I wrote about Jenny in my blog in July 2009 (“God told me not to answer the door!”) Jenny had the dubious distinction of being the person I have assessed under the MHA more than any other, a total of 11 assessments over a 7 year period. She has now extended her record, which is becoming unassailable.
Assessment 12: After 18 months without hearing anything about her (she was being managed by the Assertive Outreach team – a specialist mental health team who work with patients who have problems with disengagement from services or non compliance with medication), I had a call from their consultant. There was growing evidence that she was becoming unwell again. Workers were reporting that Jenny believed that her brother-in-law was a hacker working with MI5 and was watching her internet activities. She has also said that she had been freaked out by a Whitney Houston video where Whitney was singing a song about her. She had subsequently refused to let workers in to see her.
Jenny was told we would be visiting her to assess her under the Mental health Act yet again, and somewhat surprisingly she agreed to this. So the following day her consultant, another psychiatrist and I turned up at her door.
Sue answered the door and let us in. Jenny was cooperative and pleasant throughout the interview. There was little evidence of active psychosis during the interview – the only matter of possible concern was her freely disclosing that she engaged in sexually explicit activities on a webcam. There was evidence that she had been taking her medication. She appeared sedated and said that she had taken a double dose the previous evening. She agreed to continue to engage with the Assertive Outreach Team and agreed to an increase in medication. She said that she had not had any cannabis for about a month, but this was more through lack of supply than lack of desire. She did admit to having used speed recently. We were there for about 45 minutes, during which she remained friendly and cooperative and did not display any of her usual symptoms indicating relapse. We could not justify detaining her on the basis of this interview.
Assessment 13: However, things were somewhat different a month later. Her consultant reported that since Assessment 12 her relatives were reporting increasing concerns about her mental state. She was engaging less with the Team, there was evidence that she was not taking her medication, she was reported to be drinking alcohol, which is unusual for Jenny, and most worryingly she now had a supply of skunk again, which usually makes her worse. There had been more damage to her house – breaking a window and smashing belongings – again this was a typical part of her relapse signature.
She was contacted and told we would be conducting another formal assessment, and the next day we were standing in the snow again knocking on her door. She let us in, but, unlike the previous occasion, she was immediately hostile. There was evidence in the house of damage, including the kitchen door hanging off, holes in the kitchen wall, a broken window in her living room and a broken mirror. She sat in the kitchen rolling a joint from a large bag of herbal cannabis and then proceeded to smoke it while we were attempting to interview her. As the kitchen filled with the aromatic smoke she told us that she was no longer mentally ill and did not need medication or further involvement with mental health services. Cannabis was all she needed to keep her well. She was very preoccupied with people she knew who might be paedophiles, and made several loud and explicit allegations which seemed unlikely to be true. She identified me as the principle villain on this occasion, shouting and swearing at me and making an inventive threat – she told me darkly that she had a copy of my death certificate, signed and dated. After about 20 minutes, Jenny ordered us out of the house. We had had enough, and were glad to leave.
We retreated to the warmth of my car to discuss our assessment, and within a few minutes we had completed the paperwork. I went back to her to tell her what was happening. She refused to open the door and swore at me through the letterbox.
I called the police for assistance, fearing that I might have to get a magistrate’s warrant (Sec.135) in order to enter her house and take her to hospital. The doctors having made their excuses and left, I sat in my car and watched from a discrete distance as the police knocked on her door. To my relief she let them in.
I followed inside after a few minutes and explained to Jenny that she was now detained and would have to go to hospital. By now she was somewhat calmer – the spliff she was smoking freely in front of the police when I entered may have helped – and was becoming resigned to the inevitability of her admission. She would not come with me (I had an escort with me), but said she would allow the police to take her. However, she wanted everyone out of the room while she packed a bag. I realised that this was so that she could find some way of concealing her stash and smuggle it onto the ward (she had managed this in classic drug mule fashion in the past) and alerted the police, who persuasively offered to look after it at the police station for her.
I think I am now becoming as resigned as Jenny to another knock on her door sooner or later in the future.