Every time I use the PIRS I am reminded of why I think it is so inadequate. I saw a young man yesterday who was removing an air-conditioning compressor for a boss who was paying him cash in hand. He had to cut the power cable to the unit. His boss told him the power had been turned off-not correct. This fellow was electrocuted and had severe burns to his right hand and wrist. He had weeks in hospital with about 20 operations including debridements and skin grafts and has been left with pain, weakness and ugly scarring of his right hand. He has had nightmares, flashbacks, fear of electricity and became significantly depressed. This was exacerbated by the refusal of his boss to acknowledge that he was working for him.
So I saw him three years later. In the meantime he had developed an ice and cannabis addiction, he had been imprisoned for housebreaking and thefts, his relationship had broken down and he had attempted suicide by gassing himself in his car. He had support and had been able to stop using ice and cut back his use of alcohol and cannabis. He had attempted to return to work on three occasions but had not been able to continue with two of the jobs because of problems with his right hand and because of his fear of working near machinery and using electrical equipment. When I saw him he was working part-time for a fish wholesaler although the cold was causing more hand pain and he remained uneasy about machinery and electrical equipment but he was determined to push himself.
He had a significant post traumatic stress disorder, a substance use disorder and a chronic adjustment disorder with depressed mood. This is where I get frustrated – his PIRS rating was 5% (in his state the issues of pure mental harm and consequential mental harm do not apply)! His grooming has improved, he has been encouraged to socialise more and has been trying to do so, he is still uneasy travelling to unknown areas, he still has some difficulties with concentration but was able to do a plant operator’s certificate and was working part-time. There is nowhere in the PIRS descriptors to Take account of his continuing drug use, his mood issues and his symptoms of traumatisation. You are unable to score these important matters. The PIRS deals with proxies of mental disorders rather than mental disorders themselves. The only pleasing feature is that we are not obliged to use the sixth edition – that is so much worse!