“In my first report I noted some diagnostic uncertainty in this case. F seemed to have episodes of psychotic and affective symptoms but also had an ongoing set of systematised persecutory beliefs which seemed to persist in the absence of more acute symptoms which may indicate paranoid personality disorder. I did not think a definitive diagnosis could be made at this point without further information and assessment. He has had some of that with the EIS assessment but unfortunately it appears his engagement with that was limited. They have a working diagnosis of paranoid personality disorder with possible transient psychotic symptoms. My views are largely consistent with those of the treating in-patient team last year and with EIS. We all believe there is a probable underlying personality disorder with occasional episodes of psychosis. The information is increasingly suggestive of a paranoid personality disorder, transient psychosis, with overlying episodes at times of increased stress based on F’s engagement with and response to professionals since discharge from hospital last year. Until F engages consistently with mental health services over a prolonged period of time it is unlikely that he will receive a definitive diagnosis of personality disorder. That will not be obtained by a one-off assessment with the treating Psychiatrist. It would require him to engage openly and honestly over a period of time. Unfortunately, the nature of F’s mental disorder is likely to prevent this. He is likely to continue to make complaints, disagree with professionals and not engage fully with them whilst attributing responsibility to them for that. This is an intrinsic part of his paranoid thinking and makes thorough assessment or treatment of individuals with this sort of pathology very difficult. I remain of the view that a combination of anti-psychotic medication, psychological intervention, would be ideal to address F’s mental disorder. Meaningful psychological intervention can be very difficult to deliver for people with paranoid personality traits/disorder. It is likely he will continue to have difficulties in interpersonal relationships and hold/develop paranoid beliefs about others as a way of coping with those for the foreseeable future. This is likely to impact on his ability to co-parent effectively with the mothers of his children. At this point a psychological assessment of personality may be of more benefit than at the time of my first report because the more acute psychotic symptoms present in late 2021/early 2022 seem to have diminished based on the EIS conclusions. That would probably help with an understanding of his personality structure and could make treatment recommendations, but I am unsure if that would lead to a greater acceptance of his own responsibility and difficulties of or addressing those.”
“7.1.1. In summary, it is evident that F has experienced a number of mental health difficulties over the past few years, particularly at times of stress. As highlighted, it is felt that his difficulties are linked to personality traits, namely in the form of Paranoid Personality Disorder traits and an Anti-social Personality Disorder style, which underly a comorbid mental illness, as described by Dr Bacon’s report and the EIS. 7.2. F would therefore benefit from a course of Schema therapy to address his personality difficulties. As with all personality disorders, progress can be slow and some recommendations consider 12 months for treatment to be effective.”
“26. What did I make of F? The person I saw in the witness box was the person described by Dr Bacon. I asked him, when I read to him and went through Dr Bacon’s paragraphs that I have read into this judgment, whether he recognised the person she was describing, and he said, “not really”
“1/29/2024 F on1/29/2024 11:28PM texted (viewed by M on1/31/2024 1:09PM): Hi, how did your chat with your solicitor go, what came of it?1/31/2024 M on1/31/2024 1:10PM texted (viewed by F on1/31/2024 1:10PM): I'm waiting for them to get back to me. F on1/31/2024 1:12PM texted (viewed by M on1/31/2024 3:27PM): How long are you going to wait for? This is moving at a really slow pace M. SB and IB’s welfare is more important than this, please would you ensure you and your representatives give it due priority from now on M on1/31/2024 3:33PM texted (viewed by F on1/31/2024 3:34PM): I understand your frustration however, as you are proposing to deviate from what CAFCASS have recommended, and I am having to rely upon third parties in this matter, time scales are to some degree out of my hands. F on1/31/2024 3:38PM texted (viewed by M on2/1/2024 11:04AM): I (F) don't accept this M. SB and IB are our responsibility, not theGuardian’s, and not your Solicitor’s. This responsibility needs to be understood. I asked you 2 weeks ago for your availability and you still haven't offered any availability, and it's still not apparent there is any justification for the 2 week delay you have caused. I'm not frustrated, I'm simply highlighting the facts as they stand. I look forward now to you taking responsibility for this matter and driving it forward without further delay.”