I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

NHS pyschiatry (inpatient) with several years experience. Please ask away :)

There are certain protocols that I am not directly involved with thankfully. Yes I agree terrifying

I work with a wide range of issues but if I had to pick a favourite it would be trauma. Have a look at Beyond Pills and Potions by Dr Steve Bierman.

Thanks for the thread; very interesting, and a lot of effort on your part.

I'm a recently retired healthcare professional in the U.S. with a couple of observations. ECT is used here too, but it's generally seen as a treatment of last resort. I think it deserves to be more of a front-line therapy for the right patient population. It got a horrible reputation here in the early years.

Re compensation, I think that part of the difference is due to the massive student loan burden on MDs here. But I think most of the difference is due to the NHS being a de facto monopoly employer in the UK. Here, hospitals and medical practices have to compete to hire staff, so it's more reflective of supply and demand. A good psychiatric RN with 5-10 years of experience can easily make $130k per year in a major city.

I'm in New York and have had a fair few British patients who came here for treatment that wasn't available on the NHS.

Absolutely.

Sleep. Diet. Excercise.

The holy trinity. Very simple and work far, far better than any pill ever made. If I could bottle the benefits of excercise alone and sell it i'd be the next trillionaire. Very, very few of our patients want to put the work in. We have very poor health ownership in the UK and expect doctors to fix a lot of our problems without meeting them halfway. This is true for heart disease, diabetes and other ailments etc etc.

The caveat to this is severe mental illness like established schizophrenia or psychosis. As you said mental health however I assume you mean things more akin to low mood + anxiety

Out of interest, why don't you believe in psychopathy / what do you believe is wrong with the kind of people (like, say, Axel Rudakabana) who society would generally label a psychopath?

It's more of a reasearch concept. In fact, I shouldn't say I don't believe it doesn't exist because it genuinely doesn't. Both the ICD and DSM have removed psychopathy as a diagnosis. I couldn't diagnose someone as that even if I wanted to. We are generally moving away from blanket catch-all diagnoses. The human brain rarely operates in strict binary categories. Modern psychiatric research increasingly views personality traits as spectrum-basedvrather than discrete "types."

Labeling someone a "psychopath" implies a distinct species of person, whereas data suggests it is simply an extreme cluster of dimensional traits (high trait boldness, high meanness, low disinhibition). The kind of person you might be imagining when we say psychopath very rarely exists (cold, callous, remorseless, generally quite evil).

Re: Axel, I can't claim to know anything more than the public. He was diagnosed as autistic before the events happened. He had a very longstanding psychiatric history. I can only hazard a guess he was/is extremely psychotic and had almost no relationship with reality when the events happened and was severely mentally unwell. There was likely a lot of psychotic delusions involved. Sometimes the patients make a full recovery and become almost suicidal when they start to understand or realise what it is they actually did. Who knows. The fact he is being transferred to Broadmoor probably means he is indeed extremely mentally unwell and requires treatment under the mental health act (something that cannot be done in prison).

@DoctorDr no evidence of psychosis or any mental health issues was presented at the trial of AR, so to suggest he was likely psychotic and had no grasp on reality when he committed the attack seems like a massive leap. Why would you think that? And, many people feel that the move to
Broadmoor is manipulative on ARs part and that he is deliberately trying to play the system.

I have personally done research in this field and have also found a large crossover with autistic traits and non-contact sexual offending in particular - looking at CSAM online, for example.

Obviously that does not mean people with autism are all sexual offenders, but there seems to be something going on in the data that suggests some sort of correlation at least. It’s an uncomfortable topic for sure, but one we shouldn’t shy away from. More research is needed.

Admission to Broadmoor is extremely hard to come by. A panel of experts have made that recommendation after extensive interviewing and examination. They don't make those decisions lightly and I don't accept you can manipulate your way in. The people who think he manipulated his way in (journalists and speculative lay-people) have absolutely no more information than anyone else. Admission to the low-level psych hospital I work in is difficult enough.

No evidence of MH issues being presented is not the same as them not existing. It is still unclear why his MH issues were not presented in the defence. I don't claim to know, but this would be my overall assumption. I think most serial killers will be severely mentall ill to some degree.

Has the Right Care Right Person initiative had any profound impact and if so, has this been positive or negative?

I haven't come across it and had to google it so unfortunately for that reason I would probably say no it hasn't had a profound impact.

Yes I understand that, but if the team who was very well acquainted with his situation didn’t suggest that at all at any point, why would you make that assumption and feel that’s a more appropriate conclusion? Can you explain that rather than just telling me that I’m wrong?

I'm not saying you're wrong. I completely admit I don't have the answers. I'm just saying that I think it's more likely that he is extraordinarily mentally unwell given his transfer to broadmoor, his extensive psych history and the lack of obvious motive in his crimes. I know nothing more than anyone else and I don't fancy trying to acces his records at the risk of my GMC number 😂 Second generation immigrants have much higher rates of schizophrenia and mental illness

@DoctorDr perhaps it might have been better not to speculate on AR’s state of mind during the attack. I would agree that he is clearly extraordinarily troubled, in whatever way that has been caused or manifests.

I’ve found this really interesting, thank you OP

Tells me a lot about your attitude, thanks for the rude response to my quite measured contribution. Sadly if you can’t understand/wont understand the concept it’s a lost cause.

In my work I am seeing a huge increase in women diagnosed with schizophrenia, including those who have been sectioned. Have you seen a similar spike?

A few years ago it was numbers with EUPD that were the rocketing, now that seems to have dropped off and it's schizophrenia.