Wednesday, 19 January 2011

Of Animals and Mental Health Act Assessments

Animals quite often figure in a social worker’s day to day work. This is because of Sec.48 of the National Assistance Act 1948, which states essentially that where a person has been admitted to hospital or admitted to a care home and they are deemed to be unable to deal with their property “it shall be the duty of the local authority to take reasonable steps to prevent or mitigate loss or damage”. This means that a social worker may have to ensure that a house has been locked up and made secure; it also means that a social worker may have to ensure that any animals the person owns are cared for.

This has led to some unusual requests. One night when I was on call, I was contacted by the local police about a couple of New Age travellers, who lived in a traditional horse drawn caravan and would tour the commons of the county, camping for a few nights at a time at each one. They had had a fire in their caravan and it had been burnt out. They therefore needed emergency accommodation. And so did their two horses and a dog.

The prospect of finding accommodation for a couple of able bodied people at such short notice was remote. The prospect of finding emergency accommodation for two horses was virtually impossible. This called for some lateral thinking.

After a lot of ringing around I managed to contact a voluntary organisation who were able to provide a large tarpaulin and deliver it to the site. The travellers were therefore able to construct a bender using the tarpaulin and remain on the common. This meant that they could also continue to look after their dog and their horses. Problem solved.

Not all such requests are so unusual: most involve dogs and cats, having to arrange accommodation in kennels or catteries. Social workers have a list of places and organisations who are prepared to accommodate animals in an emergency, and are generally able to take these situations in their stride.

Dolores was a lady in her 60’s who lived alone in a housing association bungalow. She had a history of schizophrenia going back 30 or more years. Periodically she would decide to have a break from medication. This would then lead to a gradual deterioration in her mental state until she reached a point when she could not longer care for herself adequately and was terrorising her neighbours. I had known her on and off for about 15 years, being called on periodically to assess her under the MHA when all other avenues had been tried.

I had last seen Dolores a few months previously when she had managed to stop having her regular injection by the cunning expedient of informing her community nurse that she was moving out of the area. The local older people’s mental health service had fallen for this ruse for several months, until they were eventually alerted to the fact that she was still in her bungalow in Charwood when they started to receive reports that she had destroyed her pension book, had thrown out her furniture and all her electrical equipment, and was then arrested after she broke an elderly neighbour’s window and made threats to kill her. I had then detained her under Sec.3 MHA. After a couple of months she recovered and returned home. Since she was reluctant to have a depot injection, she was discharged on oral antipsychotic medication.

This was just what she wanted. She soon stopped taking her medication, and before long reports were again being received that she was behaving in bizarre and unacceptable ways. I was again asked to assess her.

Knowing Dolores had a cat, I had already made tentative plans for it to be looked after, and even had a cat basket in the boot of my car, just in case.

I went out with her consultant psychiatrist, her GP, her community nurse and an AMHP trainee. Dolores allowed us into the house, but was suspicious of our motives. She believed that the only reason we were there were so that we could take her bungalow from her and live in it ourselves, perhaps as some sort of mental health professional commune. She was keen to challenge her diagnosis of schizophrenia with some intriguing logical constructs which went like this:

(1) People with schizophrenia hear voices. She does not hear voices. Therefore she does not have schizophrenia.
(2) The Yorkshire Ripper has schizophrenia. She is not the Yorkshire Ripper. Therefore she does not have schizophrenia.

She took a copy of the Oxford Companion to the Mind from her bookshelf.

“I’ve read all about schizophrenia in this book,” she said. “So you can’t pull the wool over my eyes. Here. See what it says for yourself.”

She suddenly flung the book at me, which I was fortunately able to dodge. If I’ve learned anything in my years as an AMHP, it is always to be ready to take evasive action.

We took the decision to detain her under Sec.3 for treatment. This was on the basis that her diagnosis was known, it was known what treatment she required, she would not agree to that treatment being provided in the community, her presentation was entirely consistent with her usual relapse profile, and she had been detained under Sec.3 only a few months previously.

Not surprisingly, Dolores objected. In the circumstances, I felt it was wise to call the police, who very obligingly attended. She liked the police. If there’s something else I have learned, it is that older ladies who are being detained under the MHA are often partial to a man in uniform.

While we waited for the ambulance, I decided to complete the necessary arrangements to accommodate Dolores’ cat.

The cat was not happy about having a house full of strangers. The cat was also not happy about the plan to remove it. It hid behind a sideboard. When we moved the sideboard, it ran off and hid behind the curtain. When we moved the curtain it ran into the kitchen and hid under a kitchen cabinet. When I reached under to get it, it ran out of the kitchen and into the bedroom, where it secreted itself first behind the wardrobe, and then under the bed.

The AMHP trainee was keen to help. She crawled under the bed, and after a scuffle emerged triumphantly with the cat in her hands, which we popped into the cat basket.

