Tuesday, 3 August 2010

Vanessa – A Postscript

In my last post I talked about my experiences nearly 20 years ago with Vanessa, a woman with bipolar affective disorder. There’s a little more to the story.

Following her detention under Sec.3 Vanessa made a very good recovery – although she continued to harbour paranoid and delusional thoughts focused on me. Because of this, I made sure I kept a low profile. She remained a patient of the CMHT for a few years, was detained on one more occasion, but then, as she remained stable, she was eventually discharged.

Mental Health Services had nothing more to do with Vanessa for another 17 years. Then out of the blue the GP referred her to the CMHT again. He was concerned about her, as in the previous 7 days her presentation had changed markedly: she was becoming increasingly irritable, suspicious and paranoid, was experiencing poor sleep, was not eating, had lost weight, and was reported to be exhibiting pressure of speech.

I had not forgotten her. I continued with my policy of being invisible as far as Vanessa was concerned, and made sure another member of the Team saw her. As she was so unstable, the Crisis Team became involved, but she refused to cooperate with them. One evening over the weekend the police were called after she made threats to kill one of her neighbours, and she was detained under Sec.136 and taken to a place of safety for assessment. However, when assessed (and without access to any background knowledge) she presented as calm and rational, and was allowed to go home, with her assurance that she would engage with the Crisis Team in home treatment.

When they visited, however, she was again uncooperative, and appeared hypomanic and irritable, still expressing paranoid ideas about her neighbour, and waving a rolling pin around in a threatening way. Eventually, she forcefully told the Crisis Team to leave, although not in those words (I do try to avoid the use of the word “fuck” in this blog if I can help it). Her sons, who were now in their 20’s but still living with her, were also expressing anxieties about her behaviour, and were saying that they could not cope with her any longer. An assessment under the Mental Health Act was becoming inevitable.

Unfortunately, when the request came, I was the only AMHP in the team available.

Not without a degree of trepidation, I went to her house with her Community Nurse and two psychiatrists, both of whom fortunately knew her.

17 years on, here I was again at her door. I determined to take a back seat and be as invisible as possible. If I went in behind the others, she might not even notice I was there.

Yeah, sure.

“What the fuck are you doing here?” she said to me, glaring venomously past the others and fixing her eyes on me.

Determined to avoid confrontation, I said, “Look, I’m here because I have no choice. I will respect your wishes if you don’t want me to stay. I’m happy to leave right now.”

I moved towards the living room door.

“You’re not going anywhere,” she said. “Stay here where I can see you.”

I perched on the arm of a sofa, as near the door as possible, ready to make a quick – very quick – exit if required.

“I didn’t tell you you could sit down,” she said, so I stood up again.

“I hit him once,” she said to the nurse and the psychiatrists. “Didn’t I?” she glared at me again.

“You certainly did,” I replied meekly.

“Are you being fucking sarcastic?” she growled.

“Honestly, I’m not.”

“Perhaps I should hit you again. I’ve a good mind to hit you again. It’d teach you a fucking lesson about not being sarcastic when you’re sectioning someone.”

Vanessa looked around at the others. “Do you know what happened the last time he came round here?” she began. “He told a joke. Do you know what he said? He certainly wasn’t very fucking professional. He said: ‘What’s the difference between a social worker and a Rottweiler? You get your kids back from a Rottweiler.’ What sort of a joke is that for a social worker to tell a single parent with kids? It’s fucking outrageous! He should have got the sack!””

I began to feel offended. She had misremembered. She had forgotten that it had been her who had told the joke, not me! Over all those intervening years, whenever she had thought about that particular day she had it fixed in her mind that it had been me who had told the joke. If she had ever told a friend about that day, she would have told them her account of the story.

I didn’t want the other professionals to think I might have been so unprofessional as to tell jokes during a Mental Health Act assessment. But I knew that if I disagreed with her it would inflame her still more.

I felt that my presence in the room would only make things worse. She might be more reasonable if I were absent. Without saying any more to her, and without waiting for her permission, I left the room.

One of her sons was in the hallway, keeping out of the way. He indicated to me to come into the kitchen with him.

This worried me too. What would be his memory of my last visit to this house? Would he blame me for what had happened?

“I really didn’t tell that joke,” I said to him. “It was your mother who told that joke to me.”

“Yes I know that,” he replied reassuringly. “I do remember how ill mum was back then. But I haven’t seen her like this for years and years.” He was clearly upset by it all

We talked things over. Since I was still the AMHP in this assessment, I obtained more information from him about her mental state over the last week or so and possible precipitants or triggers, and discussed with him the possibility that she may be detained again. He was completely happy with this.

I slipped out to my car, and waited for the others. I was satisfied that she needed to be admitted to hospital. Her presentation was exactly the same as it had been all those years ago.

But in the end, it was all a bit of an anticlimax. Once I had left, she became much calmer. After further discussion with the psychiatrists, she agreed to an informal admission. Detention under the Mental Health Act wasn’t necessary after all. She even agreed to the nurse taking her to the hospital. And that’s what happened.

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