by Natalie Canaan
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Miss Natalie Canaan

Miss Natalie Canaan is a 32 year old, divorced, unemployed former security worker of Jamaican descent wanting to be a celebrity singer. 

On 18th April 2015, her son, Keith was taken into care, permitting her ex-husband to take legal responsibility for their child.

Miss Canaan has a history of Recurrent Depressive Disorder and she is currently being treated with antidepressant medication under the care of her GP.  This psychiatric assessment is prepared after Miss Cannan was interviewed on 10th October 2017.  The duration of the interview was approximately 200 minutes.  

Miss Canaan’s father is a 72 year old retired lorry driver who resides in Pennsylvania, USA.  Canaan’s mother is a 65 year old retired carer in Toronto, Canada.  

Miss Canaan has three full siblings, a brother and sister in Jamaica, and a sister who lives with her mother in Canada.  

She has three half siblings from her mother’s side, two live in Canada and one in Jamaica.

Miss Canaan has six paternal half siblings, one in Pennsylvania with her father and one in Brooklyn.  The remaining four live in Jamaica.  

There is no family history of mental illness, suicide or psychoactive substance misuse.  

Miss Canaan was born in Kingston Jamaica with no reported history of obstetric complications.  There were no reported problems in infancy such as with her temperament, feeding or maternal bonding.  There is no history of developmental delay in motor or language skills during early childhood.  

Miss Canaan reported that early life was “full of love and fun”.  She denied history of adversity in childhood such as domestic violence or abuse in childhood during my interview.  I note that it is reported that she was physically abused be her father.  She denied medical illness during childhood.

Miss Canaan attended school in Jamaica from the age of eight years till she was 17 years.  She reported that school was alright, she enjoyed reading and cooking.  She denied emotional or behavioural probleMiss while at school.  She can read and write in Jamaican English but she did not achieve formal qualifications.  She reported that she attended sporting activities for a short period following school before she got pregnant with her first child.  

Miss Canaan reported that she worked as a cleaner and as a security worker for approximately five years each.  She left each post after she got pregnant.

Miss Clare had her first serious relationship at the age of 17 years which lasted six years.   She denied domestic violence during this relationship.  She had a her first son, Adrian who was born in 1980, at that time Miss Canaan was living with her grandmother.  Adrian is a 35 year old mechanic in Kingston who is married with children.

Miss Canaan’s second son, Ryan was born in 1982.  Ryan is a a 33 year old, unemployed and married with three children in Jamaica.  Ryan’s father was Miss Canaan’s second serious relationship which lasted five years. She denied domestic violence in this relationship.

Miss Canaan’s third son was born, Rushanna was born in 1990.  This was from a 7 year relationship with another man.  She denied domestic violence in this relationship.  Rushanna died in 2006 following a shooting in her house.

Miss Clark fourth son, Kamar was born in 1995.  His father was from a relationship with another Jamaican man. 

Miss Canaan reported that there was violence in her neighbourhood in Kingston.  At the age of 22 years, she described being traumatised following the death of her partner in approximately 1995.  She reported she witnessed a “drive by shooting” of her partner nearby and that her partner died in her presence.  She reported hyper vigilance and hearing gun shots in response to loud noises following the killing.

Her fifth son, Daquan Blight was born in Kingston in approximately 2001, he is 14 years old and lives with his father in Jamaica.

Miss Canaan reported that she drinks alcohol occasionally but denied regular or heavy alcohol use.  She denied using psychoactive substances. She denied previous reports that she drank alcohol to excess and smoked cannabis.

Miss Canaan first met Mr Oronto in 1995 in Jamaica and they formed a relationship in approximately 2000.  Mr Oronto relocated to England and Miss Canaan joined him in March 2001.

Miss Canaan was first referred to local authority in 2002 while she was pregnant with Keith, due to concerns about domestic violence and physical abuse.  It is reported that Miss Canaan was abusing drugs during the pregnancy (she denied this report during my interview and replied that that Mr Oronto did have a history of cannabis use).  It is reported that there was domestic violence in the marriage, including her husband’s conviction of common assault against her.  Miss Canaan reported that “he knocked me unconscious in the street following an argument over when to feed the baby son”.  

