Tamara Holboll inquest: Camden’s mental health trust cancelled hospital bed search for schizophrenic killer

This was a shocking, tragic story I did a couple of weeks ago for the Ham&High. What's the solution here? More investment in mental health services, perhaps? Comment below on how we can improve our services, and indeed, whether we should.

Peter Holboll

Camden’s mental health service cancelled its search for a hospital bed for a paranoid schizophrenic who then went on to kill his mother, a court has heard.

Camden and Islington NHS Foundaton Trust (C&I) came under intense scrutiny at an inquest on Monday into the killing of 68-year-old Tamara Holboll, who was stabbed to death by her son Peter, now 45, in May last year.

The court heard that Ms Holboll and her son had pleaded for him to be sectioned, but were told by health professionals that no hospital beds were available.

Two days later, he killed her and set ablaze her flat in Lawford Road, Kentish Town, endangering the lives of five people living above. He was detained after pleading guilty to manslaughter due to diminished responsibility and arson at the Old Bailey last year.

It emerged at the inquest at St Pancras Coroner’s Court that the trust cancelled its search for a bed, without informing his doctors or nurses.

The trust has suffered a serious squeeze on beds since it axed more than 100 beds in four years, between 2011 and 2014.

Senior coroner for inner north London Mary Hassell gave a narrative ruling, and said: “Admission was agreed but no beds were immediately available. “Then, confusion about arrangements within the mental health trust following involvement by the recovery and rehabilitation team and the crisis team emerged the following day.

“Unbeknownst to them, the search for a bed had been stopped.”

No-one from C&I’s bed management service was put in the dock to answer for why the search for a bed was cancelled.

When the Ham&High asked the trust why it had cancelled the search, it said the bed management service believed Holboll was being “successfully treated in the community”.

Since the incident, the C&I has made changes to its bed management service to improve internal communications, and has put in place a 17-point action plan.

On May 7 last year, Ms Holboll rang mental health service the South Camden Recovery and Rehabilitation (R&R) Team to ask them to admit her son to hospital, telling them: “I’m afraid he will harm me”.

He was assessed by mental health workers, and it was agreed that the C&I would try to find him a bed. They were told that five other patients were also on a waiting list for a bed.

But one mental health worker admitted that he believed Ms Holboll was being “overly dramatic” - a statement wrongly denied by the C&I last year. The trust has since apologised for the mistaken denial.

Several mental health workers who saw Holboll in the two days before his mother’s death told the court that he would have been admitted to hospital if a bed had become available.

But they all said that they did not believe there was any “imminent risk” to his or his mother’s safety, and that his behaviour had “improved” the day .

Between 2011 and 2014, C&I lost the second-biggest proportion of beds of any mental health service in England, with 19.1 per cent being scrapped.

The closures meant nearly 200 patients have had to be sent elsewhere for treatment since 2011.

A spokesman for C&I said: “This is an extremely tragic incident and our sincere condolences are extended to Tamara Holboll’s family.

“We have been deeply saddened by her death which has greatly affected the staff who both knew her and her son.

“Our clinicians work in extremely difficult situations. They make assessments on people who may be suffering a psychotic episode, paranoia or some other complex condition and help thousands of people live as near normal lives as possible.

“We are continually improving services and in so doing try and prevent such serious incidents from happening again.”

Ms Hassell is to make a Prevention of Future Death report, a document to set out lessons learnt and changes that could be made to prevent deaths.

She ruled Ms Holboll’s death was unlawful, and said: “I am trying to help you all learn from this.”

She later added: “Whatever the public at large may think, this crime was very, very unusual.”

Young and carefree? The students living with mental illness

Below is an article I wrote in May/June last year, so forgive any outdated references and ages.

Unfortunately, I was unable to get this article published in the national press, which is a shame.

It's far from perfect, but I hope that even in this small way of being published on this small blog, it can do a bit of good in decreasing stigma and opening eyes.

IB

Young and carefree? The students living with mental illness

Hayley-Dawn Tearall speaks with a maturity beyond her years, despite being just 18 years old. But her sunny smile and matter-of-fact manner hide a secret. Since the age of 12, Hayley has suffered from clinical depression. In only January this year, she attempted to take her own life.

“It wasn’t a big plan, it was quite spontaneous. I have made plans before but haven’t acted them out. Some days I’ll sit and plan my funeral and think about what I’d want to happen to make things easier for my family,” Hayley says.

A stack of A-level revision notes lie by her chair in the Sutton café where she works, and where we meet to talk about her experiences of mental illness.

