A Halloween Mental Health Act Assessment

It was late afternoon one 31^st October. I had received a referral for Bert, an elderly man living alone in a cottage a few miles out of Charwood. His GP was concerned that he had dementia and was expressing severe paranoid symptoms, including being tormented by someone he called Mr Dark, who, he said, was entering his cottage, interfering with his possessions and stealing the electricity from his lights.

I popped into the GP’s surgery and got him to complete a medical recommendation for Sec.2. I then arranged to go with a psychiatrist.

The light was failing by the time we arrived at his cottage, in a remote location a little way outside the village, at the end of a narrow lane. The cottage was in a state of dilapidation; once thatched, many years ago this had been replaced by corrugated iron sheets, which were now rusting and ragged at the edges. The garden was overgrown and choked with brambles and nettles.

The psychiatrist and I made our way to the front door and knocked. A frail looking old man opened the door, and appeared pleased to see us.

“Come in, come in,” he said, without bothering to ask who we were, and led us into a heavily beamed room with a cooking range in the fireplace. We sat down on wooden chairs that were arranged around a large table.

I introduced myself and explained why we were there.

“Your doctor’s worried about you. He says that you’re worried about people coming into the house –“

“Not people,” he said, leaning into us. “Not people.”

“What do you mean?”

“Mr Dark. He’s not people. He’s not a person. He steals my light. He’ll steal my soul. He’ll extinguish me. He won’t let me alone until he’s taken everything and I’m just a husk.” He started to cry.

He continued rambling on in this vein. He looked terrified and exhausted. He couldn’t continue like this.

“How do you feel about coming into hospital?” I asked him.

“Hospital?” Some semblance of animation lit up his eyes. “I’ll go to hospital – as long as Mr Dark’s not there. Will Mr Dark be at the hospital?”

“No,” I said, “no he won’t.”

Although Bert appeared happy enough about informal admission, I did not feel he could make informed consent, and he might possibly change his mind before he got there. So the psychiatrist and I decided that it was best to complete an application for admission under Sec.2 MHA, to assess him further.

We completed the forms, and I told him he would indeed be going to hospital. This seemed to calm him.

I called for an ambulance, and the psychiatrist, as they always do, left.

Bert sat by the table, and rested his head on his folded arms. He appeared to fall asleep. By now night had fallen.

 That was when I heard a sound coming from upstairs. It sound like footsteps.

As far as I knew, Bert lived alone. I had established that he had no relatives in the area, only a sister who lived many miles away and was in a care home.

“Bert,” I said. He opened his eyes.

“Bert, is there anyone else in the house? Only I thought I heard someone upstairs.”

Bert’s face filled with dread. “He’s here! He’s coming for me.”

I was sure it must be rats. Most likely in a rundown old cottage. Rats.

I decided not to investigate. Instead, I rang Ambulance control to see how much longer they would be.

Then the door from the hall opened and someone walked in. A tall, gangly man with a pale face, coal black eyes, and a wide lipless mouth.

He pulled up a chair and sat down at the table.

Excuse me,” I said, as always polite. “What are you doing here? You’re not a relative are you?”

The man smiled broadly, revealing two rows of rotting teeth.

“A relative? No, I’m not a relative. I’m Mr Dark.”

He waved a hand and the lights in the room flickered and then went out.