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NHS criticised over suicide of mentally ill doctor

BMJ 2003; 327 doi: (Published 30 October 2003) Cite this as: BMJ 2003;327:1008
  1. Debashis Singh
  1. London

    A psychiatric specialist registrar who killed herself and her 3 month old daughter during a psychotic episode had been systematically failed by the NHS, an inquiry by the North East London Strategic Health Authority concluded last week.

    Daksha Emson, aged 34, had bipolar affective disorder. In October 2000 Dr Emson stabbed her daughter, Freya, then herself, and then doused both Freya and herself in a inflammable substance and set it alight. Freya died of smoke inhalation and Daksha survived for a further three weeks in a burns unit but died without regaining consciousness. This tragedy could and should have been avoided had her considerable risk been assessed and appropriate action taken, says the report.

    The report found that not only had she been failed by the NHS and received a “significantly poorer standard of care than that which her own patients might have expected,” but that her death was in part caused by the deep prejudices against people with mental illness who work in the NHS. Throughout her postgraduate training, which included working at Guy's and St Thomas's Hospitals in the mid-1990s, Dr Emson went to “considerable lengths” to conceal her illness from her supervisors because she was afraid of breaches in confidentiality; the stigma that would have resulted “haunted her work, life and treatment.”

    “The NHS as both an employer and treatment agency was complicit through neglect in the sequence of events culminating in this tragedy,” the report concluded. Although she was open about her illness to the occupational health services, she received no help, support, or advice from them.

    Daksha Emson, who lived in Newham, London, was seen first and foremost as a doctor, which led to an underestimate of the level of risk indicated by her personal history, the report noted.

    People who treated Dr Emson had acted in good faith but had not informed others who could have helped and supported her. For example, she was not formally a patient of the community mental health team—at her own request, to protect her anonymity in the NHS.

    Despite a serious suicide attempt as a medical student at the Royal London Hospital, five admissions to hospital, and three courses of electroconvulsive therapy, Daksha emerged as an outstanding student winning several prizes. She remained stable for some years on lithium carbonate and fluoxetine (Prozac) and carved out a distinguished career. On her elective in Ireland she met David Emson, whom she married in 1992. She stopped her medication to conceive and later breastfeed Freya who was born in July 2000.

    The inquiry made five far-reaching recommendations for action by the Department of Health, Royal Collage of Psychiatrists, NHS bodies, and social services. These centre on the urgent need to address the stigma of mental illness in the NHS, doctor-to-doctor treatment and care, inadequacies in perinatal mental health services, the care of children of parents with mental illness, and inadequacies in NHS occupational health services.

    The Royal College of Psychiatrists welcomed the report and has issued its own action plan. The health minister Rosie Winterton insisted that measures including anti-stigma campaigns and issues of doctor-to-doctor care were under way. She said: “We know there still is a lot of work left to do. We will be considering very seriously the findings of this inquiry.”


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