Wednesday, 24 June 2009

My First Mental Health Act Assessment (Part II)

Fast forward to 1981. After two years working as an unqualified generic social worker I did a two year Certificate of Qualification in Social Work course (in those days the training was only two years, and the official social work qualification was the CQSW), and then returned to work in my old area office.

I had been qualified for about a year when the new area officer, Gerald, called me into his office.

“We’ve got a request for a Mental Health Act Assessment. Fancy doing it?”

“I’m not sure I’m qualified to act as a Mental Welfare Officer,” I replied nervously. “I haven’t had any training or anything.”

“Have a look on your social work warrant. What does it say?”

I looked at my ID card. The front had a passport photograph of me, sporting the obligatory long hair and beard of a male social worker of the time, along with my name and the local authority. The back said who and what I was and had the signature of the Director of Social Services. In rather small print in one corner there was a statement which I had never bothered to study: “The holder is authorised to act as a Mental Welfare Officer for the purposes of the Mental Health Act 1959.”

I read this out.

“There you go then,” Gerald said, and proceeded to give me the details of the request.

And that was my full initiation into the arcane world of Mental Welfare Officers.

The person I had to assess was an informal patient on one of the wards of the local Victorian asylum which thankfully no longer exists. Peter was a married man in his 40’s who had been admitted because he was believed to be delusional. Although he had initially agreed to the admission, he was now suspicious that the hospital was a part of the conspiracy against him.

I spent an hour reading up on the Mental Health Act and the relevant sections. I was desperately trying to remember the training I had had on my social work course and the things I had learned from observing a few assessments carried out by other MWO’s. Then I went to the ward to interview the patient.

He seemed pleased to see me.

“This will explain everything,” he said, giving me an exercise book filled with neat handwriting.

I started to read it. It detailed his life when working as an engineer in an African state that had previously been under colonial rule. He had basically lived, with his wife, in a post colonial enclave, which, he said in his account, was run by the Masons. He had never been much enamoured of the Masons, and when he discovered that they were providing local women to single (and married) British men for “personal services”, he decided to blow the whistle on the whole thing.

The Masons had, of course, objected to this, and, according to him, had made it impossible for him to continue working there and he had then returned to his home town in England. Even there, he told me, he had continued to be hounded by the Masons, who were preventing him from getting work and were making his life not worth living.

“And now,” he said, after I had read at least some of the exercise book, “they’re getting to me here. They’re drugging me, they don’t want me to tell. They want to kill me!

I had little difficulty in reaching the conclusion that Peter was extremely unwell, and was displaying clear symptoms of psychosis, including paranoid delusions. The consultant had already completed a medical recommendation, and another doctor had already been to assess him and had left his recommendation. Although I was unable to contact his nearest relative to discuss the assessment with her, I duly completed an application under Sec.25 for assessment (this was the 1959 Act, remember).

It felt good. It had been a comparatively straightforward assessment – the patient was already in hospital, and was displaying clear signs of mental illness. I felt I had managed the whole thing rather well

A few days later, I visited his wife to discuss the situation with her. I told her about the contents of the exercise book, and his belief that the Masons had been conspiring against him.

“Oh yes,” she said. “All that’s true. It did happen. It really got him down. We had to leave the country because of it.”

A month later I completed my second Mental Health Act Assessment when I detained him under Sec.26 of the 1959 Act, for treatment. He was still clearly unwell, but this time he had a diagnosis of depression.

1 comment:

  1. As I read this with increasing dread, recognising that amongst the symptoms described, there was going to a be kernel of truth buried in there. The NR comments in this case, plunged me back into the many assessments where post mortem assessments have left me bewildered by my decisions.

    I admire the Masked AMHP integrity and honesty as although the Sec.26 application upheld the original Sec.25 decision, there would have been a moment of dread when the NR confirmed the patient's past history of persecution at the mawling mitts of the Masons.