The doctor who treated a 33-year-old woman who killed herself two days after being released from a psychiatric ward says the woman did not appear to be masking her symptoms or her mood when she was discharged from hospital.
Naomi Watson-Ley was found dead by her mother, Caroline, at their family home in the Sydney suburb of Roseville on June 24, 2015. The pair were extremely close.
Naomi had been admitted to the Royal North Shore Hospital (RNSH) on June 20, 2015, showing signs of acute distress and suicidal ideation, and she was detained, or "scheduled" under the Mental Health Act that same day.
Two days later, Naomi was discharged from the Psychiatric Emergency Care Centre (PECC) at the RNSH. A discharge plan was meant to be faxed to her GP by 5pm the same day, but it did not arrive until after she had died.
An inquest into the death is underway at the New South Wales Coroner's Court in Glebe.
On Wednesday, the inquest heard from psychiatrist Dr Samuel Lim, who discharged Naomi on June 22, 2015. He usually worked at the hospital's inpatient unit, and was covering a shift at PECC at the time he treated Naomi, where she told him she was feeling better and had no more suicidal ideation.
Lim told the inquest that in this conversation, Naomi did not show typical signs that she was being dishonest about her state of mind.
“That possibility is always across our mind,” he said, adding that Naomi was “warm and reactive” and seemed to be saying how she honestly felt.
Lim was also asked about evidence given by nurse Caitlin Starkey on Monday, who spoke to Naomi in a follow-up community mental health care phone call the day before she died.
Starkey testified that Naomi had sounded well and had a "bright and friendly" voice. Naomi had said her mood remained flat, and she was not experiencing suicidal ideation other than fleeting thoughts with no desire to act, Starkey said.
Lim said the fact Naomi had admitted to Starkey that her mood remained flat and she was having fleeting suicidal thoughts suggested she was being truthful.
"I would assume [someone trying to mask their symptoms] would attempt to obscure those thoughts," he said.
On Monday, Caroline Watson-Ley said she had argued against Naomi being discharged from PECC, believing her daughter would have said "anything" to get out of the ward.
"Naomi wasn't fit for discharge at that stage and I said I wasn't in agreement with it and I wanted it recorded in the notes," she said.
Lim said he did not recall that conversation and said it was "unlikely" that discharge would have taken place if Watson-Ley had said that.
“We would have placed a lot of weight on what we are told by a carer," he said.
Lim added that he thought Naomi needed further treatment, but the treatment should take place in the community and not as an inpatient.
“She was by no means right as rain,” he said.
In the fortnight leading up to the admission, Naomi had been prescribed a type of anti-depressant she had not been on before, by a GP who was not her regular family doctor, the inquest heard.
After it caused her anxiety and insomnia, she returned to the GP, who prescribed her a different type of antidepressant, which she had taken in the past.
“I was not sure her GP had a longitudinal understanding of what her difficulties were,” Lim told the court.
Lim had concluded that Naomi's symptoms of acute distress and suicidal ideation had been most likely caused by side effects from the medication and her background of borderline personality disorder.
He considered the possibility Naomi had major depressive disorder, but thought it was less likely for a number of reasons, including the relatively quick resolution of Naomi’s symptoms, the fact a major depressive episode is typically more sustained, and the coincidental nature of her medication changes and admission to hospital.
Two expert witnesses differ on whether the diagnosis was accurate.
Dr Christopher Ryan, the director of Consultation-Liaison Psychiatry at Sydney's Westmead Hospital said in his view Naomi had borderline personality disorder and it was possible but not likely that she was also suffering from major depressive disorder.
Forensic psychiatrist Dr Michael Giuffrida said it was reasonable to conclude that Naomi was suffering from major depressive disorder as well as other diagnoses.
The inquest continues.
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