

(a)

From:

NHS Kent and Medway

NHS and Social Care Partnership Trust

Medway Community Mental Health Team

Britton House

Britton Farm

High Street

Gillingham, Kent

ME7 1 AL

Tel: 0300 303 3189


Date: 09 May 2022

Our Ref: MQ/jab

NHS Number 628 477 1487


Private and Confidential

Mr Shantanu Panigrahi

3 Hoath Lane

Gillingham

Kent

ME8 0SL


Dear Shantanu

Name: Mr Shantanu Panigrahi Address: 3 Hoath Lane, Gillingham, Kent, ME8 0SL

DOB: 8 Aug 1957 NHS No: 628 477 1487


Thank you for attending your choice triage appointment on 4 May and sharing the following information/

Assessment type: Triage (Shantanu’s number is 07967789619) Rasmi his wife also present in today’s assessment. Also present in todays assessment is trainee mental health and wellbeing practitioner Adam Hodges. Shantanu consented to have Adam present.

Referrer: Police via Single Point of Access (SPoA) 28/04/2022

Reason for referral: SPoA documented that PC Evans reports that Shantanu sent an email to Medway court threatening to set fire at BP garage by throwing petrol. He has made previous threats to another big company. PC Evans reported that the police went to Shantanu’s address, and he shut the door at them. He reports that he seemed very unwell and needs a mental health assessment.


Presenting problem:

Discharged from CMHT in September 2021 after a medical review with psychiatrist. Found it difficult to cope with jobs, emails that he receives, and treats them like harassing emails from trolls and he can’t get much sleep, only 6 hours a night, on edge the rest of the time, very stressed, smoking cigarettes to calm his nerves.


Police are aware.


Delusions – Worry a lot about whether there is a God or demon and God making him do things. Worries he isn’t doing the right thing.

Always getting into trouble with employers and unable to hold a job.

Paranoid. – has persecution complex, thinks that the state is trying to get him in legal difficulties.

Previously took out a case against the prime minister Boris Johnson and then thought it was the Queen. Was fined £4000 last year tof trying to take the Prime Minister to court.

Having difficulties with mental state as long as he can remember.

Drinks 4 cans a day of beer 4% volume and describes himself as chain smoking puts this to stress. Cigarettes -10 a day. He says he is not drinking more that 4 cans of alcoholic drinks. He says he can also drink coffee a lot.

Grunting noises throughout the day Shantanu says he is singing but wife says he is grunting at home. Shouting a lot sometimes at wife and daughter.

Racing thoughts happening every day. Thinks about the consequences of what he says, he thinks there is a demon or God in his head.

Says he gets messages from God and gets the voice of God. Feels being monitored by God as he might be punished.

Paranoia reported daily and feels he is being watched. Says trolls are watching him, he feels his phone is being monitored and tracked. Says he gets defensive and tries to block the negative feelings and thoughts of the emails.


Eating and drinking well. Well supported by wife.


Medication:

- Depakote 500 mg gastro-resistant tablets (Sanofi), One to be taken twice a day.

- Risperidone 2 mg tablet, one twice daily as per MHT -reports this medicine is no longer effective been on this since 2004 feels its not making any positive difference.

- Finasteride 5 mg tablets, One to be Taken Each Day as per urology a/w letter,

- Tamsulosin 400 microgram modified-release capsules, One to be Taken Each Day

- Sertraline 150 mg tablets, One to be taken Each Day – morning

- Atorvastatin 20 mg tablets, One to be taken Each Day.


Past Medications:

Aripripazole (had prolactin issues with this) and Quetiapine (restless legs reported).


Mental State Examination

. Appearance and behaviour – Shantanu appeared well kempt. No signs of self-neglect. Engaged well in the face assessment. Maintained eye contact. Forthcoming with information about his difficulties.

. Speech – calm, pleasant normal tone and rhythm.

. Mood- low mood due to emails and phone hijacked by trolls and also police involvement in Shantanu’s life causing a lot of stress. He said he is not responsible for troll emails and police have been to his address a number of times. Wife also confirms this. Laptops and phones taken for 7 months due to trolls’ malicious emails/communications. Wife and Shantan feel bothered by police. Sleep is poor around 5 or 6 hours with nightmares. Eating and drinking well. Hears the voice of God and imagines a God lurking in his head and needs to talk to or a demon in his head. Smiles to himself and talks to himself at home according to wife. Also having paranoia daily that God is watching him. Mood stabilisers are working as he is less irritable. Taking risperidone since 2004 and this appears to now have worn off with no effect at present according to Shantanu.

