Wednesday, 16 September 2009

Ones That Got Away (Or Tried To) Part I

I already knew Ian. At the beginning of the year I had been called out to assess him at his flat. His family had contacted the GP because he had been saying "funny" things, and his behaviour had become increasingly odd. He was very paranoid, and had been carrying a hammer around for protection. He had told his family that he believed he was being gassed, that gas was coming out of the electricity fittings, that people on TV were talking to him, that he was "not going to be here much longer" and was "going to die". He was becoming increasingly reluctant to allow even family members into his flat.

By the time I got there with the psychiatrist, his doctor and his mother it was after dark. There was a surreal atmosphere. Ian lived in a first floor flat, and some of his furniture was stacked up outside on the balcony. His mother had a key and unlocked the door when there was no reply. We entered the darkened hall, where an armchair was lying on its side. The flat was in darkness, all the bulbs having been removed from their sockets. I managed to find some bulbs and turned on some lights so that we could continue the exploration of his flat.

We eventually found Mark in his bedroom. He got out of bed, apparently unconcerned about his lack of clothing, but was very keen for us to leave. He refused to talk to us and insisted that we leave. He appeared very agitated and suspicious. The flat was generally in a very untidy state, which his mother said was not normal for him. On the balance of probabilities we decided that he needed to be admitted to hospital for assessment, and he was detained under Sec.2.

A few weeks later I assessed Ian on Bluebell Ward. There was more evidence of his paranoia and unstable mental state. He talked to me in more detail about his conviction that the whole town were watching him on their TV’s, and discussed his obsession with unarmed combat and the SAS.

He was detained for treatment under Sec.3, was started on an antipsychotic, and after a couple of months was discharged. However, before long he started to default on his appointments with his community nurse, and we were fairly sure that he was not taking his medication.

Things came to a head in the early winter of that year. His family were again reporting concerns about his behaviour, and it appeared he was paranoid again. Another social worker had conducted an assessment, which had been inconclusive because he had been very guarded about his replies.

But concerns continued to mount, and so I found myself outside the door of his flat after dark once more, in the company of the psychiatrist, his GP, his mother and the community nurse. There was again a surreal atmosphere – this time, I noticed that there were blown hen’s eggs with little faces drawn on them situated in strategic places on his balcony. It was almost as if they were keeping watch for him.

This time Ian was a little more welcoming, with a fa├žade of friendliness. He allowed us into his living room, where he told us that everything was fine, that he had not needed any medication, and that he had not had any recurrence of his earlier symptoms. He had an air of confidence about him, perhaps created by having survived the previous assessment. But I had already assessed him twice, I knew a fair bit about his delusional beliefs and odd behaviours.

I asked him about the eggs on the balcony. He suddenly looked very unhappy.

“They’re just eggs,” he said. “I like eggs.”

“But you’ve drawn faces on the eggs. What does that signify?”

He looked lost for a reply, seemed to cast about mentally for a response, and then somewhat to our surprise he took out a long hunting knife, waved it about in a very threatening manner and told us all to leave his flat.

We left.

I called the police and explained the situation to them. We had decided that he needed to be detained, and clearly we needed their help.

This was when the police decided to take control.

“We’re going to have to treat this as a siege situation,” the duty Chief Inspector told me. “We’ll need a task force and a trained negotiator. It’ll take us a little while to get them together.”

So for two hours we waited on the ground outside his flat, looking up at his balcony, wondering what was going on in the flat, and feeling rather cold in the late November drizzle.

Then suddenly things started to happen. From around a wall an armed response officer emerged, dressed in full riot gear, cradling a rifle in his arms, and crouched down, pointing it at the flat. A similarly armed colleague chose another vantage point. This was the first time I had ever encountered armed police during an assessment under the Mental Health Act. The sense of unreality about the whole thing went up several notches.

Residents of the other flats started to notice what was going on, and leaned over their balconies, watching intently, talking among themselves.

A van arrived and 6 officers dressed in full riot gear, with riot shields, piled out. A female officer in plain clothes arrived in another car, and introduced herself as the negotiator.

Ian’s mother, understandably shaking, gave them the key to Ian’s flat, and we watched as the riot squad went up the stairs, put the key in the door, and then piled in, riot shields and torches in front of them. I could see their torches flashing as they went from room to room. He must have taken out the light bulbs again. Then they emerged onto the balcony, shaking their heads. He wasn’t there.

At some time in the previous two hours, while we had been watching his front door, he had made his escape by jumping out of a window on the other side of the flat and had gone to earth.

I lodged the section papers with Bluebell Ward, and made sure the police were aware that he was a detained patient and that they should take him directly to hospital if they happened to find him.

And sure enough, a few days later, he was found in the woods, having been living rough just as he had learned from his study of the SAS, living in a bivouac made of branches, and catching, skinning and cooking rabbits with the aid of his rather large hunting knife.


  1. I was just wondering, did you have a warrant the first time you saw Ian?

  2. If a relative is happy to take the responsibility of allowing professionals access to a house, then it would not be necessary to obtain a Sec.135 for a police officer to enter the premises. I would only apply for a Sec.135 if there was no other way of gaining access. I have had several situations in which the relative has assisted in gaining access. I have even had siutations where a police officer has used other methods of gaining entry to a property -- for instance by fishing a key out through a letterbox with the aid of a coat hanger! It is often a matter of considering what may be in the best interests of the patient -- on one occasion I climbed in through a window when I could get no reply because the patient had phoned me to say they had taken an overdose. I found them unconscious and called an ambulance.

  3. Mm.. sounds like the law may be applied differently around the country. If entry is refused or refusal is anticipated, then I think a warrant should be applied for. The warrant allows our legal presence in a person's private space, and is not merely, like a coat hanger, a practical device to gain entry. But then maybe we're overly pedantic in our authority.