Not only can I spell psychiatry and psychology but. unlike John, I have a degree in psychology which means that I can not only read and understand the judgement in RP vs Nottingham City Council but - also unlike John - I can make of the psychiatric evidence introduced during the proceedings.
The key passage is paragraph 109, which reads as follows:
"109. Given the criticisms which are made of HJ, I propose to set out the whole of her first report in full. It reads as follows: -
In order to complete the assessment I saw RP at her solicitor's office for an appointment lasting for two hours. She was forthcoming and cooperative through the appointment.
- Please assess whether RP has a learning disorder or learning difficulty and the extent of the same.
(RP) told me that she attended a mainstream school, but often truanted from school because of being bullied. She said that she had left school without taking any exams and has no qualifications. She does not think of herself as someone with learning difficulties.
In order to assess her intellectual ability, I completed a Wechsler Adult Intelligence Scale ? Third Edition (WAIS-3) with her. This is a standardised measure which indicates overall level of functioning as well as any specific strengths and deficits the individual may have. RP's scores on the WAIS-3 showed that she has a significant learning disability. This is a global disability, affecting all aspects of her functioning. I examined her scores for evidence that her functioning might have been limited by poor school attendance. However, the distribution of scores across the subtests suggests that this would not account for her learning disability.
(RP's) verbal abilities, as measured by the WAIS-3 were at the 2nd percentile (2% of the population would be expected to score at this level or below). This includes the ability to understand and recall information presented verbally, and think conceptually to resolve problems. Her performance abilities were at the 1st percentile (1% of the population would be expected to score at this level or below). This includes the ability to solve practical problems using information presented visually or in concrete form.
This profile indicates that (RP) does not have the overall understanding and ability which her initial verbal presentation might lead one to expect. Information will need to be presented to her in simple terms, using concrete rather than abstract language wherever possible. She has an ability to repeat verbal material which is in advance of her ability to comprehend or make use of this information. This can give a misleading impression, especially as she is unlikely to say when she has not understood something.
Her poor organisational and sequencing abilities to make it hard for her to plan and execute practical tasks. Complex tasks will need to be broken down and demonstrated with repetition in a consistent way. Pictures and diagrams will not be of any particular assistance to her, as she will not find it easy to transfer learning from these into practical situations.
Because of the level of her difficulties RP will find it hard to generate new solutions to problems independently. This means that while she may learn appropriate skills when she is shown, she will find it hard to adapt these when there are changes in her situation.
- In your opinion is RP able to understand these Court Proceedings and provide instructions to her solicitors?
I found that (RP) has a limited understanding of the Proceedings, and of her solicitor's role within these. She could not explain to me the stage the proceedings were at, and spoke in a confused way about what has happened so far, and what may happen next. Most importantly, she did not seem able to understand that solicitors are there to represent their clients, and perceived them as acting independently of their clients
(RP) has the ability to tell her solicitor what she wants in broad terms (for example that she would like KP to be discharged to her care), but beyond this she will struggle to understand the complexities of the choices she may have to make.
- In your opinion is RP competent to make important decisions within these proceedings herself, or should the Official Solicitor be involved?
Because of the difficulties (RP) has in understanding, processing and recalling information, I believe that she will find it very difficult to understand the advice given by her solicitor. She will not be able to make informed decisions on the basis of this advice, particularly when this involves anticipating possible outcomes. It would be appropriate for the Official Solicitor to become involved."
As most Mumsnetters will be unfamiliar with WAIS-3, I'll translate RP's score into an equivalent IQ score which should, hopefully, help to clarify the extent of her cognitive limitations. Based on this assessment, RP's IQ would fall somewhere between 55 and 70 - 100 is the average score and a score below 70 is indicative of a severe learning disability.
Based on that assessment, RP is capable of learning by rote but lacks the ability to apply what she may have learned in one situation to another similar, but different, situation. To use a culinary analogy, if you taught her a recipe for spaghetti bolognese by walking her through it step by step, she'd be able to make a spag bol, but if you then asked to apply what she'd learned about making spag bol to knocking up a simple beef lasagne she'd be completely flummoxed by the request.
Importantly, in terms of John's claim that its obvious that RP had litigation capacity just from speaking to her, the psychiatric assessment indicates that her ability to repeat verbal information exceeds her ability to understand that information or make use of it, so its not obvious at all. Appearances, in this case, are deceptive and it is only when her cognitive abilities are properly assessed by a competent psychiatric practitioner - and not an incompetent MP - that the full extent of her cognitive limitations becomes apparent.