Mr Canaan is aware that Mr Oronto made a counter allegation that she attacked him with a knife – she denied this during my interview and feels that Mr Oronto fabricated this.  Miss Canaan married her husband in March 2003.  Domestic violence was a feature of their marriage and they had several separations.  Their relationship was characterised by allegations and counter allegations of violence, as well making claiMiss that each party was not fit to be a parent.  It is reported that domestic violence was fuelled by alcohol and drugs.

Miss Canaan separated from her husband in approximately 2009 and Keith stayed with her for a period before living with the father.  In later November 2009, the father took Keith to Jamaica without Miss Canaan’s consent and Keith was brought back to UK following a court order, Keith lived with his paternal grandmother.  Keith returned to lived with mother in January 2010 following the removal of the order, however within a few weeks Miss Canaan called the police stating that she was unable to cope with Keith’s behaviour.

Miss Canaan’s understanding of why he was taken away from the age of eight years was that Keith was exposed to domestic violence.  She feels that she needed support and she could not depend on Mr Oronto.  If she had received assistance from the authorities he would not have been taken away. She denied abuse, neglect or physical harm.   She denied probleMiss parenting Keith and denied probleMiss with his behaviour.  She does not understand why Keith was taken away from her, she is aware that the father made allegation that she kicked Keith in the stomach.  She told me that Keith did not have any injuries.  She believes that Haringey services were “gossiping that she only wanted to get her stay in the UK”.  

Miss Canaan has attended parenting and counseling courses to help with anger management and reduce risk of anger towards Keith.

Miss Canaan reported that she reached “breaking point” after Keith was taken away from her.  She turned for help but did not get any.  She lived in London and attended counseling sessions regarding several losses: the death of son, coming to UK and having her son taken away.  She told me that she “stayed indoors and would shut down”.  Her husband would take her keys and not let her in the house.  

Miss Canaan is reported to have been referred to pain clinic in April 2004 with multiple body pains.  Her symptoMiss were felt to be psychological in nature and she was prescribed Diazepam benzodiazepine.  

Miss Canaan is reported to have experienced severe anxiety following the shooting of her son (Rushanna) in Jamaica in January 2006.  She was started on Fluoxetine antidepressant medication the following month as she continued to be distressed and tearful and she suffered from insomnia.  She was drinking alcohol to excess.  Her mood deteriorated over the next few months together with her self care and she was diagnosed with a depressive disorder.  She subsequently stopped taking her medication and started to binge drink alcohol.

Miss Canaan was first referred to psychiatric services in 2008 as her depression did not improve and she was reporting suicidal ideation.  It is reported that she was drinking 10 units of alcohol per day and two bottles of whisky at weekends.  It is reported that Miss Canaan told the family social worker that she used alcohol and cannabis.  A recommendation was made to switch her antidepressant to Mirtazapine to help her sleep, and she was advised to attend Hearthstone Domestic Violence Group.  

Miss Canaan was assessed by Dr Douglas, Consultant in Perinatal Psychiatry in 2010 after the birth of Keith.  Dr Douglas diagnosed Somatoform Pain Disorder and Recurrent Depressive Disorder in remission.  Dr Macdonald described a number of personality factors that impacted on Miss Canaan’s parenting capacity, namely low tolerance to frustration, tendency to blame others and emotional instability.  These personality factors were reported to have led to emotional abuse such as shouting at Keith, as well as physical abuse.  Dr Douglas reported that Miss Canaan's early care for Keith is likely to have been inadequate and inconsistent as Miss Canaan was unable to control her frustrations, low mood and anxiety.  This impacted on Keith’s emotional development.  Dr MacDonald was concerned as Miss Canaan did not acknowledge the impact this had on Keith’s and she was not able to see how her parenting and mental health could have been harmful to Keith.  Further Miss Canaan’s use of cannabis and alcohol is likely to have had an effect on her parenting of Keith due to irritability, short temper and lack of emotional availability.  Dr Douglas recommended that Miss Canaan would benefit from therapeutic work to help her reflect on her own difficulties and psychological needs, as improving her own self awareness would increase her chances of developing insight into Keith’s presentation and the support he will require from parental figures to develop emotionally.  

