The Clock is Ticking For Too Many, Sir.

Dear Prime Minister of the UK, The Right Honourable Rishi Sunak,

I write to inform you of the recent crisis handover made to Amanda Pritchard, Chief Executive of NHS England (please see the email forwarded below, as sent on 12^th May 2024).  A more precise handover will be delivered later this week to the Chief Executives of NHS Scotland and NHS Wales, Caroline Lamb and Judith Paget.

I am writing directly to you for one reason, on the NHS England website it is written that The Prime Minister of the United Kingdom is responsible for deciding, ‘…how much money [the government] gives to the NHS. The Government also decides on top-level priority setting.’  I do not know whether the NHS requires your approval to turn The Dual-Diagnosis Treatment, Care and Recovery Support Crisis into a priority, but as you will surely comprehend, without an ethical and regulated treatment pathway, many discharging consultants and responsible clinicians will be knowingly breaking the law, determinably, and in full awareness, soon enough.  Although, as we see it, and perhaps the courts will one day too, NHS Chief Executives are culpable since 10^th May 2024 onwards. 

Should the NHS Chief Executives alert their staff towards their professional common negligence and normalised lawbreaking, with regard to unsafe discharges of dual-diagnosis patients, patients presently left without comprehensive and likely to be successful treatment, at least responsible clinicians can be safeguarded and redirected towards practicing safely.  In such a way, they are instantly protected from being named in the collective action lawsuit (at least on the count of practicing unethically while in full awareness).  Practicing consultants, psychologists and nurses must surely receive a Cease and Desist Order with regard to any further unsafe discharges of dual-diagnosis patients, at least until comprehensive treatment can be offered and provided in full, and to the point of a sound recovery for such a high volume of complex psychiatric inpatients (and mental health outpatients, who may have a milder, less complicated form of dual-diagnosis).

Clinicians ignoring the dangers, risks to life, and to the community, well, that is most of what I have witnessed happening while under the care of censored NHS Foundation Trust, as the evidence will show in due course.  I know we are not alone in our abandonment and acute pain, endured and survived as a tight-knit family.  This really is a crisis, just one smothered by red tape.  It is known that over 2000 patients survive in the community with [a formal diagnosis of psychosis] in my London Borough alone, should statistics be believed, potentially 80% of them will have dual-diagnosis, likely because they learned to self-medicate in lieu of any truly effective treatment and lawful outcome of long-term recovery.  However, the introduction of dual-diagnosis treatment must extend beyond the realms of [psychiatric] illness paradigms.  As laid out in The Mental Health Act (1983), ‘Medical treatment for mental disorder under The Act (including treatment with consent) can include measures to address alcohol or drug dependence if that is an appropriate part of treating the mental disorder which is the primary focus of the treatment.’  When is it not?  That’s the question here really, is it not?

Therefore, as legislated, when mental health disorders such as, PTSD, chronic depression, bipolar, and more, present alongside addiction, and the primary disorder cannot be treated effectively without the addiction being treated simultaneously (again, when is that not the most ethical move?), the patient will often need a complex treatment pathway to reach recovery.  Perhaps not as complex and comprehensive a pathway as the one presented to you in, Manifesto for Change: Dual-Diagnosis and Disparity, but still, a complex pathway nonetheless.  In such a case as 80% of those 2000 patients diagnosed with [psychosis] presenting with dual-diagnosis, or even just 50% of them, well, you can see why it amounts to a national level crisis, good Sir.

I will wait as patiently as I can for the nation’s intervention.  I aim to write to all UK GPs and international teams of researching psychiatrists by the end of this week, to bring them into the realms of full awareness too.  The patients need everybody to be in this together, and there is no time to waste while human life is the thing at stake.  So, while you all decide what you will do, I will continue contacting anybody that I can, to make sure there are people ready to problem solve, ready to build new ethical medical paradigms that treat dual-diagnosis patients safety and into a legitimate, regulated, protected form of recovery.

In good faith, I hope to hear from Parliament regarding their full intentions soon.  I also pray to see the public enabled towards the safeguarding of their poorly loved ones, those they are not duty and honour bound to save.  That, Your Right Honourable Gentleman, is up to parliament and the NHS combined, as I hope you will agree.

Yours faithfully,

Ana Maria Santuario.

p.s. Please know that I only write in the manner that I do, firmly, because I have seen the sea of the dead and the dying, and it is who they need me to become today, and I make no apologies for that. Moreover, please consider the formal handover, emailed to every member of parliament on 1^st May 2024, as officially re-delivered directly to you this day (see the first email of all forwarded for your specific attention).

p.p.s. Download the letter and disseminate it for yourself:

The letter was redrafted and readdressed to The Secretary of State for Health and Social Care:

Manifesto for Change: Dual-Diagnosis and Disparity, was printed, bound, and delivered alongside this letter. So too, was the initial handover of the crisis, as delivered to every single member of parliament on 1st May 2024 (via email), presented in the parceled delivery (a package that includes all attachments delivered that day, e.g. letters to parliament, NHS Chief Executives, and His Majesty The King). The delivery to the Prime Minister was sent via Tracked and Signed 1st Class Royal Mail, to 10 Downing Street (as advised on the government website); The Secretary of State for Health and Social Care received her delivery at The House of Commons, as per parliamentary instruction.