Welcome to our in-depth conversation with Dr Nusrat Mir, a highly respected Consultant Psychiatrist and Expert Witness. Dr Mir’s work epitomises the intersection of psychiatric care and the legal world. His role as an Expert Witness reveals a different facet of his professional life – one punctuated by medico legal examinations and contributing his psychiatric expertise to complex personal injury and clinical negligence cases. Join us as we delve into his unique blend of roles, offering a rare glimpse into this intriguing nexus of mental health and law.
I graduated from the University of Manchester in 1995 with degrees in Medicine (MBChB) and Psychology (BSc (Hons). I was awarded a Distinction in Psychiatry. I commenced basic postgraduate psychiatric training in Oxford in 1996. Having a keen interest in the interface between medicine and psychiatry, I spent the next three years training in General Practice (MRCGP) before continuing my psychiatric training in Glasgow. In 2002, I became a Member of the Royal College of Psychiatrists (MRCPsych).
About Nusrat
Between 2003 and 2007, I held the academic position of Clinical Lecturer in Psychiatry at the University of Sheffield, during which time I conducted original neuropsychiatric research, was Academic lead for Undergraduate clinical psychiatry teaching, and completed my Higher Specialist training in General Adult and Liaison Psychiatry. I was appointed as a Consultant in Perinatal Psychiatry for Sheffield Health and Social Care NHS Foundation Trust in 2009. I led the Sheffield Perinatal Mental Health Service, a specialist service dedicated to the care of pregnant and postnatal women with severe mental health problems, for 13 years. Under my leadership, the service was transformed from a fledgling team into a regional Multidisciplinary specialist service with over 30 staff, covering South Yorkshire. This involved successfully bidding for substantial NHS government funding in 2018, in which I played an instrumental role. The transformation of Perinatal Mental Health services in the South Yorkshire region, I would consider to be the proudest achievement of my NHS career to date. During this time, I also held various other positions for my Trust, including the Named Doctor for Safeguarding Children and Clinical Staff Governor. My contribution to NHS service development, clinical service delivery, training and research was recognised through Clinical Excellence Awards on three occasions. I also served on the Royal College of Psychiatrists Perinatal Faculty Executive Committee between 2010 and 2014. In 2023 I was elected to Fellowship of the Royal College of Psychiatrists.
I currently provide medical leadership to a Community Mental Health Team dedicated to the care of patients with severe and complex psychiatric disorders such as schizophrenia, bipolar disorder, schizoaffective disorder, severe depressive disorder, generalised anxiety disorder and complex post-traumatic stress disorder. I cover a deprived area of North Sheffield, with a very diverse population which brings with it a lot of challenges and rewards at the same time. It is a chance to make a difference to the lives of some of the most vulnerable members of our society.
I am an Honorary Senior Clinical Lecturer in Psychiatry at the University of Sheffield and an Examiner for the Royal College of Psychiatrists. I have a deep interest in medical education. I have written educational articles, book chapters for health professionals and delivered numerous educational lectures and seminars on Psychiatry to medical students and postgraduate specialists over the years. I have also co-authored original peer-reviewed scientific publications in Neuropsychiatry and presented research at international conferences in Hungary, Italy and the UK. I have been active in Medicolegal work since 2009. My Medicolegal work is managed by Parkhead Consultancy in Sheffield. As an expert witness, I specialise in the psychiatric aspects of clinical negligence, personal injury, fitness to practice, capacity assessment, family law, occupational stress and fitness to plead. As one of the leading Perinatal Psychiatric Expert Witnesses in the UK, I am regularly instructed on Perinatal Clinical negligence cases from across the country. I have a particular interest in birth trauma in all its manifestations. I am on the UK Register of Expert Witnesses and am accredited by the charity, Action against Medical Accidents (AvMA). I am also on the Clinical Expert Panels of the General Dental and General Pharmaceutical Councils in the UK. I have prepared over 800 medicolegal reports for claimants and defendants and given evidence in court. My current Claimant: Defendant split is 70:30, and I prepare an average of 12 reports a month. I have been a guest speaker at meetings organised by the legal community in recent years. This has included face-to-face seminars as well as webinars. I have presented on topics such as ‘Post-Traumatic Stress Disorder after Childbirth’ and ‘Medicolegal Issues in Perinatal Psychiatric Injury’, the latter being delivered under the auspices of AvMA, in 2020.
Considering the workplace transformations due to the recent pandemic, have you observed an increase in cases related to occupational stress, and has this impacted your evaluation method? That’s an interesting question. The sud-den change in working patterns due to the pandemic inevitably brought additional stress into our lives. However, I have to say that I personally have not seen that translated into increased cases of occupational stress coming my way. This is perhaps surprising. What I have seen and continue to see is clinical negligence and personal injury cases being impacted negatively by pandemic-related issues. These have been mostly due to social distancing restrictions. For example, clients who have been hospitalised following a serious road traffic accident, had a traumatic postnatal complication or delayed cancer diagnosis, have had to face hospital admission and treatment on their own. Social isolation has always been an important causal factor in Psychiatry, but the pandemic took it to new levels.
How do you maintain confidentiality and professionalism while dealing with sensitive mental health information in your practice? As doctors, the importance of confidentiality is drilled into us repeatedly during our long years of medical training, and rightly so. As Psychiatrists, we are in a very privileged position, one in which patients, in their most vulnerable states, open up to us about the most intimate and sensitive things that they may have never told anyone else. This can only happen if we are trusted by our patients, and maintaining confidentiality is at the core of building trust. Empathy is also important during Psychiatric consultations as it helps to build rapport and shows that active listening is taking place. Consultations take place where privacy can be assured. It also goes without saying that all written documentation is dealt with in accordance with GDPR Regulations, with confidential data being disposed of appropriately at the end of a legal case.
Lastly, could you share any standout experiences or cases that have particularly shaped your career as a Consultant Psychiatrist and Expert Witness? About eight years ago, I was instructed on a tragic case in Northern Ireland in which a lady of a professional background had smothered her newborn baby son to death. I was instructed by her solicitor to examine her and provide a Psychiatric opinion on her state of mind at the time of the fatal incident. I travelled to Belfast to examine her, where she had been imprisoned. It was very clear to me that the lady had suffered from Postpartum Psychosis, a rare but devastating sudden-onset Psychiatric disorder that occurs within six weeks of childbirth. In this case, it had been characterised by a severely depressed mood and delusional thinking, the lady having been convinced that she needed to ‘save’ her child from the very evil world he had been born into. When it went to court, my independent evidence was factored into the sentencing as the Judge’s verdict, in the end, was one of manslaughter as opposed to murder. For me personally, this was a landmark case in my Medico legal career as up until then, I had only ever been instructed on General Adult Psychiatric cases, not on Perinatal ones. I have since been instructed on numerous perinatal claims, particularly clinical negligence, and continue to receive instructions on a regular basis. In terms of experiences that have helped to shape my Expert Witness career, I would say that invitations to present to the legal community have been very important. It has been an honour to be invited by lawyers to speak at their meetings as well as by charities such as Action against Medical Accidents (AvMA). I presented a webinar entitled ‘Medico-legal issues in Perinatal Psychiatric Injury’ for AvMA in 2020, which was aimed at Clinical Negligence lawyers. It was very rewarding to offer a specialist Psychiatric perspective on medico-legal issues at the interface between Medicine and Law, two great professions of the world. It offered me an excellent networking opportunity too.