When Shantanu is on a holiday with his family he is described by wife as a pleasant, calm man and very relaxed, but when in UK he is very unsettled. He said society is complicating. He describes himself as a secluded person.

Aware of the complications of mixing alcohol whilst on medications. Given details of Turning Point as Shantanu would like professional support.

. Thought- ongoing thoughts of being harassed by police. Thoughts of a god or demon being in his head. Reports concentration is not great. He concentrates on trolls hijacking his email. He says he says things without thinking.

. Perception- reports hearing the voice of God and he is always paranoid. Smiles to himself and talks to himself. Also having paranoia daily. Mood stabilisers working. Taking risperidone since 2004 and this appears to now have worn off with no effect at present. Feels he is being judged a log by people he does not know and feels provoked by others and feels he is not liked. He says he can feel worthless within himself and feels he has not achieved anything. Says universities will not hire him even for menial joibs. Feels he is a good communicator passes interviews and feels he messes up due to trolls. Shantanu feels that the Queen and Prime Minister are both trolls and arranging for his email to be hijacked and to be kicked out of England.

. Cognition- reports concentration is not great. He concentrates on trolls hijacking his email. He says he says things without thinking.

. Insight- good insight into his mental and physical health difficulties. Shantanu said he suffers from paranoid schizophrenia and persistent delusions.


Client Expectations:

Would like to get a job even if its 2 or 3 days a week when stable. He reports mental state affecting him.

I would like to see the doctor for medication review.


Carer Expectations:

Wife Rashmi would like Shantanu to be reviewed as he has been on risperidone since 2004.

Formulation/summary:

Risks:

No suicidal thoughts or plans to end his life. Shantanu stated: ‘’I want to live’’. Shantanu said ‘’I believe there is hope and one has to hope and he wants to do well’’.

Shantanu said he has no thoughts or plans to burn BP station. Wife confirms this also. He said a troll hijacked his email account and sent bad emails. Wife confirms this.

Protective factor. Shantanu cited his wife and adult daughter Rupa 31 as protective factors.

Drinking alcohol 4 cans or 2 cans or 1 can a day. He smokes 10 cigarettes a day and puts this to stress. Happy to attend Turning Point/Open Road. Signposted to it.

To others – denied any thoughts to harm others when asked. No thoughts or plans to burn a petrol station and said this is not true and is the trolls and feels scared of the Police.

From others – no evidence of any current harm. Shantanu has no thoughts or plans to harm others. He stated: ‘’I am 64 why do I want any stress’’.


BACKGROUND

Employment: No, on a pension

Accommodation: Stable lives with wife Rashmi and daughter Rupa 31 years old.


Previous contact with mental health service: Yes- known since February 2016

If Yes, what is their diagnosis? Paranoid schizophrenia and Delusional Disorder


Past psychiatric admission/s: Yes 2004 and 2008 section 2 and 3 of the MHA

Physical health concerns: Prediabetes diagnosis in 2019- managing dietary intake and intermittent and frequent urination. GP has referred to urology for a review however, Shantanu is still waiting to hear from urology at Medway Maritime Hospital.


Drugs and Alcohol history – Drugs- Drinking alcohol 4 cans or 2 cans or 1 can a day. He smokes 10 cigarettes a day and puts this to stress. Happy to attend Turning Point/Open Road. Signposted to it. Drinks 4% vol and describes as chain smoking puts this to stress.

Next of kin details: - Rashmi’s number is 07854984538


Outcome:

Following this face to face review the plans made collaboratively with Shantanu and wife Rashmi are:

Shantanu to be referred to the MDT meeting to request for a medical review as Shantanu feels his medicine Risperidone is not effective and been on this since 2004. He reports that his mood stabiliser is working for him and as he used to be very agitated.

Shantanu to contact Turning Point/Open Road to address his alcohol misuse and he would like professional support.

GP to continue to review Shantanu’s physical health. He is still awaiting to hear from urology team. GP to kindly chase this up.

