Wednesday, 5 May 2010

Just One More Section 4

Sometimes the sheer grinding unfairness of it all can seem almost overwhelming…

I had known Pam for over 10 years. She had a diagnosis of borderline personality disorder. She had had a terrible life. She had been very badly sexually abused by her father as a child. Her escape from the abuse at home had been to deliberately commit offences in order to be given youth custody – it seemed terribly sad that a juvenile detention centre was seen by her as a place of safety and comfort.

Once she became an adult, she moved into a local hostel, where she lived for several years. She would manage quite well for months at a time, but then some untoward life event would take place, and this would precipitate her into a downward spiral of hopelessness. Her main coping strategies at these times were to starve herself and abuse alcohol.

During this time, a brief relationship resulted in perhaps the only good thing that had happened to Pam – she gave birth to a son. She obtained her own flat, where she lived with her son with comparatively little support for about three years. She even got a job in a cafĂ© in Charwood.

Then her employer raped her. Pam’s response to this was to hit the bottle and to stop eating. She became thin and physically weak, and eventually stopped taking even fluids. She was no longer able to look after her son.

Over the years she had been detained under the Mental Health Act on several occasions for varying periods of time, but this time I managed to find respite care in a nursing home for her. She accepted this, and her son went into temporary care with foster parents.

The brief respite turned into a longer placement. She responded very well to the rehabilitation programme, and after a few months she was ready to live independently again. We helped her get a housing transfer out of Charwood, and she moved into a new house in a new town away from bad memories, and her son was returned to her. Although this town was in the area of another Mental Health Trust, the plan was for Charwood CMHT to keep her on until she was more settled.

All was well for a couple of months. Then she got a text message from the man who had raped her (although we didn’t know about this till later). She saw her world falling apart again. She responded in her usual way. We tried to reason with her, but she could not see that abusing alcohol and starving herself was putting herself and her son at risk.

A day or so later, Pam rang Children’s Social Services to say that she was too drunk to pick her son up from school and could they send a social worker to collect him?

Not a good plan. Their response was to get a Police Protection Order and remove her son to foster carers. They then visited her to let her know what was happening. Pam told them in no uncertain terms that she would kill herself. Late in the afternoon, they asked me to assess her under the Mental Health Act.

I went out straight away to assess the damage. Her support worker was with her. Pam was very drunk and very hopeless, and very physically weak and frail. I could not reason with her. She was intent on killing herself if left alone. As far as she was concerned, the removal of her son was the end of the world. She had nothing at all left to live for.

There was no way we could leave her like this. She needed to be in hospital. And there was no way she was going to agree.

I rang Woodland House to arrange a bed. There weren’t any.

I tried to contact Pam’s consultant, but he was unavailable, and his mobile was turned off. I spoke to the duty doctor. Although Pam was still under the Charwood CMHT, since she was no longer living in the Mental Health Trust catchment area, they refused to come out to assess.

I rang the duty doctor for the Mental Health Trust covering the town she now lived in. He, too, refused to come out – because she was not their patient.

Things were not looking good. I went to see the GP who had been out to see her earlier. I decided that the only option in the circumstances was to go for admission under Sec.4. The GP gave me a medical recommendation.

But before I could complete the application, I had to get a bed.

I rang Woodland House again. They still had no beds. Not even for a Sec.4. They said they’d try and find one and get back to me as soon as possible.

I went back to Pam’s house to provide some support to her support worker, who by now was beginning to flag. Judging by the number of empty cider bottles in the kitchen, Pam must have drunk going on for 4 or more litres of strong cider that day, at least until the middle of the afternoon. Fatigue and the effects of the alcohol were beginning to kick in. I told her what was happening. She hardly responded. I think by then she just wanted an end to it all, whatever that end might be.

I did not get a call from Woodland House until two hours later. They had at last found a bed. But it was in a private hospital. 70 miles away.

By now I was beginning to feel almost as tired and despondent as Pam.

I rang the private hospital and spoke to the bed manager. She wanted more information so that she could decide whether or not to admit. Whether or not to admit! I did not feel happy at this suggestion, and shared this with her.

I spoke to the hospital’s duty doctor. He began by insisting on an assessment by Pam’s Consultant before accepting admission. I pointed out that if such an assessment had been possible, she would not be being admitted under Sec.4. It appeared to be an issue more to do with whether funding had been arranged than whether she needed admitting.

It took the private hospital another half an hour before they eventually agreed to the admission. By now it was 9.30 pm. I had received the request at 5.00 pm. Section 4’s were not supposed to take this long. And I still had to physically get her to the hospital.

Having finally obtained a bed, I then had to arrange transport. Should I get an ambulance to take her, I wondered? I considered this for all of 10 seconds before dismissing it. It is not uncommon in our area to have to wait two hours for an ambulance to take a detained patient to a psychiatric hospital. And that’s if it is the local psychiatric hospital. To get an ambulance to take a patient to a hospital two counties away was even more fraught with difficulties.

I decided to take Pam myself. By now, she was very drowsy, and very unlikely to put up much resistance to being taken to hospital. I asked very very nicely, and her support worker agreed to act as escort. And so eventually, at nearly midnight, Pam was admitted to a hospital bed.

Then all I had to do was drive the 70-odd miles home again. And of course taking a detour to drop off the support worker back at her car on the way.

Unexpectedly happy ending
Yes, there is a happy ending to this story. Pam spent about two months in hospital, the Sec.4 being converted to a Sec.2, and then a further application being made for Sec.3. She eventually went back to her new home. I managed to transfer her care to the local community mental health team. She got her son back. And 8 years on, he’s still with her.