Author: rob

As we enter day three of Mental Health Awareness Week, we start to ask ourselves what kindness is and how can it help at a time like these?

Hosted by the Mental Health Foundation, Mental Health Awareness week is a chance for everyone to come together and focus on one singular theme, Kindness. During these unprecedented and uncertain times when the world feels upside down, kindness can be the key to turning things around for someone.

There are many definitions of what it means to be kind and kindness is often related to other feelings such as empathy and compassion. At its core, researchers suggest that kindness is a gesture motivated by genuine, warm feelings with an aim to improve the feelings or lives of others.

From saying hello as you walk past someone (at a safe distance of course), to paying it forward or coming together on a Thursday evening to Clap for our Carers. Kindness really can come in all shapes and sizes and can have real benefits for our mental health and wellbeing

Mark Rowland, chief executive of the Mental Health Foundation, said: “We want to use Mental Health Awareness Week to celebrate the thousands of acts of kindness that are so important to our mental health. And we want to start a discussion on the kind of society we want to shape as we emerge from this pandemic.”

Company Director, Zofia, recently decided to close the Expert in Mind office early to host a team quiz via Zoom and included dinner delivered to each of the teams’ houses. Business Manager, Sophie, has a surprise planned for each of the team later this week.

What have you done recently to be kind?…

From the ALS Ice Bucket Challenge and Movember to the countless legal walks and bake sales, it’s safe to say the team at Expert in Mind like a challenge and now is no exception.

Whilst the COVID-19 pandemic has resulted in the team working from home remotely and the UK unable to enjoy most of their normal comforts, the  #SEE10DO10CHALLANGE is a creative way to promote maintaining a healthy body, healthy mind and a perfect opportunity to reach out to someone when you pass on the challenge to them and talk.

We proudly announced earlier this year that we have partnered with Combat Stress as our charity of the year. Our Business Manager, Sophie, decided she couldn’t pass up on the opportunity to start our teams involvement in the challenge. Today she completed her #SEE10DO10CHALLANGE and has now encouraged the Expert in Mind team to also take part.

Check out her video here:

 

It’s important now more than ever that we all remember whilst we might be apart, we are all still working together. If you would like to take part in the #SEE10DO10CHALLANGE and challenge your colleagues, friends and family you can find everything you need about the #SEE10DO10CHALLANGE by heading to the Combat Stress Website https://www.combatstress.org.uk/see-10-do-10

Happy Birthday Expert in Mind!

May 2020 sees Expert in Mind celebrate its 12^th year in business which brings a time for reflection at all that we have achieved and more importantly, a time for us to share our birthday celebration with you. Because now more than ever, while we might be apart, we are all still working together.

The COVID-19 pandemic has certainly made everyone at Expert in Mind reflect. We have seen some bumps in the road previously however this pandemic has certainly required some adaptation of how we work however, with the right team anything is possible!

It was 12 years ago that Expert in Mind was born in the spare room of our company director Zofia. Since then, the business has gone from strength to strength moving from Zofia’s spare bedroom into a new office which we then needed walls knocking down a year later so we could expand our team further into a bigger space. With a team which is now five times the size it was six years ago and having built on many relationships with the firms and Experts that we partner, we’re able to fulfill our values of being friendly and approachable ensuring our professional yet personal service.

Over the past 12 years at Expert in Mind, we’re incredibly proud to have received a number of high-profile nominations and prestigious awards. In 2018 Expert in Mind were thrilled to receive nominations for the Business Excellence CEO of the Year Award, Personal Injury Medicolegal Provider of the Year Award and also win the Expert Witness Awards 2018.

In 2019 our Company Director Zofia stood proud as finalist for the Business Women of the Year Awards. Not only was she a finalist, she was chosen to be one of eight finalists from a total of 500 nominees across the UK! Our Business Manager, Sophie proudly attended the 2019 Personal Injury Awards following her nomination as a finalist for Young Achiever of the Year.

It might be an uncertain time for everyone but at Expert in Mind, we’re looking forward to what the next year has to bring as we continue to grow and do what we do best by providing those in the legal profession who require reports from our highly esteemed Psychiatrists and Psychologists! We are also excited to be working with our chosen charity of the year Combat Stress and look forward to raising money for them through several challenges as a team.

Watch this space…

The office environment and how we conduct business has changed for many and like us, most businesses are now working from home.

Whilst these times are unprecedented, we’re proud with how our industry has evolved, from our valued Experts increasing their availability while working from home resulting in our timescales being shorter, to the use of encrypted platforms such as Skype and Zoom to carry out remote assessments and court hearings.