Shantanu can contact Imago (care Navigation Services -working with local GPs and care teams) for support in the community.

Shantanu and Rashmi to contact Citizens Advice regarding support with the police as they feel harassed by the police regarding trolls that hacked email address and also getting help from the Citizens Advice regarding police support.

Shantanu and Rashmi both given leaflets for LIVE WELL KENT, MEGAN Peer Support to access their community and recovery programmes when Shantanu is ready. Shantanu and wife Riashmi both agreed to contact these services when Shantanu is much stable.

Crisis plans discussed with Shantanu and wife Rashmi such as contacting the duty Team at Medway Mental Health Team, Single Point of Access (24 hours a day). Crisis Team (24 hours a day), Mental Health Matters, SHOUT to 85258 (text), to speak to wife Rashmi and daughter Rupa, for support as he finds them helpful, A&E in emergency, GP, Samaritans, The Safe Haven @ the Medway. Shantanu and Rashmi verbalised their understanding of the crisis support plans.


Yours sincerely

(Sent unsigned to avoid delay)

Michael Quarm

Community Mental Health Nurse

Encs: Safe Haven, Turning Point, Talking Therapy, Rubicon, Megan, Live Well Kent, IMAGO, Crisis Numbers.


Cc GP Dr Shah A

Long Catlis Road Surgery

Parkwood Health Centre

Long Catlis Road

Rainham

Kent

ME8 9PR


You may find the following mental health support services helpful:

www.livewellkent.org.uk 0800567 7699

Mental Health Matters – 0800 107 0160

Samaritans – 116 123

NHS – 111

GP and out of hours GP services

Urgent Mental Health Helpline – 0800 783 9111



Trust Chari: Dr Jackie Crasssait

Chief Executive: Helen Greatorex

Help KMPT learn from patient’s experience at www.kmpt.nhs.uk/get-involved/how-are-we-doing.htm

For further details about how your personal data is managed by the organisation please visit https://www.kmpt.nhs/about-us/confidentiality-and-gdpr/


(b)

From:

NHS Kent and Medway

NHS and Social Care Partnership Trust

Medway Community Mental Health Team

Britton House

Britton Farm

High Street

Gillingham, Kent

ME7 1 AL

Tel: 0300 303 3189


Date: 09 May 2022

Our Ref: MQ/jab


PRIVATE AND CONFIDENTIAL

Mr Shantanu Panigrahi

3 Hoath Lane

Gillingham

Kent

ME8 0SL


Dear Mr Shantanu Panigrahi


Following your assessment with me, you were discussed in the Multidisciplinary Team Meeting (MDT) on the 05/05/2022 and the outcome of the discussion are:


- For you to attend Turning Point to address your alcohol misuse.

- For you to continue with your current medications.

- For you to be discharged from CMHT to your GP. Your care has been transferred to your GP in primary care. GP should not hesitate to re-refer to secondary mental health services if need arises.

- Attached to your copy of the letter are the useful support services such as IMAGO, Livewell Kent, MEGAN Peer Support, Medway Talking Therapies, Rubicon Cares Counselling, Safe Haven services@ the Medway, and other useful services in the community that could help enhance your sense of well-being and recovery.



Yours sincerely

(Sent unsigned to avoid delay)


Michael Quarm

Community Mental Health Nurse

Medway CMHT


Cc

GP: for information only

Dr Shah A

Parkwood Health Centre

Rainham

Kent


Freephone number for the Samaritans: 116 123


CONTACT US NOW

Whatever you’re going though, call us free any time, from any phone on 116.123

We ‘re here round the clock, 24 hours a day, 365 days a year. If you need a response immediately, it is best to call us on the phone. This number is FREE to call. You don’t have to be suicidal to call us. Contact us now on 116 123





www.livewellkent.org.uk 0800567 7699

Mental Health Matters – 0800 107 0160

Samaritans – 116 123

NHS – 111

GP and out of hours GP services

Urgent Mental Health Helpline – 0800 783 9111



Trust Chari: Dr Jackie Crasssait

Chief Executive: Helen Greatorex

Help KMPT learn from patient’s experience at www.kmpt.nhs.uk/get-involved/how-are-we-doing.htm

For further details about how your personal data is managed by the organisation please visit https://www.kmpt.nhs/about-us/confidentiality-and-gdpr/





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