The issue of analgesia is an interesting one. I wonder if the patient had declined analgesia, rather than not having been offered it ? It is always worth remembering that mental illness does not automatically equate with lack of capacity so medication cannot be forced onto a patient if they prefer not to take anything - this has always been a potential minefield in mental health especially when patients suffer intercurrent psychiatric and physical problems. An inflammed foot (gout, cellulitis, septic arthritis, etc) is almost always best dealt with by an NSAIDs rather than paracetamol (assuming there are no contraindications) so perhaps there are issues about the initial management by the psychiatrist, or A&E doctor who had both examined the patient before referral ? Many people have strange ideas about analgesics - they stagger into A&E virtually crying because of back pain, headache, joint problems, etc, but look in horror at the triage nurse when asked if they have taken anything for it (before answering no, they haven't - even though they've had symptoms for 3 days). Mind you it's hard to give the nurse the benefit of the doubt when they exhibit such poor communication skills, notwithstanding beakies robust defence, of course ;o)