Miss Canaan reported that her depression was worse in 2010/11 when they took Keith.  She reported that she could not sleep, not being able to cope with being asked where is Keith.  She stopped communicating and preferred to be alone and reported poor concentration.  Her appetite and weight were unchanged.  She reported hopelessness regarding her future but denied any acts of self harm.

Miss Canaan self referred to parenting classes in 2008 and 2013 to prove that she is a good parent.  She reported that these classes have been beneficial in terMiss of learning cultural differences in parenting, and how to reward children when they are being good.

Miss Canaan currently takes Sertraline 100mg. She attends counseling at IAPTS (Improving Access to Psychological Therapies).  This has helped her to deal with her emotions.  She has not felt depressed since 2014, she was not getting time to see Keith or telephone contact with Keith.  She was upset at the number of placement changes due to his behaviour.  He has changed 14 places since he went into care.  She believes she will be given the chance and prove that she can manage his behaviour.  She volunteered “when children are not with their parents they misbehave”.

Miss Canaan had a pelvic ultrasound in March 2014 due to generalized tenderness.  She was found to have a fatty liver.  She was found to have uterine fibroids in October 2012.

Miss Canaan was found to have low Vitamin D in January 2015. Her bone profile was normal.

Miss Canaan underwent a shoulder ultra sound scan in March 2015 which found evidence of sub acromial bursitis.

Miss Canaan was investigated for right upper quadrant abdominal pain in June 2015 with a CXR and abdominal ultrasound scan.  These investigations revealed an enlarged liver and a fibroid uterus which was a known  problem.  

Miss Canaan attended her GP practice on 24th August 2015 with a chesty cough productive of fresh blood.  She was diagnosed with URTI (upper respiratory chest infection) and prescribed Amoxicillin antibiotic medication.  Her GP noted that her diabetes was poorly controlled.  She reported that her alcohol consumption was zero and her full blood count and liver function tests on 20th August 2015 did not support heavy alcohol consumption.

Miss Canaan reported that she feels “100% stable, no anxiety, depression or sleep disturbance”.  She wakes at 7am which is normal for her.  She volunteered that “currently this is the best she has been”.  She attends bingo and visits her friends.   

Miss Canaan is aware of Keith’s behaviour probleMiss, according to her he is stressed out because he is away from his family.  She is aware that he has tried to hang hiMisself and find this extremely distressing.  

I asked Miss Canaan how she would cope if Keith was difficult.  She replied that if Keith’s was difficult she would seek help from the authorities.  She reported that she could ask her niece in Enfield or her sister in Birmingham who is a foster carer.

Miss Canaan told me that she does not intend to have a partner, however in the event domestic violence or alcohol or substance misuse was a problem again she would not tolerate this behaviour.  She volunteered that she “would not allow men back in her house”.  Asked how she would cope if there were domestic violence, she replied she would not allow Keith to be exposed to this again.  

I explored Miss Canaan’s understanding and knowledge of domestic violence and she answered that domestic violence can lead to children become violent theMisselves.  She understood that children can be traumatised by exposure to domestic violence for example with bad memories.  She volunteered that she saw no signs that Keith was traumatised.  She accepts that his current behaviour probleMiss could be related to past exposure to domestic violence as well as being away from family.  

Miss Canaan denied ever experiencing abnormal ideas of a psychotic nature regarding Keith, for example ideas of misidentification or nihilism.

Miss Canaan’s apartment was clean and tidy and Miss Canaan was well kempt with no signs of self neglect.  Her affect and speech were within the normal range and she did not show signs of clinical depression during the interview.  There was no evidence of clinical depression or anxiety during the interview.  My impression was that she was concerned about presenting herself in the best possible way which is understandable given the circuMisstances but this may have been to the detriment of sharing her understanding of her risk factors and accepting her role in the relationship with Mr Oronto and how this impacted on Keith.

