Saturday, 14 December 2013

A Christmas Eve Mental Health Act Assessment

Don’t you just hate it when you’re on AMHP duty on the day before Christmas, and just as you think you can go home, you get a call?

It was an elderly man. The GP had visited Nicholas at home and was very concerned. He said that he was displaying marked delusional thinking and was also hoarding. The GP said that he appeared to have been buying large quantities of children’s toys, which he was storing in his house, and when questioned about this said that he was going to give them all away.

On the face of it, there appeared to be a number of risk factors, including self neglect and spending money he could ill afford on inappropriate goods.

I obtained a medical recommendation for a Sec.2 for assessment from the GP, and arranged to visit with a Sec.12 doctor. I also took my AMHP trainee with me.

Nicholas lived in a remote house on the outskirts of a village outside Charwood. It was a large rambling farmhouse, set in several acres of garden and paddock. As far as we knew, he lived alone.

I knocked on the door, and after a moment, the door creaked open and a large elderly man with a long flowing unkempt white beard answered the door.

“Hello, Nicholas,” I said, “Could we come in and speak to you?”

He looked distracted. “Do you think you could come back after Christmas?” he asked. “Only I’ve got a lot on just at the moment.”

Peering past him, I could see that the hallway and the room beyond were piled high with boxes and objects of all sizes, all wrapped in Christmas paper. It did indeed look as if Nicolas was a hoarder. Diogenes Syndrome? Obsessive Compulsive Disorder? It was too soon to tell.

“I’m an Approved Mental Health Professional. Your doctor is worried about you. We do need to see you today.”

He looked resigned. “Very well,” he sighed. “But not too long. I’ve got a lot to do before the night’s out.”

We entered the large, heavily beamed hallway, festooned with holly, ivy, and other traditional Christmas decorations, and he led us through into a huge farmhouse kitchen. The table and most of the surfaces were all piled high with parcels of all shapes and sizes. An Aga on one wall kept the room cosy and warm.

This was most unusual. I had never come across a case of hoarding quite like this before. Although it appeared chaotic, all the parcels looked new and were all immaculately wrapped and tied with ribbons and bows.

As I looked around, I could hear rustling noises among the parcels, and movement. It must be rats, I thought with a shiver.

“What’s moving about in the room here, among these, er, parcels?”

“They’re my helpers,” the old man replied, with a kindly smile on his face.

Mental alarms started to ring. “Helpers? Can you tell me a little more about these helpers?”

“They’re mainly elves,” he said. “Do you think I could wrap all these presents on my own?”

“Elves?” I said carefully. Just this brief conversation was confirming my suspicion that Nicolas had dementia and was hallucinating.

“Oh yes,” he said happily. “They’re always so helpful. They help me get everything ready.”

“And what are you planning to do?” I asked.

“Why, I’ve got to deliver all these parcels tonight.”

I looked around. There appeared to be literally thousands of parcels. And this was just what I could see in one room. How could he possibly deliver all of these, even if he did have “elves” to help him?

“So who will you be delivering all these parcels to?” I asked.

“Why, all the children, of course.”

My worst suspicions were confirmed. Nicolas appeared to be planning to give these “presents” to children, children whom he could not possibly know, and to whom he had no legitimate business giving presents. As well as the risks to himself, he was clearly also potentially dangerous to the wider community.

“And how will you be distributing these presents?” I asked.

“I’ve got a sleigh round the back. Do you want to see it?”

“We’d love to,” I said.

He led us out of the kitchen back door into a yard. In the middle of the yard was a large wooden sleigh, complete with runners.

“But there’s no snow,” I said gently. “This sleigh wouldn’t work, would it?” I was trying to see if he still had even the slightest grasp on reality.

Oh, that’s not a problem,” he announced proudly. “My sleigh doesn’t need snow, because it will fly through the air!”

“Fly through the air?” I repeated.

“Why yes! You see, it’s a magic sleigh! Magic will allow me to fly all around the world, giving out presents to every child!”

I had heard enough. We made our excuses and retired to my car, where the doctor completed his recommendation and I filled in my application.

When I told them about his plans to visit children in their homes, the police were very obliging and turned out to ensure that Nicolas went into the ambulance without a fuss.

“But what about all the children?” Nicolas cried mournfully as he was assisted into the back of the ambulance.

“What about all the children indeed,” I thought to myself. While the distraught look on his face made me feel a little sad, I knew that I had done the right thing.

I made sure the house was secure, and looked around outside. I saw a large stable on the other side of the yard, and peeped inside. “Uh oh,” I thought, my heart sinking. Then I had an idea.

“Here’s a job for you,” I said to my AMHP trainee. “Under the Protection of Property regulations, we’re going to have to accommodate nine reindeer! And judging by the condition of its nose, one of them is going to need checking out by a vet!”


  1. Fantastic! Merry Christmas to all those dedicated AMHPs, S12's, Police Officers, ambulance crews and others I may have forgotten x

  2. I'm sorry the police lack available resources to convey because it's Christmas Eve - we're currently dealing with a large volume of alcohol related disorder so as the duty inspector, I've over-ruled the officers who said they'd help get him in the ambulance. Anyway, we'd had reports (from local children and their parents) about three out-of-place individuals skulking around Nicholas' house, looking shifty with clipboards and leather satchels. We tried explaining that we'd been given notice of a medical assessment, but had to agree it seemed unusual because it's happening out of hours on Christmas Eve!?

    We will have a unit free tomorrow after the Queen's Speech, perhaps we could convey him then? Anyway, on behalf of the children of the world, we decline to accept your delegated authority under s6 MHA because we know Nick of old and we agree with the kids: you've over-medicalised his situation here and tried to shatter their dreams on Christmas Eve!

    So to prevent a world-wide riot, we will be unable to help on this occasion ... or at least until we've scoffed more mince pies. ;-)

    Merry Christmas, Sir - hope to meet you in Wales in March, if they get it all sorted out!

  3. Brilliant loved it, sounds just like where I used to work! Typical though giving the hardest job to your student

  4. Could Nick have gone in informally as he seemed cooperative with staff?