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Our chosen charity for 2020 is Combat Stress – the UK’s leading charity for Veterans’ mental health. They help former servicemen and women deal with trauma-related mental health problems which include anxiety, depression and post traumatic stress disorder (PTSD). The support they provide is to Veterans from every service and every conflict over the phone, online, in the community and at their specialist centres. The demand is growing and our donations are vital funds enabling them to help change lives and give those suffering, along with their families, hope for a better future.

Working in the Mental Health industry, the team at Expert in Mind see first hand how difficult it is for those who deal with illnesses such as anxiety, PTSD and depression on a daily basis.

We are therefore raising funds and making donations of our own to help them continue changing the lives of those who have served our country. Our first fundraising events are next month and we can’t wait! We will be attending their annual black tie dinner in London and taking part in the challenge March in March!
March in March is a 10 mile run or walk on any day in March, anywhere at anytime and is being completed by individuals all over the country! The Expert in Mind team will be completing their 10 mile walk on the 28th March 2020 from the Cooden Beach Hotel to the Fisherman’s Huts in the old town of Hastings with a few loops on the way – watch this space to see how we get on and please sponsor us if you can, every penny helps!

https://www.justgiving.com/fundraising/team-expert-in-mind

 

Zofia, our Company Director was due to take part in The Cancer Research UK London Winter Run on Sunday 9th February 2020. This is an annual 10k challenge through the heart of the capital, passing world famous landmarks, and instantly recognisable areas that have been taken over by winter creatures such as penguins huskies and polar bears!

Since the first event in 2015, over 83,000 people have taken part, raising nearly £3,000,000 for Cancer Research UK and other good causes. These invaluable funds have helped double survival rates in the UK over the last 40 years. But we need to do more! Every four minutes, someone in the UK loses their life to cancer.

The goal is that by 2034 we will see 3 in 4 people surviving all cancers. As there is no government funding, every pound is raised by fundraisers.

Unfortunately, the organisers had to take the difficult decision on Friday afternoon to cancel the event. Storm Ciara had been threatening the UK for the week leading up to the event and by Friday forecasters were certain that the UK would see winds of up to 90 mph on Sunday (event day!) so the safety of the volunteers, organisers and participants had to take priority.

On Sunday the UK was indeed battered by the wind and rain of Storm Ciara with power being lost, fallen trees blocking train tracks and roads, some areas experiencing flooding and in Hastings the lifeboat had to be deployed to rescue a man who had decided that surfing was a good idea in those treacherous conditions but got separated from his board!

The organisers of the race were well aware how hard everyone had been training for the 10k event and kindly gave participants the option to run the distance anytime this week, anywhere, and send a screen shot of a running app to prove it to secure a medal.

Zofia decided to run 10k on Saturday before the winds became too ferocious! She managed to secure a personal best time and completed the run in 1 hour 1 minute and 48 seconds. All the hard work has paid off and she has managed to increase her average speed from 7 minutes 4 seconds to 6 minutes 10 seconds. Not bad for someone who started with couch to 5k last year and initially wasn’t able to run for 1 solid minute. She is now looking forward to the medal arriving in the post.

An article by Chireal Shallow, Consultant Psychologist

This historical and annual celebration of love, friendships and romance known by many names has become fixed in our call sets to be acknowledge on 14th of February. Some look towards the middle of February with excitement and enthusiasm. The anticipation of a romantic meal, cute presents, the declaration of love and maybe, just maybe, the long-awaited proposal.

However, February 14th isn’t always a time of positivity, fuelled with love as you might expect. Some people dread this time not because they are killjoys or party poopers, but because of loneliness; because of the loss of love, lack of love and the limited availability of close friendships.

For those individuals, Valentine’s Day represents something entirely different. It’s a stark reminder that they don’t have that special person in their lives anymore. For them it is a time of reflection; a time where they may focus on their isolation and loneliness and this can have a huge impact on their psychological wellness. Is this you? Can you relate or know someone this applies to? Interestingly our brains can have a way of making us feel like we are the only people alone or without a partner on All Saints Day when in fact the reality is that there at 15 million people who are single in the UK at present. Yet the despair and feelings of low mood can make us internalise our experience and focus on our own feelings of being without rather than focussing externally and finding the evidence that refutes this mind muddle.

We also must remember that being alone in itself it not a mental health problem, there are many individuals who choose to be alone and being alone for them gives them great peace and satisfaction. Being with oneself and enjoying one’s own company is a far cry from those who find this time of year especially hard and do not wish to be alone and those who struggle with anxiety and low mood.