“When I was younger, about 12, I used to think about it a lot. I’d think, I want to die. I used to have a journal and the amount of times I had written those words in it... But when you’re 12, it’s not easy to do.”

Hayley did not need to go to hospital after taking an overdose that January afternoon and for months, she kept the secret between herself and her GP.

“I felt there was a massive overreaction because nothing had actually happened. My GP responded quickly and was very helpful but I wasn’t 18 at the time so he couldn’t really do anything,” Hayley says. She is not upset or emotional in any way, chatting as if we are just talking about a bad day at school.

“My family didn’t know until recently, I think. I’m still not sure my dad knows but I think my mum does. She mentioned it a couple of weeks ago in passing.”

Like 20% of the student population, Hayley has a mental health problem. 13% of those have had suicidal thoughts and a staggering 92% of students surveyed by the National Union of Students (NUS) in May have suffered mental distress at some point during their studies.

There’s no simple explanation behind it. According to the NUS, the pressures of keeping to coursework deadlines accounts for the majority of mental health problems among students, above exam stress, workload and academic performance.

Perhaps unsurprisingly in the years since student course fee rises and cuts to funding, the same amount of students are suffering from distress as a result of financial difficulties.

Despite the staggeringly high proportion of students with mental health issues, 64% have never used any kind of formal service to help them, whether that be the university’s own counselling practice, GPs or mental health professionals.

Quen Took, 21, has battled with depression and psychosis ever since he can remember. About to take his second year at the University of Exeter for the fourth time, he has found that the quality of his care has varied dramatically.

“During my school years I was obligated to see the school counsellor, who was one of the most horrendous people I have ever met. Everyone who went to see her felt worse afterwards. That was my first experience of any kind of mental health support,” he says.

“It does colour your attitude to getting help in the future. Mental health professionals who deal with children and teenagers need to remember that their initial dismissal is going to have a knock-on effect on this person throughout their adulthood and it may make them less willing to seek help later on. Children and teenagers with mental health problems need to be treated with a lot more respect.”

Seven years on from her first GP visit, Hayley’s depression still takes hold on a regular basis, despite receiving support during much of that period.

But her care has been fragmented, changing care services five times and antidepressants four times since turning 18 in February.

“It would be good to have something permanent in place, to have a weekly session where I know I’m going to get on with the person I’m seeing and that I’m going to get somewhere with it,” Hayley says.

Hayley and Quen’s experiences point to an underlying inconsistency in the quality of mental health care for young people, which may be contributing to the large number of students who do not seek any formal help for their mental distress.

NUS Disabled Students’ Officer, Hannah Paterson, says: “We are currently meeting with mental health organisations in a bid to bring all stakeholders together to examine the standard of mental health care in UK universities. We’re hoping to make an announcement in the coming weeks on the shape this will take.”

Alice*, a 33-year old PhD student in the field of mental health at the University of Central Lancashire in Preston, has tried almost every avenue of support for her anxiety and depression, which has never been properly diagnosed. Some support services were better than others, but ultimately none lasted long enough to help her.

“I went to see a student counsellor when I started at the university to do a conversion course before beginning my PhD. It did help quite a bit so after therapy I asked my GP to come off antidepressants,” she says.

“The first time I had done this years ago they had brought me off them over a few months but this time it was over weeks. I felt awful. I was having suicidal thoughts and it went on for months. After I came in to some inheritance in December, I used it to pay for private therapy, which I’ve been receiving ever since.”

Alice has been on and off medication, on and off different courses of therapy since her first year at university as an undergraduate at the University of Manchester studying History. But she thinks she has suffered from mental health problems since she was at school.

“At high school, I went to the doctors with symptoms that nowadays would have pointed to mental health problems. At the time though I was just told I was trying to skive off school. There was no recognition that children can have these problems,” she says.

“I’ve had a difficult time in getting a diagnosis. They’ve grudgingly given me medication but it makes me wonder if it is depression or whether it’s something different. Sometimes I wonder if I just have a bad personality.”

The British Association for Counselling and Psychotherapy (BACP) at Universities and Colleges reports that out of over 1000 students in 53 higher education institutions who had received in-house counselling, 84% said that counselling helped them to continue their studies with 81% doing better academically as a result.

A spokesperson from BACP Universities and Colleges said: “BACP recognises the value of counselling in supporting the student population, who may be more vulnerable than other young people as they face the challenges of adapting to a new environment, the demands of their courses, potential isolation, peer pressure to misuse drugs and alcohol, and the additional stress of financial pressures.”

The figures from the BACP reveal that student counselling services do at least provide a crutch for those with poor mental health to rely on as they try to finish their degrees. But it is alarming that over half of all students experiencing mental distress are left to struggle alone. Why is the proportion so high when these figures reveal the benefits of therapy?