Working together with our leading experts in Psychiatry and Psychology, Expert in Mind is proud to say that whilst we might be apart, we are still working together.

Shorter Timescales

With physical travel limited and everyone now settled into home working, our timescales for mental health assessments are evolving. These uncertain times are proving tough for everyone, from those who are awaiting assessment or have an upcoming court case to the countless teams who are doing everything they can to keep the legal system working.

Our incredible panel of Psychiatrists and Psychologists are proud to be able to offer more availability during this uncertain time to ensure that while we don’t know when we’ll be returning to normal working, our experts can continue to provide a high quality service with timescales to meet our client’s needs.

Remote Assessments

Finding the right Psychiatrists and Psychologists for mental health assessments can be tough anyway, let alone when you add in social distancing and travel restrictions. At Expert in Mind our experienced panel of experts have adapted the mental health assessment process where possible to include the use of video conferencing to conduct assessments.

Utilising platforms secured with AES-256 encryption such as Skype and Zoom to conduct remote assessments, our Psychiatrists and Psychologists can provide a safe and secure way to continue offering mental health assessments without delay during the COVID-19 pandemic.

Let’s Work Together

Each of our Experts is assigned a personal case manager who is there to discuss any aspect of the case with from start to finish. We are not a call centre, nor an agency so whilst we might all be working apart, we are still working together to provide our clients with a seamless process in pairing their case with the right expert.

Don’t let the COVID-19 restrictions add any additional stress to your day, let’s work together to find the perfect solution.

Please note that due to the unprecedented circumstances surrounding the COVID-19 pandemic and to ensure everyone’s safety, the launch of Law Talk has been re-scheduled to take place on Tuesday 22^nd September 2020 at The Law Society, London.

We hope you’ll be even more keen to join us and our esteemed experts at the Law Society and welcome you to reserve your place at our new launch now by contacting sophie@expertinmind.co.uk

Until then, Stay Safe.

Law Talk; a series of engaging events for legal professionals, designed to shed light on complex presentations of mental health issues in clinical negligence cases.

The first of our Law Talk events, intriguingly titled ‘What lies beneath?’ is being held at the Law Society in London.

This will be a convivial evening, starting with a drinks and canapé reception, followed by fascinating talks from two Expert in Mind panellists, Dr Paul McLaren Consultant Psychiatrist, and Dr Tim Green, Chartered Consultant Clinical, Forensic and Neuro-Psychologist who will touch on physical symptoms and hidden truths as they relate to legal cases. Afterwards, you’ll be able to raise any questions and to catch up with your peers in a relaxed environment. 

Two fantastic speakers

Our first speaker is Consultant Psychiatrist, Dr Paul McLaren, Medical Director of The Priory Hayes Grove. His subject will be ‘Medically unexplained symptoms in clinical negligence cases’, notably recent developments in the understanding of somatic symptom disorders. These are mental disorders that manifest as physical symptoms suggesting illness or injury, but which cannot be fully explained by any underlying medical condition.

 

Our second speaker is Dr Tim Green, a Chartered Consultant Clinical, Forensic and Neuro-Psychologist who holds clinical appointments in the Forensic Service of South West London and St. George’s NHS Foundation Trust. His talk, ‘Ever get the feeling you’ve been lied to?’, will look at clinical assessment with regard to ‘assessment of effort’ in the context of malingering.

One evening well invested

The evening begins at 6.00pm and will finish at 9.00pm. As well as the chance to network, you’ll also have the opportunity to meet your contacts at Expert in Mind and representatives from Combat Stress; our Charity of the Year for 2020. This seminar will be invaluable for any legal professional involved in clinical negligence cases where mental health is prevalent. The broader understanding that you will gain will inevitably contribute to maximising the best outcome for your client.

If you are interested in more information on the event or would like to join us, please contact sophie@expertinmind.co.uk as soon as possible as spaces are limited.

Written by: Dr Utpaul Bose, member of the Expert in Mind Expert Witness panel

 

In children, ADHD is conceptualised as being at one end of a normal distribution curve; that is children who are the least attentive and those who are the most hyperactive are considered to have ADHD. A lot of the detractors of childhood ADHD make an issue about the cut-off point at which the children will be diagnosed. Therefore, if the cut-off point is lowered, there will be a lot more children diagnosed with the condition. However, adult ADHD cannot be diagnosed in this way. If you asked most General Adult Psychiatrists about the most inattentive patients they have seen in their clinic, they would think of patients who are floridly psychotic and paying more attention to their inner world than your questions. In addition, if you ask the same question about who their most hyperactive patients were, they would think of patients who were in the middle of a manic episode.