The huge emphasis on Valentine’s Day love can feel so intense that not only do you feel lonely on this day, but you may also feel left out. So, what can you do to combat the thought that this massive amount of love and desire seems to be universally happening for everyone else but you. So, do you have to be lonely at this time of year? Are there things you can do to overcome loneliness and the low mood that may accompany it at this time?

Be kind to yourself: learn to love you. Treat yourself like the friends you would want. Do something special for yourself, buy yourself a gift, take yourself out for a date. Learn to be good to you.
Find a pet, hug an animal or go for a dog walk. Animals are a good source of happy feelings. If you don’t have a pet of your own, go to a farm or an animal sanctuary and use this interaction as a good way to keep the blues away and feel connected with something that is just so very happy for you to be there and gives unconditional affection and warmth.
Find a hobby. Think about what you enjoy doing and do more of it. Whether its sports, language or a walking club, get involved in what you enjoy and find out what is available in your local community
Reach out to friends. Valentine’s Day is about friendships not just about romance. Make Valentines your own and send cards to all those people who hold a special place in your heart.

By Dr Muffazal Rawala, Consultant Adult Psychiatrist and member of the Expert in Mind Expert Witness Panel

 

Psychiatrists, the general public and the Courts are aware about the widely used terminology of Post-traumatic stress disorder (PTSD). The psychological consequences of exposure to trauma were extensively researched in Vietnam War veterans, which led to the development of diagnostic criteria for posttraumatic stress disorder.

In the 90s, research in the experience of (domestic) violence in children and women suggested that a meaningful clinical distinction may be made between single traumatic events and repeated, prolonged, interpersonal traumatic events occurring in a context of an authoritarian control. This clinical definition of complex trauma has since gone virtually unchanged – “exposure to repeated or prolonged instances or multiple forms of interpersonal trauma, often occurring under circumstances where escape is not possible due to physical, psychological, maturational, family/environmental, or social constraints”.

PTSD may present with a range of symptoms including re-experiencing the trauma, avoidance, hyper-arousal, depression, emotional numbing, drug or alcohol misuse and anger as well as unexplained physical symptoms. The symptoms of PTSD are extreme and encompass more than just remembering the event or dreams, but a combination of disabling recall, dreams and memories. A large percentage of trafficked women and men present with anxiety, depression or PTSD. PTSD sufferers may not present for treatment for months or years after the onset of symptoms despite the considerable distress experienced.

Complex-PTSD is a subtype where adults or children who have experienced repeated traumatic events like neglect, abuse or trauma over a longer time period may develop signs and symptoms of PTSD. Complex PTSD is thought to be much more severe if the abuse and trauma happened early in life and caused by a parent or carer, the person experienced repeated incidents over a number of years and felt entrapped with complete control of the abuser over the victim, for example, in the case of asylum seekers from totalitarian regimes or victims of human trafficking. Children with complex-PTSD could show behavioural problems, affect their personality development, develop negative coping mechanisms and as adults may become socially isolated and unable to form trusting relationships.

It is a widely held view that traumatic incidents are an extraordinary life experience capable of causing a wide range of physical and psychological suffering. Most clinicians and researchers agree that the extreme nature of the traumatic event is powerful enough on its own to produce mental and emotional consequences, regardless of the individual’s pre-morbid psychological status. The psychological consequences of repeated trauma, however, occur in the context of personal attribution of meaning, personality development and social, political and cultural factors. It is important to recognize that not everyone who has been repeatedly abused develops a diagnosable mental illness. However, many victims experience profound emotional reactions and psychological symptoms. The emotional restriction and inability to consistently recall details of the abuse do not lead to any dispute in either the authenticity of being a victim of abuse nor does it question the diagnosis of complex-PTSD. The emotional withdrawal, defensive indifference to traumatic memories and inability to consistently recall all details during asylum interview or statements, suggest a defence mechanism to safeguard from reliving and re-experiencing the horrific traumatic abuse, features commonly seen in victims of abuse and complex PTSD rather than feigning of symptoms.

In refugee samples, PTSD has been shown to be common amongst victims of human trafficking, domestic violence and torture, though complex-PTSD has received little attention in this area. Two small studies in non-refugee samples investigated German victims of torture and domestic violence and found high complex-PTSD prevalence, whilst none have investigated human trafficking.  The effect of major human rights violations on the presence of complex-PTSD in asylum-seeking populations’ and victims of human trafficking, torture and domestic violence has not been consistently researched although is widely seen in clinical practice of Psychiatrists with experience of working with asylum seekers.

