Catherine Chadwick RMN: A Specialist Mental Health Nursing Expert Witnesses Perspective on a Complex Case

Introducing Catherine Chadwick RMN: A Specialist Mental Health Nursing Expert Witness

Catherine Chadwick is a highly experienced Registered Mental Health Nurse (RMN) and former Senior Lecturer in Mental Health Nursing. Her career spans across high-acuity environments including adolescent and adult acute units, forensic services, community mental health, and secure facilities.

Until recently, she served as a Senior Clinical Nurse Specialist and Professional Lead within a child and adolescent mental health service. In this capacity, she not only provided care but also led investigations into serious incidents, contributed to policy development, and advised NHS Trusts on nursing governance and care standards.

As Clinical Lead and Non-Medical Prescriber, Catherine provides clinical leadership, direct patient care, and oversight of a team of nurse prescribers. She acts as the CQC-Registered Manager, develops service protocols, supervises complex cases, and ensures delivery of safe, evidence-based ADHD treatment in line with national standards. Her knowledge is underpinned by years of direct clinical engagement, making her uniquely positioned to comment on both theory and real-world practice.

In her capacity as an expert witness, Catherine provides objective, evidence-based opinions on the standards of mental health nursing care. She is particularly recognised for her meticulous ability to interpret clinical records and behavioural presentations within the broader context of nursing practice, aligning her assessments with NMC standards, NICE guidance, and multidisciplinary expectations.

Case Study: Examining Failures in Multidisciplinary Mental Health Care

In one particularly complex instruction, Catherine was asked to provide her expert opinion on the care delivered to a patient detained under the Mental Health Act within a secure inpatient mental health facility. The patient presented with significant psychiatric complexity, including a primary diagnosis of post-traumatic stress disorder (PTSD) and traits consistent with borderline and dependent personality disorders. Their clinical history documented a persistent and escalating pattern of self-injurious behaviours, including recurrent ligature use and the ingestion of hazardous foreign objects.

The event under scrutiny began when the patient swallowed a pen - an act that, due to its potential for internal injury, required immediate medical attention. They were transferred to an acute general hospital, where they underwent emergency abdominal surgery to remove the object and manage the resulting complications. While the initial crisis was appropriately addressed in the physical health setting, concerns arose following their return to the mental health unit for post-operative care.

Upon their reintegration into the psychiatric environment, the patient began to exhibit signs of physical distress: ongoing abdominal pain, increasing wound discomfort, and indications of possible infection. Despite the known risk of complications following abdominal surgery, especially in patients with repeated self-harm behaviours and complex psychosocial needs, the care team did not appear to respond with sufficient urgency. There were repeated delays in clinical escalation, fragmented documentation, and a concerning absence of integrated monitoring between physical and mental health indicators.

Catherine’s comprehensive review of the case records revealed a pattern of missed opportunities to intervene appropriately. Nursing notes and observation charts reflected inconsistent documentation of the patient’s post-surgical symptoms, with no clear rationale for why decisions were delayed or dismissed. There was no evidence of timely escalation to the medical team when signs of infection began to emerge. The lack of a structured, multidisciplinary follow-up plan - despite the high-risk nature of the patient - compounded the issue.

One of the most troubling aspects of the case, as Catherine outlined in her report, was the apparent disconnect between mental health care planning and physical health monitoring. The patient’s symptoms were frequently attributed to behavioural distress or psychological manipulation, rather than being assessed clinically and holistically. As a result, their genuine physical needs were not met with appropriate care responses.

Catherine also highlighted the absence of adaptive care planning. Despite the patient’s known history of complex self-harming behaviour, there was little evidence that the clinical team adjusted their care strategies or risk management framework in response to their deteriorating condition. Instead, care plans remained largely static, and the multidisciplinary team did not appear to engage in dynamic clinical review.

In her expert opinion, the care delivered fell significantly below the standard expected of a reasonably competent mental health nurse working within such a setting. The failure to assess, document, escalate, and manage the patient’s physical symptoms in a timely manner constituted a breach of duty. Catherine made it clear that the patient’s subsequent re-admission to hospital, and the considerable discomfort they experienced during this period, were likely preventable.

Her written evidence contributed critically to the legal case, offering a detailed account of where care delivery broke down and how professional nursing standards were not met. Drawing on national guidance and her own clinical leadership experience, Catherine provided the court with clear, structured reasoning to support her conclusions. Her report not only helped to clarify individual accountability but also reinforced the importance of integrated, patient-centred care in mental health settings.

Conclusion

This case underscores the crucial contribution of a specialist mental health nursing expert in both healthcare accountability and legal proceedings. Catherine’s analysis not only clarified what went wrong but offered a measured framework for what should have occurred.

Her insights were grounded in the fundamentals of good nursing care: observation, escalation, documentation, and professional judgement. For healthcare providers, it serves as a reminder that clinical responsiveness must be consistent and patient-centred. For legal professionals, it highlights how expert testimony can translate clinical complexity into clear, actionable findings.