However, this was not the only thing the AMHP trainee had emerged with. The cat had understandably been frightened by the strangers in the bungalow and by our efforts to catch it. It had been very frightened. So frightened that it had emptied its bowels under the bed. The product of this action was now liberally smeared all over the AMHP trainee’s blouse.

So while I went off with Dolores and the ambulance to the hospital, the AMHP trainee went home to have a shower and change her clothes.

AMHP learning points
1. If AMHP’s wore uniforms would they receive a better reception? Discuss.
2. Don’t ever crawl under a bed to retrieve a frightened cat.


  1. 1) I think it would definately depend on what kind of uniform. I have a picture of a male AMHP in a naughty nurses uniform. It might certainly lighten the situation or maybe even confuse it more. However, it would brighten up my day not sure you could convince me to go along quietly though.
    2) No further advice required. Poor trainee AMHP.

  2. I think a white shirt, correctly ironed of course, black clip-on tie, black epaulettes and a peaked cap would suit you just fine. Accessorised with a bunch of keys on the end of a chain. Although it's not really necessary - the mental health industry are obvious from miles away, which is just as well when you don't want to meet them.

  3. Ouch.. most of my animal stories seem to involve cats - I guess that comes from working in an inner city area! Our animal warden is fantastic and introduced me to the joys of the 'cat trap' (completely humane!).

  4. Might I suggest a little packet of 'cat treats' might just do the trick next time.

  5. 1) Possibly to little old ladies, it might have a calming effect? They might enjoy being taken away by a nice man in uniform. (I understand this is terribly un-PC, plus I didn't really notice the uniforms of the police..)

    2) I agree, my cats would just go into "attack mode"..

    outwardly x

  6. I once briefly thought that I might have been responsible for a herd of feral cows. The admin staff at work were unhelpful and my attempts to arrange temporary boarding arrangements around the team were not appreciated. Happily for the cows other arrangements were made by a family member.

  7. Peoples' response to uniforms can vary by area. Having worked in inner city Liverpool and some fairly urban bits of Wales as well as in various idyllic Welsh rural settings I can testify that the presence of uniforms gets a different reception depending on where you are. The attitude of the Police varies too and this is crucial. Rural coppers seemed more committed to hanging about and talking things out. I suppose this comes from their day to day experience that there isn't an armoured division that will tootle over the hill to save them if the situation gets inflamed. Some urban coppers seemed inclined to handcuff the AMHP let alone the poor service user in their impatience to get on. I did once attend an assessment for an older woman with nihilistic delusions who wasn't impressed at all with the variety of uniforms on display. Once of the Police Officers nearly went into meltdown when she told him he wasn't a real officer, ignored his warrant card, declined his offer to ring Police HQ and dismissed the panda car and the ambulance standing fairly fluorescently and conspicuously outside her house as being 'false'. How flimsy the roots of authority can be. I wonder if this tack would work for me if I ever got pulled over at the roadside? We resolved the situation by all hanging around until everyone was thoroughly bored and me noisily and noticeably packing a suitcase to convey the inevitability of the transition.

  8. I wonder if your old woman remembers the days when policemen were smartly dressed in tunics and therefore dismisses the current fashion of body armour and hi-viz as not a real uniform.

    Are your victims 'service users' in the same way that a rat is a 'service user' of Rentokil? I suppose as long as you get to arrest your prisoner and thus maintain your authority it doesn't matter how long or how many uniforms it takes.

  9. Hi Anonymous. I think you may have missed the traces of irony in the post.

  10. Michael SW Student1 March 2011 at 11:17

    Dear Masked AMHP,

    I would like to get in touch regarding using some content from your blog as part of a social work dissertation.

    Can you reply to this post suggesting how I can get in touch with you and send you more information? I cannot find a contact section of the blog.


    Michael Crompton.

  11. Hi Michael. Thanks for reading my blog. I have now included my email address on the right of my blog page.

  12. thanks for exposing this to world, amazing stuff! Impressive stuff!Mental Health Assessment Form

  13. What bmi would you say a person could be placed on a cto at

    1. I would say a minimum of 18-19.

    2. If bmi was 17 and section 3 was lifted and not be placed on a cto if you lost weight to a bmi of 14 and maintaining and engaging with your care team and attending physical monitoring and bloods in normal range would the team keep you in community as long as you were keeping yourself safe?

    3. Weight loss of the extent you describe would imply that the patient was reluctant to adhere to the intention of the care plan, which would tend to be to assist the patient to maintain a healthy BMI and ultimately to resolve the eating disorder.

    4. What do you mean by this if all attempts were tried as an IP. Would the patient then be able to be classed as a seed patient (severe enduring eating disorder) so they were not made to continue to reach a healthy bmi? If numerous admissions has failed and patient was reluctant to change , give the eating disorder up?

    5. I can only give you my opinion as to how I would respond as an AMHP in this situation. You really need to discuss these issues with your care coordinator, psychiatrist, etc.