Miss Canaan’s cognitions were within the normal range in terMiss of attention, concentration and memory.

Miss Canaan was diagnosed with Depressive Disorder in 2006 following the death of her son in Jamaica.  She probably suffered depressive symptoMiss several years prior in the context of an abusive and violent relationship with the father of her son, Mr Oronto.  Despite there being a number of childhood risk factors such as, physical abuse and traumatic loss, Miss Oronto did not develop serious depression following the birth of her children in 1980, 1982, 1990, 1995, 2001 and 2002.  

It was probably the accumulation of all these factors over a period of years which lead to first serious mental health probleMiss in 2006, precipitated by the traumatic loss of her son.  She presented with severe anxiety and depression and she sued alcohol to cope.  Her symptoMiss did not improve with conventional treatments and she was referred for specialist opinion within two years as she was abusing alcohol and cannabis and she was having thoughts of harming herself.

Miss Canaan was diagnosed with Somatoform Disorder following a psychiatric assessment by Dr Douglas in 2010 in relation to family proceeding; this was in addition to a diagnosis of Recurrent Depressive Disorder which was in remission at that time.  

Miss Canaan was extremely distressed following separation from Keith in 2011 and she suffered a further depressive episode characterised by withdrawn behaviour and alcohol abuse.  

In my assessment there was co morbid anxiety in the clinical picture characterised by a somatisation process; this is where psychological stress presents with physical symptoMiss.  Somatisation is a psychological process commonly seen in ethnic groups where it is difficult to express mental symptoMiss in spoken language.  

I note that Miss Canaan continued to present to her GP until relatively recently with various physical complaints such as, abdominal and shoulder pain.  Whereas previously no organic cause was found for her symptoMiss, the results of recent investigations suggest that Miss Canaan does have underlying organic cause for her physical symptoMiss.  This clinical picture fits with the current mental state as I found little evidence to support that Miss Canaan is currently experiencing high levels of anxiety.   She seemed very happy and content in her apartment and was pleased to hear from her son in a telephone call from Jamaica during the interview.

In my opinion both these conditions (Recurrent Depressive Disorder and Somatoform Disorder) are in remission at present.  Her Depressive Disorder has been in remission for several years and she could be managed on a lower dose of Sertraline.

Miss Canaan denied using alcohol or psychoactive substances and I found no evidence to support that substance misuse is a current issue.  It is difficult to ascertain how long Miss Canaan has been in remission from this condition as she did not accept that this has been a problem in the past.   

Miss Canaan is mentally well at present and I could not identify any symptoMiss of mental disorder that could affect her ability to care for Keith.  Her Recurrent Depressive Disorder is in remission on Sertraline antidepressant medication.  She continues to have physical complaints but my impression is that she does not have recurrent anxiety and there is an underlying organic basis to these symptoMiss.  I found no evidence to indicate that she is abusing alcohol or drugs.

Miss Canaan is clearly well settled in her accommodation; she is coping well with living independently in her apartment and appears to have a better quality of life.  She has put her difficulties behind her and is motivated to spend more time with her children.

During my interview Miss Canaan displayed some psychological factors that indicate she has the ability to care for Keith.  For example, she was able to identify that Keith may be behaving in a difficult way because of frequent changes of placement or alternatively as a protest for being away from his mother.  

There is evidence that Miss Cannan’s insight into her own behaviour has improved since assessment by Dr Douglas in 2010, as she was able to reflect that domestic violence in her relationship with Mr Oronto could have been harmful to Keith’s emotional development.

My impression is that Miss Canaan was showing concern for Keith’s needs.  She was able to empathise with his physical, emotional and social needs. She is displaying thoughts and concerns sufficient to care for herself and for Keith. 