Charity Mental Wealth UK believe the stigma surrounding mental illness goes some way to dissuading students from seeking help.

A spokesperson says: “More work needs to be done to help create a culture of openness about mental health on campuses across the UK.  Unfortunately many students are still not open to talking about mental health, misunderstand what it means or what to do if they experience poor mental health.

“In Mental Wealth groups in over 30 universities, students interested in mental health, many with personal experience, aim to demystify mental health by challenging discrimination as well as hosting discussions, information days and organising campaigns to stimulate positive change.”

Alice says she hides how she is really feeling from people, so much so that her GP once took her off antidepressants because he did not believe she needed them.

“I put on a clown face, which is what I call it when I’ve been crying and crying but become really enthusiastic and positive when I’m around people. There’s something circus like about it. It’s an act and it feels over the top.

“The doctors didn’t understand that with depression, there are points where you feel numb all the time and cry for hours. But you become adapted to it. If you’re crying all the time can’t get on in life.”

Ms Paterson, who regularly visits campuses across the UK to talk to students about disability and mental health issues, says many students suffering from distress don’t know what is available for them.

She says: “While there are mental health services provided by universities, students do not seem to be using them. Whether this is due to lack of knowledge or standard of care is difficult to identify.

“We need to work on de-stigmatising mental health issues to ensure that people will seek help for their problems. If you have a persistent headache you will see the doctor. We need to make mental health care as standard as physical health care.

“It’s also vital that institutions commit to informing their students about mental health care and indeed providing a universal standard of mental health care.”

Georgia*, 22, dropped out of the University of Westminster where she was studying architecture with interior design in her first year in 2011 after becoming anorexic and bulimic in the summer of 2010. She says she was not made aware of any onsite counselling services, instead privately paying for a psychiatrist and nutritionist.

“I asked my tutors for help because at that point I was eating less than 150 calories a day. But I was told to get on with my work and that everyone else manages. If I hadn’t started that course severely unwell, I reckon I would have done well. But there was no way I could physically do it anymore,” she says.

“In February, I got the tube to go to a site I was working on and broke down in tears. That was it. I got on a train to Norfolk, where my family are from, and I never went back. That was the end of all my studies. My hard work down the toilet.”

Two years on, she is working in Portsmouth at a recruitment website company. She had to stop private care, which varied dramatically in quality, after she left London because she could not afford the fees anymore.

“I haven’t got the money to do it and the care I did receive has put me off. But if I came into some money, it would be the first thing I would get.”

There’s no answer to the problem of getting more students to seek help for their mental health problems, particularly when the experiences of so many who have had support have had varied experiences. It’s clear that the combination of inconsistent quality of care and a reluctance to talk about mental illness is a lethal one, resulting in the large proportion of students who don’t even attempt to seek formal help.

Hayley is taking a gap year before she goes to university, having accepted a conditional offer from the University of Southampton.

Like many other 18-year-olds, she is nervous about leaving her hometown and her friends. But she is more worried that her depression will affect her ability to revise.

“That’s why I’ve come to the café to revise, to get out of the house and actually do my revision. I struggle a lot with motivation even though I know my exams are so important and if I don’t do it, I won’t get into uni and that will be my fault.”

With nothing planned for her gap year after a year-long placement fell though, she’s been thinking about travelling.

“Sometimes I think there’s no point planning my gap year because I might not be here anymore - but logically I think to myself that I probably will be so I should plan something for the year. I might feel better tomorrow.”

*Some names have been changed.

Samaritans provides confidential emotional support to anyone in crisis, around the clock, every day of the year. Trained volunteers listen, without judgement and without giving advice.

You can contact Samaritans by calling 08457 90 90 90 or visiting your local branch.

Good intentions

I had very good intentions to keep up with this blog after writing my first introductory post.

More than a year later, I'm writing my second.

I'm determined this time to really keep on top of it, and to use this blog as a place to share all the content I've written about, what I feel, are socially important issues, or subjects that the media should do more to raise awareness of.

The first thing I'm going to do is re-post some articles I wrote back in May/June 2013 which I promised the amazing people that I interviewed that I would put on my blog.

14 months on, I'm going to keep my promise - and sorry it took so long.

IB

Changing theme

Before this post, my blog was just the place where I'd (ineptly) keep readers up to date with the latest articles I had written for various publications on a number of different topics.

Looking out for stories...

After graduating from City University with an MA in Newspaper Journalism and starting my first permanent (and paid!) journalism role at the Ham and High, I've had some time to think about what to do with this blog.