In adults, as opposed to children, ADHD presents as a syndrome of extremes. In addition to inattention there is hyper-focusing, which is when an emotion is attached to a task at hand. There is both procrastination and impulsivity; hyperactivity and hypoactivity; disorganisation and perfectionism. The main feature of adults with ADHD is their variability.

Leading London Consultant Psychiatrist Dr Utpaul Bose explains how adult ADHD presents in both men and women and the negative effects that it can have on people’s behaviour if left untreated.

 

How does ADHD affect people’s behaviour?

Childhood ADHD had a 60 year head start over Adult ADHD (1935 vs 1995). Unfortunately, children to at least the age of 10 cannot give a good description of their mental state. Children do not usually refer themselves to child psychiatry clinics but are usually referred by other people e.g. parents and/or teachers and are more likely to be referred for externalising symptoms (behavioural problems) rather than internalising symptoms e.g. anxiety, mood and low self-esteem. However, children with ADHD actually suffer with both internalising and externalising symptoms. It is the ones with externalising symptoms that get noticed because the adults can see them and the ones with negative externalising symptoms, which impinge on others, that are likely to be referred the most. Thus, the sample of children with ADHD that are diagnosed with the condition is an extremely biased one. It misses a lot of children who predominately suffer with mood swings and emotional incontinence; that is, they burst out crying when their classmate says they don’t like them, or they run around the playground a hundred times after scoring a goal. It also misses out on all the space cadets (usually girls) who do not have any observable behavioural problems but daydream all day long.

However, Adult ADHD is not predominately a behavioural disorder – as opposed to childhood ADHD. Not all people with ADHD suffer from temper outbursts. In fact, some spend all of their mental energy trying to control their tempers, with the odd occasional leakage. When temper outbursts do occur, they are usually because of frustration due to impatience like missing a train or the person in front of them spending too long in a queue. The focus on negative behaviours because of the emphasis on childhood ADHD overlooks the fact that all emotions are uncontrolled. Therefore, those with ADHD can also suffer with poor regulation of positive emotions and many individuals who never lose their temper, but have an abnormally loud laugh, suffer with ADHD as well.

 

Does ADHD have a negative effect on people’s behaviour?

Individuals with ADHD are impulsive; that is, they prefer smaller immediate rewards rather than larger long-term benefits. Therefore, they have financial difficulties, problems organising themselves and with household tasks such as running a family. They are also particularly prone to compulsive behaviours, which can range from shopping, masturbating, knitting exercises and risk-taking behaviours such as gambling, extreme sports, risky sex, risky driving (speeding) and shop lifting. Some of them self-medicate with illegal drugs.

 

How can ADHD be managed?

This can be managed with ADHD medication, life coaching or cognitive behavioural therapy (CBT). The benefits of treatment for ADHD are often much more dramatic than other psychiatric disorders.

 

Does ADHD present differently in men and in women?

There is a trend amongst women for more internalising symptoms such as anxiety, depression and low self-esteem. However, these symptoms can be very prominent amongst men and there are also many women who are sensation seeking risk-takers.

How do you assess someone for adult ADHD?

As children cannot tell you how their brain works, childhood ADHD is diagnosed based on their behaviours. General adult psychiatrists, however, use the mental state examination to diagnose mental disorders. It is therefore appropriate not to use specialised checklists that were designed for children but to diagnose it primarily on the way the individual describes their mood, thinking, behaviours and sleep.

We are currently facing uncertain and unprecedented times following the recent outbreak of the Coronavirus. In light of this uncertainty, we would like to assure you that the health and safety of our team, Experts and clients is our top priority and therefore we are monitoring the developing situation extremely closely while following all guidelines issued by Public Health England and both us and our Experts are acting accordingly.

While it is business as usual for Expert in Mind, the team are taking all of the necessary precautions to try to assist with the national global effort to minimise the spread of the COVID-19 virus and have requested that our Experts do the same. The team are now working remotely to adhere to the social distancing regulations and advice. Please bear with us during this adjustment period. We are making every effort to continue to deliver high quality reports and assessments are currently ongoing remotely via Skype or Zoom. A member of the Expert in Mind team or your Case Manager will be able to assist in arranging this. Should you experience any problems with our phone lines, please email your regular contact at Expert in Mind or email office@expertinmind.co.uk for a swift response.

We will continue to update all our valued clients as the situation changes and the team hope you remain safe.

In 2019 we were approached to feature in the 2020 Law & Justice Parliamentary Review highlighting best practice. The following is our article which was published in March 2020:

 

From starting her company in a spare bedroom to reaching the final of Business Woman of the Year, Zofia Ludwig’s past ten years in business have been anything but boring. Providing the legal sector with experts in psychiatry and psychology, Zofia says her service is underpinned by highly trained and specialised mental health professionals. In spite of financial cutbacks, the business continues to grow, with plans to expand year-on-year. She talks with the Review about the intricacies of GDPR, her team of experts and the importance of teamwork.

