Hole Ousia

This post is not about Donald Trump.

I first communicated with Professor Sir Simon Wessely not long after he had been elected as President of the Royal College of Psychiatrists. In his e-mail of introduction to me he asked me to call [him] “just Simon”. I appreciated this to be nothing but an act of extraordinary kindness. I was wowed that the President of my college was on level with me.

At this time my uncle, Dr Guy Scott, was President of Zambia.

My uncle’s Presidency of Zambia was short lived.

Professor Sir Simon Wessely has since moved on from President of the Royal College of Psychiatrists to be elected as President of the Royal Society of Medicine.

I have never met Professor Sir Simon Wessely, however he did walk by me when I protested outside the RCPsych International Congress in Edinburgh, 2017. I noted that he arrived with a carefree…

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Transparency: Revision of NICE guidance on Depression

Hole Ousia

In a recent post I shared a letter that I had sent to the BMJ that was not published. It was based on correspondence with Professor Sir Simon Wessely who is one of the members of a stakeholder group who requested a revision of the Draft NICE Guidelines on Depression in Adults: Recognition and Management

In correspondence with Professor Sir Simon Wessely he suggested that I make a Freedom of Information request to NICE. I followed this advice and have received the following four documents (shared here below as received).

I also share here, to provide open and transparent context, the correspondence that I had with Professor Sir Simon Wessely. I will let the reader decide on whether this is the correct thing for me to do. I have concerns that such a powerful and influential UK medical leader should confuse transparency about a matter of public interest with me as…

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‘Flight of Ideas’

Hole Ousia

One of the current clinical definitions of “flight of ideas” is: “a rapid flow of thought, manifested by accelerated speech with abrupt changes from topic to topic: a symptom of some mental illnesses, especially manic disorder.”

I have never experienced mania and reckon that I never will. I am naturally of a quiet temperament and may be inclined to think a little more negatively than positively.  However I have found that “flight of ideas”, as a psychiatric concept, can be misapplied and misused. I have two personal examples.

First example:

In the early days of my writing on mental health I wrote a reply to a paper on the renaming of “schizophrenia”. I shared my reply with a psychiatrist colleague who sent me his perspective on it:

“There are two types of comments I want to make, one relating to the theme, and one to the way you put your…

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Healthcare Improvement Scotland and Realistic Medicine

Hole Ousia

Last week I sent an open letter to the Chair of Healthcare Improvement Scotland on Realistic Medicine in NHS Scotland. I have received this prompt reply:

I am sure that we all welcome the initiatives that Dame Denise Coia has outlined. I certainly do. However, it is the case that the improvement work undertaken by Healthcare Improvement Scotland is based on IHI methodology – a reductionist approach that was developed in the engineering industry. It remains to be seen whether this approach can be used as a universal model for healthcare and whether it delivers the outcomes that really matter to people.

I note that Dame Denise Coia has not responded to my open question on allocation of resources to the Institute for Healthcare Improvement, Boston, USA.

If anybody has any thoughts on realistic medicine I would welcome them. Please add as comments below.


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Accountable to the Law, not the NHS

Mental Health Cop

On 12th November 2013, I wrote a blog entitled ‘Here We Go Again‘, following the death of a vulnerable man in Bedfordshire who we now know was called Leon Briggs. His death is subject of an ongoing criminal inquiry, more than four and half years later and that means, regardless of what happens criminally, there is still a potential disciplinary process to come, certainly followed by a Coronial hearing to establish all the issues around Mr Briggs’s unexplained and unexpected death on 4th November 2013. The full circumstances around that incident are yet to emerge and be tested and my best guess is, the legal process for that will run well in to 2019, if not the next decade.

But on 12th November 2013, I sat down in the evening to write that very general post, trying again to point out to police officers the various factors that…

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Letter from consultant neurologist (private)


In February 2017 I decided to consult a neurologist privately due to long waiting times on the NHS.  It was a terrible consultation.  I had a witness present and he was aghast.  The consultant completely denied that my many symptoms and resulting disabilities were anything to do with benzodiazepine withdrawal.  He refused to answer questions and was extremely evasive.  If I had been in that consultation alone, it would have been even worse.  I have been re-reading his letter to my GP after the consultation.  I paid £150 for the consultation, £650 for an MRI scan and £750 for blood tests and £100 for nerve conduction tests.  I was advised that the scan and tests would be unlikely to show anything after the consultant did a few cursory tests of my legs and arms.

The letter starts off as follows:


  1. Depression
  2. Epilepsy
  3. Functional neurological impairment – aetiology undetermined.


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Exacerbating Tensions

Mental Health Cop

I’ve had to ask myself recently whether I’m guilty of potentially exacerbating tensions or conflict between the police and mental health services, after a number of suggestions on social media and elsewhere that this is the effect of what I am doing. It didn’t take long to work out that this is precisely what I am deliberately doing, on just some occasions. I would argue this is of necessity, other options being unavailable or unacceptable. In addition to thinking that the management of mental health demand cannot just be about what the mental health system thinks the police should do, I have also come to believe very profoundly, the key to determining the role of the police lies in the rights, protections and views of those of us who live with mental health problems. And somewhere in there, even without us considering the roles and realities of policing, lies tension.

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