One of my specialisms, and my passions, is socially conscious journalism. The industry has had a bad press and the reputations of journalists are lower in the eyes of the public than they have ever been before.

There's been a lot of mistakes, and a lot of corruption. But this doesn't take away what journalism is at its core. 

I've wanted to be a journalist ever since I sat determinedly next to my mum in the car on the way to a football match in Ipswich when I was 13 trying to figure out what to do with my life. After all, time was slipping away from me.

At the time, I knew journalism involved writing, a lot of writing, and that's what I loved to do. But as I grew older, working at unpaid placement after unpaid placement, I realised there was a lot more to the industry than just writing well.

Journalism, at its core, is one of the most important public services of them all. Holding authorities to account, to make sure they serve the public well, and to keep everyone informed with the latest news is such a thrill. Anyone who badmouths the press, sometimes with very good reason, will undoubtedly still be reading the papers or watching the news.

As Stan Lee once said, with great power comes great responsibility. In the last few years, my favourite articles have been the ones that have helped under-represented groups of people to reach a wider audience or that highlighted an under-reported issue. Societal and socially conscious journalism, at its strongest, is incredibly moving and can do a lot of good.

Now my weekends have been freed up from the heavy postgraduate workload, I want to provide a space for my humanitarian articles, thoughts on human-centred issues in the national press and links to any socially conscious articles I have recently read and admired.

My job at the wonderful Ham and High fills up most of my time so many of the articles posted here may be ones I have written for the paper. But whenever I get a moment, I will endeavour to update the blog with original thoughts just for the blog.

So flick through, have a read and I hope some of these articles and thoughts spark your interest. 

Any comments or suggestions for articles are welcomed with open arms. If you want to write a guest post  for the blog, email imogengblake@gmail.com.

Overdue update

Just a small post to say I will be updating the blog soon with articles I've written over the past few months.

It's been a hectic year so far, with work experience placements, finishing off my course at City and starting a new job as Trainee Reporter at the Ham and High.

I'm loving every moment of it so far though so keep watching the blog for a more substantial update soon!

IB

Feature: Islington refugee charity backs One Billion Rising to help women in hour of need

This feature was published over two pages in the Islington and Hackney Gazettes on Thursday 14 February.

Islington refugee charity backs One Billion Rising to help women in hour of need

By Imogen Blake

Some of the woman in the video campaign highlighting the problems refugee women face. Photo: Women for Refugee Women

To many, Valentine’s Day simply means showers of red, sparkly confetti, sickly-sweet cards and messages of devotion dominating the aisles of almost every shop.
But this year one billion women are claiming February 14 from St Valentine – as they dance and sing in protest at violence against women in organised events across the world .

It is all part of the One Billion Rising campaign.

Islington-based charity Women for Refugee Women (WRW) has promoted the movement to highlight the suffering of female asylum-seekers.

In a video on their website, stateless women are joined in song while a shocking statistic – that more than half of the women who use the charity have been raped – flashes on screen.

WRW is the base for a self-help group of female refugees who meet at the charity’s office in Featherstone Street to chat, eat and drink, practise their English and to speak out against injustices suffered by asylum seekers.

The charity is supported by Colin Firth’s wife, film producer Livia Firth, broadcaster Mariella Frostrup and actor Juliet Stevenson, who directed a play put on by WRW based on the experiences of women and children in immigration detention.

In a report released by WRW last year, it found 42 out of 65 female UK asylum seekers questioned had suffered some kind of gender-based persecution, including genital mutilation, rape and forced prostitution – but most have their application turned down.

Applying for leave to remain in the UK is a long and difficult process, with the odds stacked against applicants: WRW found that 67 out of 70 female refugees they interviewed had been refused asylum.

But figures don’t reveal the suffering these women have gone through, nor the fight they face in claiming asylum after – in many cases – fleeing unspeakable atrocities.

A 35-year-old woman, who did not want to be named and now calls the WRW her official residence, was forced to marry a family friend in her home country of Cameroon when she was just 16.

“I wasn’t happy living with him, I was really suffering. He hit me all the time,” she said.

In 2004, she met a woman who was able to fly her out of the country but her struggles didn’t end there.

When she arrived in England, she was forced to work as a prostitute in a brothel.

“I didn’t know where I was going but I had no other option. When I arrived, they took my documents and money. I had never done anything like [prostitution] before.

“I couldn’t call the police because they would make me go back to Africa. I was so scared.”

After eight months, she managed to escape and started working illegally in a care home, but the police caught her and she was imprisoned for working without papers for three months in Derby.

When she was released, she was homeless and destitute with no-one to turn to.