We are an award-winning company providing the legal sector with experts in mental health. I founded the company in a spare bedroom in 2008 and my efforts to grow and develop the business have been recognised by my inclusion as one of the eight finalists for Business Woman of the Year. Our service is underpinned by a panel of highly specialised psychiatrists and psychologists, based throughout the UK, who are experienced in providing reports for legal proceedings. Our office is based in St Leonards-on-Sea and solicitors, barristers, government bodies and local authorities contact us when they have a case in which a mental health assessment is required. This can be in a multitude of areas such as family proceedings, employment tribunals, personal injury, medical negligence, immigration and criminal matters.

The right expert for the right case

The knowledge of our experts enables us to provide details of those who would be suitable to assist on a case, dependent on the area of law, timescale, fee allowance and expertise required. We provide appropriate nominations and, once instructed, manage the case from start to finish. Each expert is assigned their own case manager, so they have one go-to person who knows the ins and outs of each case. There are many strands to every case and some have a long lifespan so having someone who knows the intricacies makes it a seamless experience all round. I, and all nine of our employees, value the importance of a happy, hardworking, knowledgeable and driven team. We have a common goal: to ensure a professional, efficient and personal service to our clients and our experts. This culture has served us well and since 2015, the company has seen case instructions, the expert panel, the team and our turnover at least double.

A whole team effort

The whole team take an active role in driving the business forward and continuing the expansion that has been taking place over recent years by building on valued, established relationships with clients and participating in linking to new ones. Career growth for team members is equally important. One of the case managers who started at the company in 2014 has completed a management training course and was promoted initially to office manager and now business manager – taking on more responsibility regarding the running of the company. She was a finalist for the Young Achiever Award at the Personal Injury Awards in December 2019.The team are actively involved in charity events and this year alone they have raised nearly £4,000 for Guide Dogs for the Blind, Access to Justice and Cancer Research by taking part in events such as half marathons, charity tea parties and the ten-kilometre London legal walk.

Adapting to financial cutbacks

In 2014, severe cuts were made to legal aid which meant that expert fees were almost halved overnight. Initially, as a result, case instructions reduced dramatically and unfortunately it meant that a number of valued experts did not continue in this field. For us, this brought a period of great adjustment and sadly resulted in several redundancies and an office downsize. Fees are now lower than ever, and yet high-quality experts are still required for their valuable opinions. Of course, the cuts and the continued scrutiny of the Legal Aid Agency have had major effects on legal firms, with several smaller businesses closing. The LAA are taking an increasing amount of time to settle invoices and are then often disputing the figures, meaning legal firms, and companies like ours, are having to spend valuable time trawling through old files to justify costs. These delays mean that money that is received from the LAA is being used by legal firms to cover running costs and staff salaries rather than being passed on to settle outstanding invoices. From our perspective, this can mean that invoices are not settled for lengthy periods, and increasingly are never settled, as more firms have no choice but to go into liquidation. In extreme cases, we have issued legal proceedings against a solicitor where a large sum of money is owed and despite having been to court on numerous occasions, no payment has been received. For a small business this is incredibly costly, and it seems unbelievable that there is no safeguard that avoids such expensive, repetitive court attendances with no resolution forthcoming.

The intricacies of GDPR

The introduction of GDPR in 2018 has brought both positive and negative effects. While it is beneficial to have guidelines, especially those which protect the privacy of individuals and their personal data, there are many ambiguous areas. We have had several cases where a parent who has been the subject of a mental health assessment in a family proceedings case contacts us for copies of the notes and documents that an expert has seen in relation to the case and to their children. If it is the case that the child has not had contact with this parent for some time, it is a very grey area as to whether the parent should be allowed sight of such documents. However, neither the ICO nor our legal advisors have definitive answers for specific cases such as these, which can be upsetting for the person wanting to obtain the information, and frustrating for us as a company with the risk of breaching GDPR. It would help greatly if there were a go-to for these complex situations that have arisen as a result of the introduction of GDPR. Going forward, we plan to continue our expansion, gradually, to maintain the high calibre of experts by hand picking new additions to our panel, and to ensure that we never compromise the personal service for which we are renowned.

To see the original article or read the other features click the below link: https://www.theparliamentaryreview.co.uk/organisations/expert-in-mind

We are delighted to announce the launch of Law Talk; a series of engaging events for legal professionals, designed to shed light on complex presentations of mental health issues in clinical negligence cases.