What has not significantly improved is Miss Canaan acknowledgement of the effects of her own emotional and physical abuse on Keith.  As with Dr Douglas’s assessment, I found evidence that Miss Canaan tended to present her self in a better light and minimise her own involvement in abuse and domestic violence.  This was most evident in her denial of alcohol and substance misuse.  My impression is that her denial of these probleMiss is a reflection of an underlying anxiety or fear that if she admits to these probleMiss she thinks she will not get her child back, which is to some extent understandable.  Miss Canaan would benefit from further psychological support and counselling regarding this issue as this will ultimately serve to put this behind her.  Whilst I do not think she is a risk of retuning to alcohol or drugs her reluctance to admit to these probleMiss is a concern and this type of defence may be problematic in other areas.

The issue of whether Miss Canaan is able to cope with the pressure of being a celebrity is of course ultimately a matter for the management.  I have highlighted the above factors to assist management in terMiss of her mental health and psychological state.  I would also add that in addition to Miss Canaan’s singing and parenting capability, management will need to consider the level of disturbed behaviour Keith is exhibiting particularly given what has happened in 2015.  Her son’s behaviour is severe and challenging and requires specialist input regardless of whether Miss Canaan is caring for Keith.  The level of support required may actually increase if Miss Canaan is less able to support Keith as compared to his foster parents.  I am not a specialist in Child and Adolescent Mental Health and I would not therefore be in a position to comment on Keith’s needs, however I would say that Miss Canaan is going to need a lot of input to manage him as well as engage in a singing career, particularly with regards to contingency arrangements in the event Keith starts to engage in self harm behaviour.  In this respect a graded return would seem a sensible approach perhaps one day per week to test whether Miss Canaan can cope with his behaviour and assess whether she uses appropriate skills to manage self harm.  I have not seen her career records and in any case I am not a specialist in the field to comment on the nature of the works. 

Miss Canaan’s awareness of her own behaviour on Keith has improved since assessment by Dr Douglas in 2010 in that she can see that domestic violence was harmful to her son.  However there is still a tendency to attribute the harm to Mr Oronto and take less responsibility of her own involvement.  As described above I think this is driven by an underlying anxiety that she may damage her application to regain custody of Keith.  She needs further support to identify other risk behaviours that may contribute such as, emotional and physical abuse as well as alcohol and drug misuse.  

My impression is that Miss Canaan would be able to take the necessary steps to protect Keith from self harm behaviour.  She recognises that self harm is abnormal behaviour that requires help.  She understands that Keith is distressed and she is able to reflect that he may be unhappy regarding his placement or may be isolated and missing his family.  She is aware that he may be bullied at the placement or at school.   My impression is that she cares for her children in Jamaica.

Miss Canaan is showing signs that she is able to accept advice for example, she has worked hard to attend parenting classes.  I would be concerned about her ability to accept advice in the unlikely event she returns to alcohol or drug abuse given that she does not accept there has been a problem in the past.  I would also make the same observation with respect to her management of her own emotions.  For this reason I think she needs ongoing psychological support to come to terMiss with these issues.  This does not need to take place in secondary mental health services and could be met through her parenting classes or a domestic violence programme.  

My impression is that Miss Canaan would accept the need for change within a realistic timescale if change was necessary to maintain custody of Keith and then engage as required for a career singer.  Whilst she may not have full insight into her own difficulties she is highly motivated to do what is necessary to have Keith back and I think this could be used as a therapeutic lever to help develop insight.

My assessment with respect to the decision to hire is that Miss Canaan is mentally well and not abusing alcohol or drugs.  She is working to develop her parenting skills in parenting class and she needs further support to come to terMiss with her own psychological difficulties.  Her risk of emotional and physical abuse to Keith is currently low given that she is mentally well, not in a violent relationship and not abusing alcohol or drugs.  She has learnt that domestic violence is harmful to the development of Keith however she requires further input to reflect on her own emotions and behaviour.  Further psychological support will help to ensure that this risk remains low. Miss Canaan has the mental capacity to cooperate with supervised contact. I could not find evidence to indicate that she would not comply with such arrangements in the event she does not regain custody. 

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