“I met someone who let me stay in her living room and she said, ‘I’m not going to rape you, come and stay with me’ but it was on the floor which was cold and hard. After a while she pushed me out, screaming at me.”

She relies on the support of her church and charities for money and shelter after being refused asylum.

Notre Dame Refugee Centre in the West End gives her a few pounds for travel and some food parcels but it is not enough. The church she attends is her only comfort.

“I came into contact with the charity, Notre Dame, who give me £2.70 a week and I found a church on Old Kent Road to go to. The church members are the few friends I have around me. When you’ve been scared and traumatised all your life, your dreams and hopes go up and down all the time.”

Sophie Radice, the WRW communications executive, said: “Even if a woman is persecuted for reasons that are not based on her sex, because of her religion, for instance, or her ethnic background, that persecution is more likely to take the form of rape or sexual violence.

“It would be wrong to insist that all of the women experiencing such persecution should find refuge in the UK but the treatment of women by the UK Border Agency is too often disbelief and refusal of their claims.

“Many of these women will be removed back to countries where they are in danger but many live among us in the UK, existing in legal limbo, destitution and fear of forced removal, compounding their trauma.

“Days of action like One Billion Rising are so important because it highlights the way that treatment of women across borders must be spoken about openly.

“We are campaigning to end the destitution of those refused asylum by giving them permission to work if their case has not been resolved within six months and to provide welfare support for all asylum seekers who need it, up until the point of return or integration.”

Profile: Puppet master exploring the dark side of her art

This profile of Sian Kidd was published in the Islington and Hackney Gazettes on Thursday 14 February.

One of Sian's creations. Photo: Sian Kidd

Puppet master exploring the dark side of her art

By Imogen Blake

Before we head upstairs to her workshop, puppeteer Sian Kidd warns me to be careful of the “bicycle forest” in the hallway of the house the 26-year-old shares with friends in Stoke Newington.

It’s a small room with three or four marionettes, including a green zombie called George, hanging from the window. A conjoined twin puppet lies unfinished on the table next to us.

Sian works at Puppet Barge, a family-run floating marionette theatre moored at Little Venice in winter and Richmond in summer. After completing a three-month traineeship with the company in 2009, she now performs part-time for an audience which has included Brad Pitt, Angelina Jolie and their children.

“They’ve really given me an amazing opportunity to develop a dying skill. Every time I think about it I go: ‘God you’re so lucky!’ But in the long run I hope that I’ll be able to work on my own stuff and not have to rely financially on them.”

Sian, who is also a care worker at Centre 404 in Holloway, recently founded her own puppetry business, Mirth and Misery, with marionettist partner Adrian Alexander Allen, who also works at the Puppet Barge.

Their first show of the year will feature the conjoined twin puppet alongside a wooden dwarf, hand-made by Adrian, in an “alternative Valentine’s Day” event at arts venue, Passing Clouds, in Haggerston on Saturday.

“We’re both interested in slightly darker work aimed at more of an adult audience than at the Barge. The show will be a starting block to try to explore the spectacle of deformity in Victorian freak shows. My experience of working with disabled adults feeds into that,” she says.

She said: “I’ve done a hundred million other jobs and I hated them all. They never made any sense. I’d rather work with people and do something good than earn an extra couple of thousand making big companies more money. Care work isn’t about any qualifications you get, it’s about having the ability to be empathetic.

“But my love is absolutely for puppets and marionettes. I love the tiny hand-stitching you have to do for their clothes: you can’t just go to H&M and buy a puppet costume.

“If I could take the time off, which I would love to do, making a marionette would be a two-week process. It is time consuming but they are so enchanting. It’s like you’re a miniature god when you make them come alive.”

Sian became interested in puppetry at school after her teacher asked the class to make 30 puppets for a play when she was 18. She was hooked but didn’t pursue a degree course in the craft. “I chose Middlesex University because they had a module in puppetry,” she said.

“The Central School of Speech and Drama was the only place which offered a course at the time but I got scared off by my sensible family. They said: ‘You’ll fail! It’s useless!’ Now I think...” She slaps her forehead.

Since she has been working in puppetry for four years, with hindsight it seems like a foolish decision. “But I loved Middlesex and my family is incredibly supportive. Now that they see I can financially fund my lifestyle, they have relaxed,” she adds.

Sian needs to finish the conjoined twin puppet soon, but in between her care work, folk music nights and a candlelit life drawing class, she hasn’t found time. She says: “I’m a naturally busy person. If something is fun, interesting and it’s an opportunity to meet new people, I’ll do it. I’m seeing what the world gives me at the moment. I just like enjoying life.”

Check it out online.

IB