Rule One: Keep at a Safe Distance

The course of an assessment under the Mental Health Act is quite often unpredictable: this one, although it took place some years ago now, particularly sticks in my mind.

I was on night duty one evening when I got a call from the local police station. They had a man detained under Sec.136 – this is when a police officer who finds someone in a public place who “appears to him to be suffering from mental disorder and to be in immediate need of care or control” can “remove that person to a place of safety”. Nowadays there are usually specially designated places of safety on hospital sites where people can be taken to be assessed, but back then a police station was the usual “place of safety”.

There was nothing at all known about Andrew except for his name, age (30) and address. The police had been called to an incident in the street outside his house. He had resisted all attempts to calm him down, and then started to atack the police who had attended. The police had found his house in a squalid condition, floors covered with dog faeces and rotting food in the kitchen. His electricity had been disconnected long ago. He had a rather neglected looking dog which was taken to a boarding kennel. There was no record of any previous psychiatric involvement, and he did not even seem to be registered with a GP.

I assessed him with two doctors. As we approached his cell he could be heard talking to himself and making odd noises. He abruptly stopped as we entered and looked at us with some hostility. I was glad we also had a police officer with us, and kept at a safe distance.

Andrew was unable to concentrate on what we were saying, and was unable to give us any information about his home circumstances, relatives or friends. He stared straight ahead most of the time, and after a while he began pacing the cell and breathing increasingly heavily, forcing the breath in and out through his clenched teeth until he began to foam at the mouth. This was disturbing.

We reached a tentative conclusion that he was experiencing a hypomanic episode. The state of his house seemed to indicate that his mental health had been deteriorating for some time. It was possible that this was a drug induced psychosis, but he had vehemently denied illegal drug use when asked. Either way, he needed further assessment and was in no state to give informed consent to this, so we completed an application under Sec.2.

I informed Andrew of the decision and explained to him that he would be taken to hospital by ambulance. Surprisingly, he seemed quite happy about this, followed us meekly out of the cell and strolled down the corridor flanked by two police officers.

I left the police station to get to my car, which was parked outside the police compound. I watched as an ambulance backed up to the rear entrance, from where Andrew and the two officers were emerging. One of the ambulance crew got out and opened the ambulance doors, and then stood there in the orange light of the sodium compound lights, waiting for the group to approach.

I watched as Andrew suddenly broke free from the police officers and lunged forward. I watched as the ambulance man folded up when Andrew’s head connected with his stomach, and the two disappeared into the ambulance. I watched as the police officers dived into the ambulance after them. I watched as the ambulance began to shake violently and two other police officers dived in. Then the ambulance doors were suddenly closed from inside, the blue lights started to flash, and the ambulance sped off to the hospital.

This broke me out of my stunned state. I quickly got into my car and followed the ambulance to the hospital, where it parked right outside the admission ward. One of the police officers opened the ambulance doors and went to the ward. He returned with two male nurses and the duty doctor. Even though Andrew was being restrained by three police officers, he was still struggling, causing the ambulance to shake constantly. The nurses restrained him some more, while the doctor administered an injection of intramuscular Haloperidol, of a dose considered more than sufficient to incapacitate him.

Andrew continued to attempt to struggle, hissing and panting through his teeth all the while, flecks of foam landing on the arm of the officer closest to his head. I saw that somewhere along the way he had incurred a head injury, and blood was oozing down his face. The officer nearest him also had a cut over his eye, which was also oozing blood. There seemed to be quite a bit of blood in the ambulance.

After 15 minutes, the doctor decided that the injection should have taken effect and they attempted to try and transfer him into the ward. But as they momentarily adjusted their grip on him, he took the opportunity to make a break for it, and very nearly got away.

It took another injection and another 20 minutes of relentless restraint before he was sufficiently sedated to be transferred safely into the ward.