Many asylum seekers and refugees have fled their country of origin to escape the horrors of war, persecution, organised violence, or torture. Psychiatrists with experience of working with asylum seekers routinely see that individuals would either have difficulty in elaborating their statements, might have gaps in their history in their witness statements or make conflicting statements during their asylum interviews or hearings. This makes it crucial that such individuals are referred to specialist psychiatry services with knowledge and experience of working with asylum seekers and their ability to interview them in a supportive environment to help overcome the emotional constriction and guarded behaviour.

 

If you need a psychiatrist or psychologist to provide a high-quality report for your personal injury matter, contact the team at Expert in Mind who can recommend experienced Experts in the field of mental health.

Baking to help provide access to justice for our country’s most vulnerable

We can’t wait to take part in the Great Legal Bake! Anything that gives us a worthy excuse to eat cakes is fine by us, and the fact that it will raise funds for local advice charities helping to protect the most vulnerable people in our community is the cherry on top!

On Friday 14th February 2020 we will be taking part in the Great Legal Bake, selling cakes and cream teas to local friends, colleagues and businesses to help raise much needed funding.

Cuts in Civil Legal Aid and council grants have made it far more difficult to access free legal advice. In 2012-13 there were 870 not for profit legal aid providers in England and Wales. However, following the legal aid cuts in 2013/14 this number reduced to just 95. An enormous fall of 90%.

Free legal advice changes people’s lives. It provides expert help to reduce debt, poverty and homelessness and to combat discrimination and injustice. The money raised can help, among others:

Survivors of domestic violence.
Families living in terrible housing conditions
People who have been unfairly dismissed or who are discriminated against at work
Elderly people who need support to stay living independently
People who suffer disability or illness and their carers
Women and children who have been trafficked to the UK to become domestic or sex slaves

As well as ensuring access to justice for individuals, the funding can enable legal professionals to obtain essential expert opinion in cases where assessments are required of a person’s needs, mental and/or general health, presentation, safety, vulnerability, and can even mean the difference between life and death. Experts can range from psychiatrists to paediatrics to independent social workers to psychologists to name but a few. Many strands of a case may need to be investigated and brought together to ensure the best and safest outcome for a child, family and/or individual(s). This is extremely costly, and in most cases, vulnerable individuals would not have access to funds for these necessary processes.

There is a network of seven Legal Support Trusts across England and Wales working with the Access to Justice Foundation to support pro bono and advice agencies, ensuring funds can be distributed where needed most. The London Legal Support Trust supports London and the South East so lets bake and support our communities! Find out more information on their website:

www.londonlegalsupporttrust.org.uk

By Mr Simon Easton

Chartered and Clinical Psychologist

&

Visiting Research Fellow, University of Portsmouth

 

Clinical psychologists, medics and allied health professionals acting as expert witnesses draw upon their experience as clinicians when writing reports for the Courts, but can be less familiar with the literature relating to assessment of lying and malingering (see: Resnick, 1995; Rogers, 1997; Drob et al., 2009;  Vrij, 2000; Vrij et al.; 2011).

There is evidence that people are usually not good at detecting lies (Vrij, 2000), and experts, such as members of the Criminal Intelligence Agency, for example, have been shown to perform only slightly better than most other people (Ekman, et al., 1999).

The literature on lying tends to view dishonesty as active clear cut – either what you say is wholly true or wholly untrue. In medico-legal settings the detection of partial truth may be particularly relevant. Resnick (1995) distinguished between: Pure malingering (feigning non-existent disease); Partial malingering (exaggeration of existing symptoms) and False Imputation (falsely ascribe real symptoms to unrelated cause). Resnick (1997) went on to suggest that the clinician might also attend to other factors in assessment of validity of a claimant’s reporting, including: irregular employment & job dissatisfaction; previous claims for injuries; lack of co-operation at interview; psychological test results.

• Rogers (1997) provided a list of factors a clinician might be alert to in interview:
• Rare symptoms (honest respondents might describe symptoms that a malingerer might not know about),
• Indiscriminate symptom endorsement (confirming presence of all symptoms asked about),
• Obvious symptoms (observable signs of difficulty),
• Improbable symptoms (unlikely difficulties in the context),
• Attention to presence of improbable combinations of symptoms,
• Presence of symptoms of improbably extreme severity.

Lanyon (1997) suggested that, in assessing likelihood of malingering, an individual’s accuracy of knowledge about a disorder is important, and investigators might usefully seek to identify whether or not someone is familiar with information which would not be readily known. The assessor might also consider whether someone presents information in a way which is consistent with common expectations for a disorder, but which does not actually reflect empirical validity.

