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    A pen writing on paper

    Becky Mairi Farrell: Dear Psychiatrist…

    Becky Mairi Farrell writes to the psychiatrist to report on her recent review of herself.

    Dear Psychiatrist

    Re: Becky Farrell D.O.B. 23/04/1974

    I have seen myself in life today. I presented with elevated mood which has become more pronounced since I last saw myself to review myself.

    In the past when I have seen myself under similar circumstances the most effective treatment has been a short-term increase of antipsychotics; either the ones I have been prescribed at that time or chlorpromazine. My notes over the last 10 years suggest that the most effective manner for these to be administered is not by incremental increase but by an abrupt but short increase with possible antidepressant reduction for the same period as adjunct. At the moment, this would be an increase of quetiapine to 700mg per day in divided doses or a 7-day prescription of chlorpromazine 300mg per day. In discussion with myself it was decided that the second of these would be the best option as I am currently in the process of reducing quetiapine to transfer to aripiprazole due to the severe side effects which I have noted when reviewing myself on my present antipsychotic. As it has also been noted that lorazepam can aid in the prevention of the currently unexplained periods of several hours of uncontrolled movement of all limbs, it is also helpful for the client to have a supply of lorazepam 1mg prn, which she takes extremely sparingly due to the fact that it would be easier for her to learn the recipe and concoct it herself in her non-existent lab than actually be prescribed any.

    When I have observed myself with a similar presentation to today, as discussed in detail with my support worker and in brief with my care coordinator, it has been noted that, as respite and Crisis House admission are not able to cater for my needs while I am not considered to be safe at home alone, the best thing to do is to send me home and leave me to my own devices.

    As you will see when you review my notes, this is the current position as authorised during my non-existent psychiatric assessment in A&E after my discharge on 12 February 2017 by someone called Helen. I am unsure at this time whether my notes covey the essence of this assessment. However, I am in a position to provide a full paraphrase herein. Helen told me to ask my carer to bring my purse and keys so I could leave. This assessment, recommending my return home, has subsequently been endorsed by the team. Other than the aforementioned discussion, no evaluation was made which included how the client was subjectively. It was observed that she had sat nicely on her bed all morning, but as she was not consulted it was not possible to ascertain at that time that her stillness was due to spending most of the day in a state of dissociation.

    My recommendations considering this summary of my review of myself today are that chlorpromazine and lorazepam are prescribed as detailed above. And that consideration should be given to how the recent referral, to home treatment, can keep the client concerned safe during the coming days in their two or three ten minute visits when, as observed and noted, I have observed that most of the time I don’t know what the fuck I am doing and whether it corresponds in any way to the continued existence of myself or my immediate environment.

    I look forward to hearing from you when you get round to it.

    Signed electronically,

    Becky Farrell

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