Tuesday, 19 July 2011

Lenny: A Life and Death in the Mental Health System – Part 1

I’ve thought a lot about Lenny over the last few years since his death. I’ve thought about writing his story on this blog for a long time. I feel that I need write about him, since otherwise, Lenny and people like him tend to get forgotten, as if they had never existed. But Lenny did exist, and so this is his life story. This is too long for a single post, so Part 2 will follow in a few days.

I can’t really say much about his early life, as he always refused point blank to discuss anything about his childhood, and would become agitated and distressed if he was pushed about this. All I know is that his parents separated when he was 13. After his parents’ divorce, he lived with his mother.

Lenny first became a patient of psychiatric services at the age of 14, when he was assessed by the Child and Adolescent Mental Health Service (CAMHS). Was there a connection between his parents’ divorce and the beginning of his mental health problems? If so, it was not identified. They diagnosed him with depression, noting that there appeared to be an unhealthy relationship between him and his mother, but at the time no further treatment was offered.

When Lenny was 16 he was admitted to psychiatric hospital, again with a diagnosis of depression, and was followed up this time after discharge. When he reached the age of 17, he was transferred to adult mental health services. That was when I first met him. By now, he was living with his father, who had remarried, after his mother went off to “find herself” in some sort of therapeutic community. The main reason I was asked to see him was because things were becoming increasingly difficult at home, as he did not get on with his step-mother, and this was affecting his mood. I arranged for him to move into a hostel in Charwood.

Lenny lacked skills in making friends, and remained quite isolated within the hostel. He found it difficult to fill his days, but was reluctant to engage in activities that might improve his self confidence. He refused to have any therapy, and used to blow his benefit money on alcohol each week, and spend the next day or two drunk. During these times, he often also took fairly minor overdoses, which he would then tell everyone about, or would try and provoke other hostel residents.

At that time I was on the management committee of the hostel, and the committee members used to have regular fortnightly dinners with the residents. I came to know Lenny quite well, although he always remained suspicious of everyone, and never allowed anyone to get close to him in any way.

Over the 13 years I knew Lenny, I had to assess him under the MHA on a total of 8 occasions. Initially, these were following overdoses. The first two assessments did not result in an admission – there was no real suicidal intent, and hospital admission would not have achieved anything therapeutic.

This behaviour continued, but was generally tolerated by the hostel staff, the committee and the residents. It was simply what Lenny did.

One day, however, when he had been at the hostel for 3 years, and was approaching 21 years of age, he went to a day centre he sporadically attended armed with a large knife and threatened to kill himself in front of the staff and other service users. He was arrested by the police and I then conducted my third assessment under the MHA. This time I somewhat reluctantly concluded that I had no option but to detain him under Sec.3 for treatment.

He remained on the ward for several months, but would not engage in therapeutic activities, and resisted other treatment. But he remained a significant risk if he were discharged. For several years his main diagnosis had been that of depression, but his consultant at that time concluded that he had a personality disorder, and that the only suitable treatment was enforced psychotherapy in a secure unit. I was not sure about this – not that I did not think that he probably did have a borderline personality disorder, but my concern was whether it was either ethical or possible to engage someone in psychotherapy against their will. Nevertheless, funding for this was agreed, a suitable hospital was identified, and Lenny was transferred there.

Lenny hated it. He hated being forced to conform. He hated having to attend therapeutic groups. He hated having to attend sessions with clinical psychologists and occupational therapists. In fact, he hated everything and everybody. Although I had had no control over this transfer, he blamed me. He appealed against his detention.

The Tribunal was interesting. His Charwood psychiatrist presented a report and attended the Tribunal hearing. But he had made some errors in his report. He had stated that he could find no evidence of formal psychiatric disorder, but also stated that Lenny had a borderline personality disorder. Both the Tribunal and Lenny’s solicitor picked up on this. If Lenny did not have a mental disorder of a nature or degree sufficient to warrant his detention for treatment, then the Tribunal would have no option but to discharge him. So how did this statement accord with his diagnosis?

The psychiatrist tied himself in knots trying to justify the contradictory statements. But he was sinking without trace. The Tribunal were from the beginning sceptical about the idea of enforcing psychotherapy, and the inpatient psychiatrist was unable to state that this treatment was making any difference to Lenny’s mental state. So what justification could there be for continuing to detain him if treatment was not alleviating his problems? Lenny’s solicitor was pushing at an open door. The Tribunal discharged him, leaving just enough time to identify an address to discharge him to. Lenny stated that his sister, who lived in Charwood, would gladly offer him a place to live.

A week later, he moved in with his sister. I visited him at her home. He had used his new freedom to begin drinking again. His sister did not like this behaviour in front of her children. She wasn’t prepared to keep him.

There happened to be a vacancy at the hostel, so he returned there. He refused any further contact with the CMHT, although I continued to see him from my involvement with the hostel committee.

Something had changed about him. Although his sporadic alcohol abuse continued as before, he became even more suspicious and reclusive. For the next couple of years he remained at the hostel, where he started to make odd allegations about other residents, sometimes (usually when drunk) alleging that people were contaminating his food or his drink, or were trying to poison him.

To be continued

Next time: Lenny's incarceration in a secure unit for three years -- and eventual freedom.

No comments:

Post a Comment