The first of our Law Talk events, intriguingly titled ‘What lies beneath?’ is being held on the evening of Thursday 30th April 2020 at the Law Society in London.

This will be a convivial evening, starting with a drinks and canapé reception, followed by fascinating talks from two Expert in Mind panellists, Dr Paul McLaren Consultant Psychiatrist, and Dr Tim Green, Chartered Consultant Clinical, Forensic and Neuro-Psychologist who will touch on physical symptoms and hidden truths as they relate to legal cases. Afterwards, you’ll be able to raise any questions and to catch up with your peers in a relaxed environment.

 

Two fantastic speakers

Our first speaker is Consultant Psychiatrist, Dr Paul McLaren, Medical Director of The Priory Hayes Grove. His subject will be ‘Medically unexplained symptoms in clinical negligence cases’, notably recent developments in the understanding of somatic symptom disorders. These are mental disorders that manifest as physical symptoms suggesting illness or injury, but which cannot be fully explained by any underlying medical condition.

Our second speaker is Dr Tim Green, a Chartered Consultant Clinical, Forensic and Neuro-Psychologist who holds clinical appointments in the Forensic Service of South West London and St. George’s NHS Foundation Trust. His talk, ‘Ever get the feeling you’ve been lied to?’, will look at clinical assessment with regard to ‘assessment of effort’ in the context of malingering.

 

One evening well invested

The evening begins at 6.00pm and will finish at 9.00pm. As well as the chance to network, you’ll also have the opportunity to meet your contacts at Expert in Mind and representatives from Combat Stress; our Charity of the Year for 2020. This seminar will be invaluable for any legal professional involved in clinical negligence cases where mental health is prevalent. The broader understanding that you will gain will inevitably contribute to maximising the best outcome for your client.

If you are interested in more information on the event or would like to join us, please contact sophie@expertinmind.co.uk as soon as possible as spaces are limited.

By Dr Joseph El-Khoury MD MSc FRCPsych, Assistant Professor of Psychiatry

Eating disorder is a category of mental health disorders that include a range of clinical presentations sharing in common a dysfunctional psychologically driven relation with food. The ICD-11 lists six official diagnoses. Preoccupation with weight and body image is a characteristic of the two better known conditions: Anorexia Nervosa and Bulimia Nervosa. For these, the peak onset is in late adolescence and early adulthood, but they may still appear later in life. Anorexia is a particularly serious illness due to high mortality associated with metabolic complications.

Initially, eating disorders perceived as ills of western developed societies, heavily influenced by modern beauty norms and the fashion industry’s obsession with thinness. Nowadays individuals who suffer from one of the eating disorders come from all walks of life, all social classes, ethnicities and religious background. The condition also affects both genders, with evidence of it having increased in men over the last decades. This may simply because of better detection of cases as a consequence of increased awareness and among healthcare professionals. With all these variables, the stereotypical image of a thin young girl is far from representative of the majority of eating disorders cases. To confuse matters further, the evolution of the illness beyond one diagnostic framework is fairly common. The consequences of having an eating disorder extend beyond the psychological (preoccupation with food, weight, body image) and social (impact on social interaction, relationships, parenting) to the physical health. A recently published large Canadian study revealed that Bulimia was associated with a higher risk of cardiovascular events and related deaths than the general population.

Anyone who has worked in the national Health Service will agree that current mental health services structure is poorly suited for providing the necessary support for all but the most severe cases requiring intensive therapy and hospitalization.  The private sector on the other hand can only cater for a small category of privileged patients and for a short period of time. This state of affairs tends to discourage many from seeking professional help, which explains the difficulty in accurately estimating the prevalence of eating disorders in the community. Experts propose a number between 1 and 4 million across the United Kingdom.

This leaves psychiatrists with the challenge of diagnosing conditions that will most likely not receive the needed attention. In terms of what works and what does not work for eating disorders only a few pharmacological agents have shown at best moderate efficacy. These include antidepressants such as SSRIs, some mood stabilizers and stimulants. Others have been investigated inconclusively.  Instead medications are used to alleviate comorbidities such as depression, anxiety or insomnia for example. Psychological intervention remains the go-to treatment with several strategies having been tested. The strongest evidence is in favor of specialized versions of Cognitive Behavioural Therapy (CBT) with also an established role for interpersonal therapy and family therapy, particularly in younger patients.

Recognizing and treating eating disorders should be an essential part of the skillset of every general psychiatrist and licensed psychologist. Reliance on specialist services should be reserved for the most challenging cases. It is hoped that raising awareness will help contribute to this desired goal.