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The nuts and bolts of repatriating patients

Special Registrar in Psychiatry, Lyndon Clinic, Hobs Meadow, Solihull B92 8PW,

P. C. Naik

Consultant Psychiatrist, Lyndon Clinic, Solihull

We read with interest the review article by Gordon et al (Psychiatric Bulletin, August 2004, 28, 295–297) on air travel by passengers with mental disorder. We would like to share our experience of the difficulties in assessing a patient and the process involved in repatriation.

Our patient was from an Eastern European country, which recently became a member of the European Union. She was admitted with a history of aggression and bizarre behaviour. Gordon et al emphasise that assessment of fitness to travel is essential. However, this can prove to be difficult in individuals who do not speak English as the understanding and interpretation of symptoms in psychiatry is not consistent across languages. In spite of efforts to assess our patient through an interpreter, we were not entirely sure of the psychopathology, diagnosis and risks involved. Our working diagnosis was of one of a psychotic disorder, she was treated with neuroleptics. There was limited improvement.

The patient persistently asked to be repatriated. This left us in a dilemma as to whether we should continue her treatment in the unit or repatriate her. On the one hand, we were uncertain of the services in her country and her suitability for travel, but on the other hand, her persistent request to return home was making her worse. We eventually decided that it was in her best interest to be repatriated. There was a substantial delay between the time when we decided to repatriate and the actual departure. This was due to a number of reasons including: initially the wrong form being requested by the insurance company (E107, which does not exist); lack of communication directly with the insurance company; and uncertainties as to whose responsibility it was to make the travel arrangements and meet the costs.

We found an official from the patient’s Consulate in London to be of invaluable aid. They were useful in liaising with the insurance company, identifying the correct form (E111) that authorises expenditure for treatment and repatriation and arranging for someone to meet the staff and the patient at the destination point.

Reports were provided for the insurance company and the airlines. The airlines made us aware that travel arrangements would be more complicated if medication was required during the flight. The travel arrangements were made by the trust management team. Eventually, the patient was repatriated successfully. We were left feeling exhausted, but learned from our ordeal.

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This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Arif, R. Articles by Naik, P. C. Search for Related Content PubMed Articles by Arif, R. Articles by Naik, P. C.