During my years practising first as a Mental Welfare Officer, then as an Approved Social Worker and now as an AMHP, I’ve been in a few tight spots (being chased round a bungalow by an old man with dementia brandishing a shotgun being one that springs to mind). However, I have only rarely been actually physically assaulted. I like to think that’s because I know how to keep myself safe and de-escalate potentially violent situations, but perhaps luck also has something to do with it. When I look at the situations in which I was assaulted, generally I can recognise that I’ve made mistakes of judgment (although sometimes they are completely unpredictable).
I’ve already mentioned Derek in my August 2009 post, The Mental Health Act Assessment of Fear. I would certainly count what happened there as a physical assault. In fact, there’s something uniquely repulsive and invasive about someone spitting into your face. Over the next couple of posts I’ll write about some other memorable incidents.
Violet was 93 years old. She lived alone, with no other living relatives. She was suffering from dementia. Although she was remarkably physically fit for her age, she was forgetting to eat, was going out at night and forgetting where she lived, and was generally putting herself in danger. She had also become quite paranoid, and although she had initially accepted home care from social services, she had begun to accuse them of stealing things from her house, and had stopped letting them in. Her social worker was becoming increasingly worried about her, as it was only the home carers who were ensuring she was eating adequately.
When her GP, the old age consultant psychiatrist, her social worker and I arrived at her house early in the evening and knocked on her door, at first there was no reply. We could see her peering round the curtains, but she wouldn’t come to the door. However, while we discussed what to do next, her curiosity clearly got the better of her, because she opened the door. Recognising her GP (GP’s often seem to have a supernatural ability to persuade reluctant patients to cooperate with assessments), Violet decided to let us in.
At first, Violet listened politely to us as we asked her questions and tried to reason with her. She made an effort to answer us, but her answers made little sense. She wanted to defer a decision until her husband came home from work (he had died 20 years previously); she didn’t need home care because her daughter did all her shopping for her (she had never had children); she never went out after dark (the police had had to bring her home in the early hours on several occasions). It was clear that her dementia was quite advanced.
Once we had completed the interview, we withdrew into her kitchen to discuss our conclusions, and then completed the forms for detention under Sec.2. Then it was my job to tell her what was going to happen next.
Violet again appeared to listen politely to me. However, when she realised that our intention was to admit her to hospital, she became quite irate, insisting that she was as fit as a fiddle and that there was nothing at all wrong with her. The doctors made their excuses and left, leaving her social worker and me to manage her while waiting for the ambulance.
I continued to try to negotiate with her and prepare her for the arrival of the ambulance. She ran to the top of the stairs, then rather impressively high stepped down the flight of stairs, saying, “Look, look! There’s nothing wrong with me, is there young man?”
She then ran straight upstairs again and went into a bedroom. I followed, rather more slowly. When I went into the room, she was standing behind the door and was holding a full roll of wallpaper in her hand. While I tried to work out what was happening, without warning she swung the roll at me like a baseball bat, and hit me with surprising force on the side of the head.
For a moment, I reeled sideways and nearly fell over, completely disoriented. Full rolls of wallpaper pack quite a punch, and although I was not significantly injured, I was certainly in pain.
I staggered down the stairs just as the ambulance crew arrived.
“So we’ve got a 93 year old lady, have we?” the ambulance man asked, looking at his paperwork.
“Yes,” I replied, rubbing the side of my head, which now had a noticeable contusion. “But you need to be careful, she’s quite aggressive. She’s just hit me.”
The ambulance man looked at Violet, who was again high stepping on the stairs, and then looked rather pityingly at me.
“I don’t think we’ll have too much trouble managing her,” he said slightly condescendingly, and proceeded towards her up the stairs.
“Hello, Violet,” he said, smiling insincerely as he approached her, holding his hands out. “We’ve come to take you to hospital.”
“Oh no, you’re not,” she said, and punched him on the nose.
The ambulance man fell backwards, bumping down the stairs and clutching his nose, which was bleeding. His colleague rushed up the stairs, getting past her, and then grabbed her from behind, clutching her round the waist and pinning her arms against her sides.
“Quick, grab her legs!” he shouted at me.
I was a bit taken aback. I don’t normally make any physical contact with patients in my role as an AMHP (or as a social worker, come to that), but instinctively did as I was told, gripping her ankles, and between the two of us we managed to carry her downstairs, despite her objections and struggles. The ambulance men then strapped her into a chair and wheeled her into the ambulance.
“And let that be a lesson to you, you ruffian,” I heard Violet say triumphantly to the injured ambulance man as they closed the doors.
Moral: Never underestimate the capacity of a 93 year old lady to inflict significant harm.