There may be a wide range of other psychological factors that will affect assessment and prognosis. Ferrari et al., (1999) suggested that the prognosis for injuries in medico-legal settings can be affected by a range of aspects, such as: blame, expectations & labelling, attention to symptoms, social factors, litigation and the sick role.

The clinician, when preparing a report for the Court, will usually have the opportunity to review other sources of information, such as medical records. Extensive and detailed questioning at interview will provide the opportunity to evaluate the validity of the informant’s story in the light of that prior knowledge (Vrij and Easton, 2002).

Psychological tests can serve to alert the clinician to possibility of inconsistency in presentation, but frequency of false positive and false negatives needs to borne in mind. Interpretation of Psychometric test results requires care: Maguire, at al., (2001) reported that Pure malingerers (those inventing history of pain) tend to produce similar scores to those of “real” pain patients on psychometric tests (eg; Pain Patient profile), whilst Partial malingerers (those exaggerating existing pain) tend to substantially over-endorse symptoms.

Faking psychological distress or pain is not difficult: Edens et al., (2001), for example, showed that successful malingerers asked to feign a mental disorder tended to endorse a lower rate of legitimate symptoms, avoid overly unusual or bizarre symptoms and/or base their responses on their personal experiences.

The opinion of an expert witness to the Court should be based on evidence cited in support of conclusions, and result from a comprehensive assessment. The structure of the interview, the relevance of areas covered, the recognition of limits of expertise, and the awareness and consideration of alternative interpretations of evidence must be taken into account when the Court assesses the weight to be attached to an expert’s report.

In the clinical setting, careful observation targeting the deception cues detailed above, extended interview probing, without revealing available information, together with such additional tests a may be appropriate, may increase the chance of detecting malingering. However, the only way to be confident about the veracity of a client’s report is to thoroughly investigate the issue, and search for collateral evidence (medical reports, statements of independent witnesses, forensic evidence) which supports or contradicts claims made.

Awareness of the relevant literature and/or formal training in the relevant techniques may be a requirement for expert witnesses. The expert assessor’s attention to these key issues will assist both in the forming of opinions and the expert’s expression of confidence in those opinions.

Autism and Asperger Syndrome are both part of a range of related developmental disorders known as Autistic Spectrum Disorders (ASDs). They begin in childhood and last through adult hood. It is a spectrum condition, which means that while all people with autism share difficulties, their condition will affect them in different ways. The symptoms are grouped into three categories. ASD’s are characterised by significant problems with language, social interaction, social imagination, and behaviour. Many people with an autistic disorder also have learning difficulties/below average intelligence. Another category of diagnoses known as pervasive developmental disorder not otherwise specified (PD-NOS) is given to those individuals who display symptoms that fall between an autistic disorder and Asperger’s syndrome. They share some, but not all of the traits of an Autistic Disorder or Asperger’s Syndrome.

Individuals with Asperger’s Syndrome tend to present with milder symptoms that affect social interaction and behaviour but language development is usually not affected. They do often have problems in areas of language such as understanding humour or figures of speech.

Individuals on the autistic spectrum are not able to maintain eye to eye contact, as they find this painful and intimidating. They can misinterpret social situations and this can often leave them feeling socially isolated and at times resorting to social media sites to engage in social interchange. Failure to understand the behaviors and intentions of others can lead to individuals with an ASD to get involved or be influenced into participating in illegal activities, which in their mind is likely to be considered normal behavior (because they have not understood the intention of the person or persons involved).

Autistic individuals typically have processing delays, and as a result, need extra time to respond to questions or instructions. They take things very literally, and may not fully understand instructions unless they are concise and clear.

While the person with an ASD may have, in the literal sense, committed a criminal offence, they usually do not understand the question of intent. For example, they can be very literal in the way they obey instructions instead of thinking about the impact their actions can have on another person/s.

People with an ASD often do not understand the implications of their behaviour due to their difficulties with social imagination and they may require support to understand the consequences or implications of his/her actions and decisions.

It is very possible that an individual with an ASD may not comprehend ‘intent’, ‘responsibility’ and ‘conspiracy’ because they tend to be concrete and ‘rule oriented’ in their interpretation of their outer world. For example, the individual may accept the meaning of the word ‘intent’ but not understand how this might apply to their current situation.

Professor Fox’ study on Z-drugs

Recent research has highlighted new issues with medication and harms. In April 2018 Professor Fox reported in the British Medical Journal (BMJ 2018;361:k1315)

Results of a study with risk of developing dementia and use of antidepressants, medicines for bladder incontinence and Parkinson’s medication. The research looked back over 20 years, analysed primary care records in 100,000 patients and reported a 20% increased risk of developing dementia with commonly used medications; for example, antidepressants prescribed to 1 million people. This study is the first to specifically link certain medication with anticholinergic effects to dementia. NICE Dementia 2018 has highlighted the risks and prescribers are being advised to be careful with use of these medications and to discuss and document discussions with patients.

