Saturday, 11 July 2009

My First Mental Health Act Assessment (Part III)

On 28th September 1983 the 1959 Mental Health Act was rescinded. I ceased being a Mental Welfare Officer and on that day became an Approved Social Worker. It certainly sounded more modern, as did the 1983 Mental Health Act itself, which incorporated more human rights safeguards in the process of compulsory detention in hospital.

As well as having a few more assessments under the 1959 Act under my belt, those to be designated as ASW’s had actually had some training in the new Act, so this time I felt a little more prepared when I received my first request for an MHA assessment under the 1983 Act two weeks later.

I was on call, and the request came in the early evening. Her name was Emma. She was in her 30’s, married with two young children, with a diagnosis of bipolar affective disorder. She had been seen by her GP earlier in the day, but had removed herself from his presence when it looked as if he might be considering admitting her to hospital. She was now in a police station about 25 miles away from the town where I worked, detained under Sec.136, having been removed to a place of safety from a public place by a police officer who had reason to believe she may have been mentally disordered. She therefore had to be assessed by an ASW and a medical practitioner.

(All the sections in the 1959 Act changed in the new 1983 Act – Sec.25 became Sec.2, Sec.26 became Sec.3, Sec.29 became Sec.4 – with the exception of Sec.136, the only Section the police could impose, which remained the same. We ASW’s assumed it was because the police would never be able to remember a new number, but perhaps we were too cynical.)

Before I went out to see her, I took the precaution of visiting the GP, who was still in surgery, and got more information. She had been going high for a few weeks, and had managed to obtain a bank loan, purchase a franchise with an international cosmetics chain, and had opened an office in the town, despite having no experience in this field whatever.

I obtained from him two medical recommendations – one for Sec.2, and another for Sec.4 – just in case – and then set off for the police station.

When I interviewed her, Emma seemed quite calm. She was clearly extremely tired, having not slept for several days, but sensibly recognised that it would be a good idea to go home, take some medication, and get some sleep.

I decided that, having assessed her, she did not need detaining, and could therefore be discharged from the Sec.136. The police sergeant thought otherwise. He had read Sec.136 of the Act, which stated that the purpose of detention under Sec.136 was for the person “to be examined by a registered medical practitioner and to be interviewed by an approved social worker”. Since she had not been examined at the police station by a medical practitioner, he could not allow her to leave the police station. He was probably right. However, my interpretation of the Act at that time was that since she had been assessed by a medical practitioner that day, she did not need assessing again by another medical practitioner in order to fulfil the requirements of Sec.136.

After a considerable and sometimes heated discussion, he acceded to my superior knowledge and allowed me to take her back to her home town, with a female special constable as an escort.

What an interesting journey that was. Once we had set off, Emma started to go high again. I realised that she was rapid cycling. As we drove, she became more and more charismatic, and even appeared to physically increase in stature. It was an awe-inspiring sight. A messianic glow seemed to emanate from her being as she told us about her plans for world domination through the cosmetics industry. I was becoming steadily more alarmed the more I drove – would the car be big enough for the three of us, or would she continue to inflate indefinitely until the car burst asunder? The female special constable however, with very little experience of mental illness, was drawn completely under Emma’s spell. Not only did she take issue with my opinion that Emma was mentally unwell, but she was even considering investing her life savings in Emma’s scheme.

At last we arrived at her home. By then I had serious misgivings about leaving her with her husband and children in this state, and when her husband saw her, I could tell he was even less happy than I was. She had no intention of taking her medication and going to bed; she was instead going to her new office to order even more of the cosmetics, right then, and then she was going to see her solicitor to get a divorce.

I knew that chaos would ensue if I were to leave her, and in those days without mobile phones I suddenly felt extremely tired and lonely and isolated. Why on earth did I ever decide I wanted to be an ASW?

In an attempt to regain control of the situation I calmly but firmly indicated to her that this was not a wise thing to do, that she was extremely unwell, and that she really had no option but to go to hospital. Somewhat to my surprise, she agreed that I could indeed take her to hospital, so before she could change her mind I marched her to the car, again accompanied by the female special constable, who by now realised that something was severely amiss with Emma and was now reluctant to sit next to her, or even be in the same vehicle, and drove the 15 miles to the hospital, knowing that if I could get her safely ensconced on the ward, then if necessary we could keep her there on a Sec.5(2).

By 11.00 pm we arrived at the hospital, and we walked down the long, dim, silent corridors until we at least reached the ward. I sat her down in the nursing office with the admitting nurse, beginning to allow myself to feel relief. This was when she drew her trump card.

“I’m not staying,” she said.

“But you agreed that you would go to hospital.”

“I agreed that I would go to hospital. I didn’t agree that I would be admitted!” She gazed at me in triumph. She had outwitted me.

But I had my own trump card. I left the room for a few minutes, filled in a form, and returned.

“Emma,” I said to her, “you are now detained under Sec.4 of the Mental Health Act 1983. That means that you have been admitted for assessment for up to 72 hours. There is no right of appeal against that decision.”

The Consultant converted this to a Sec.2 the following day, which of course did provide her with the right to appeal. So two weeks later I had my first Mental Health Review Tribunal of the 1983 Act. But that’s another story.

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