In a second recent related study Professor Fox has been investigating the harms of commonly prescribed sleeping tablets in people with dementia – so called Z drugs (for example Zipiclone and zolpidem). Investigating patient records has found a risk of serious fractures of the hip in these patients with a 40% increase. These fractures have a 30% mortality rate. Professor Fox has concluded that People living with dementia should only be prescribed a hypnotic if the benefits clearly outweigh the risks, and any such prescription should be regularly reviewed. Fractures in people with dementia can have a devastating impact, including loss of mobility, increased dependency, and death. We desperately need better alternatives to the drugs currently being prescribed for sleep problems and other non-cognitive symptoms of dementia.

 

A link to a summary of Professor Fox’s findings can be found here.

Addiction to prescription painkillers is a very topical subject at the moment, with sufferers including high-profile celebrities. Our lead Expert Dr Paul McLaren wrote a letter, which was published in yesterday’s Evening Standard in response to their investigation into over-the-counter opioids:

 

“Your article on opioid addiction was timely and highlights a serious and growing problem [March 15]. The pathway from prescribed strong opioid painkillers to illicit use and dependence is well trodden.

Another problem is the abuse of over-the-counter preparations containing opioids, which can be purchased in local chemists without a prescription. In these preparations the opioid is combined with an anti-inflammatory drug. I have seen more teenagers and adults being given one who have liked the mildly euphoric effect.

They can be the gateway drugs  for stronger prescription painkillers referred to in your article and for heroin. However opioids are formulated, their addictive potential is huge  and should be treated with respect by patients and medical  professionals alike.”

  –  Dr Paul McLaren, Medical director, Priory Hayes Grove Hospital

 

See the full article and investigation on the Evening Standard’s website here: www.standard.co.uk/opioids

The Personal Injury market is now controlled by the insurance industry. And, there is more to follow…

The combination of the Jackson Reforms and the Ministry of Justice reforms in personal injury were fully implemented in July of this year, largely in respect of new cases but some of the effects are affecting accidents before 2013. Cases where the damages awarded do not exceed £25,000 (and this can include some significant injuries) have seen the legal fees recoverable slashed dramatically particularly for cases where liability is admitted. These fees bear little resemblance to reality. It is necessary to obtain medical evidence to prove losses and when an insurer will not accept the true value of a claim, it costs money to pursue it. As the burden of proof remains on the claimant, unless an insurer agrees a fair and reasonable amount for the claim early on, it is unlikely that solicitors will be able to help in these cases as they will not recover their costs. The paying and receiving of referral fees for personal injury work has been banned. This is something that we applaud as in PMI we do not pay referral fees for any work that we receive. We have been fortunate that our clients find us through recommendation because of the reputation we have in this field.

Liability and legal expense insurers have taken over existing law firms and created law firms, announcing in many cases that they will become alternative business structures. In effect, these enable referrals of work to continue but now it is paid by way of profit sharing within an organisation rather than a fee, which would be illegal. Because a large part of the market is controlled effectively by insurers now, proponents will say that resulting efficiencies will ultimately benefit all consumers. We doubt that, because the primary objective for liability insurance companies is to reduce the amount they pay out on claims, to avoid claims where they can and to look at issues with the policy to see if they can, in some way, declare it void. Their motive is to maximise the return to their shareholders not to compensate the injured.

It has been the insurers’ aim for some time to control the claimants’ side of the insurance industry as of course it is in their best interests to reduce their outlay. We doubt that there will be any reduction in the overall cost of insurance premiums and sadly this will all be at the expense of those consumers who have legitimate claims. 2% of our population per year are injured. It is becoming increasingly difficult for clients to be able to enforce their legal rights to receive full compensation for their injuries. We hope that there is still a place for us in the market completely independent, unencumbered and still making a difference to the lives of our seriously injured clients. We are delighted to be recognised in the Chambers UK – A Client’s Guide to the UK Legal Profession 2014 as “leaders in the field” in personal injury receiving the highest accreditation of Band 1.

One of our clients said that we are “exceptionally personable and have always had the client at the heart of their drive and their thoughts”. We were described as “incredibly compassionate” and “maintaining our professionalism very well”.

Our Frances Pierce, head of the PMI Team, was also named a leading individual in the field of personal injury and clinical negligence work.