When I was working in a community mental health team, I was
once asked to attend a public meeting regarding a Housing Association tenant.
The meeting was arranged following a large number of complaints from tenants of
one of the Charwood social housing estates.
It was to be chaired by the Housing Association, with
representation from the local District Council and the police. They also wanted
someone from the CMHT, as it was thought that the tenant who was the subject of
the meeting might have mental health problems.
So I somewhat reluctantly attended as a representative of
the CMHT. I was reluctant, because I was not sure what would be expected of me.
Having checked the name of the person, who I will call John, on our records, I
knew that he had no previous involvement with mental health services.
The hall in the local community centre where the meeting
was to be held was packed. I was one of the panel members situated at the front.
The others were the local chief inspector and a senior housing officer from the
district council. Being faced by several dozen hostile tenants felt quite
intimidating, to say the least.
John had not been invited to attend, and was not aware that
the meeting was taking place. I only knew that John was male, single, and in
his 30’s.
The chairman, the chief officer of the housing association,
summarised the reason for the meeting. They had received many complaints about
the conduct and behaviour of John in public areas of the estate.
Almost immediately, people started making allegations about
him. It appeared that he was often to be seen naked to the waist, swaggering
around near the estate shops, brandishing a pair of martial arts nunchuks, and
that he often verbally threatened passers by.
Allegations started to be made that he was a paedophile.
The chief inspector intervened.
“Could you tell me on what basis you are making these
allegations?” he asked.
“Just a few weeks ago he was chasing a 15 year old girl
down the street. It’s good job she got away from him. We told the police, but
nothing happened,” one of the tenants said.
“Let me put this straight,” the chief inspector said. “I am
aware of the incident you are referring to. The person in question was actually
running away from the police, who were trying to arrest him. The girl just
happened to be in front of him.”
The tenant who had made the allegation looked momentarily
deflated. “Yeah, but he’s a menace. He needs to be sorted.”
A woman in the audience, whom I recognised as being a
patient of the CMHT, looked at me.
“What’s he doing here?” she demanded. “He must be a nutter.
What are you doing about it?”
Both the audience and the other panel members looked
expectantly at me.
I was not actually anticipating having to say anything. I
was suddenly concerned about breaching confidentiality. But was it a breach to
say that someone was not a patient?
“I am just here as a representative of Charwood CMHT,” I
said. “I can tell you that he is not one of our patients. I know nothing at all
about him, other than what I’ve heard today.”
“Well why don’t you know about him? He obviously needs
sectioning,” another of the tenants said.
“Look, we honestly don’t go round looking for people to
admit to hospital under the Mental Health Act. In order to be seen by the CMHT,
their GP has to make a referral. And that has to be with the consent of the
person. We’ve never had a referral for John.”
While the tenants were clearly not satisfied by my
response, the chairman steered the discussion to what the housing association
could legally do about John in response to the concerns expressed by the tenants, and I
was not asked to comment again.
After the meeting, the panel members had a private
discussion. I discussed with the chief inspector the potential use of S.136 if
John appeared to be mentally disordered and in a public place, which would
facilitate a formal MHA assessment.
I was struck in this meeting by two things. One was how
people can make assumptions based on misinformation and prejudice. The other
was the assumption that someone behaving in an unusual or antisocial manner
must by definition be mentally ill.
What happened next?
I’d like to be able to say that John was never heard of by mental
health services again.
However.
A few months later John was arrested in a public place in
Charwood during the evening. He was armed with a large knife, was stripped to
the waist, and was threatening to kill anyone who came near him.
He was taken to Charwood police station and assessed under
the MHA by the out of hours AMHP. He was reported to be floridly psychotic and
too unwell to give any coherent account of himself. As a consequence of his
dangerousness, he was detained under S.2 and admitted to a psychiatric intensive
care unit (PICU).
I assessed him again a month later and detained him under
S.3.
He remained a patient of the CMHT with a diagnosis of
paranoid schizophrenia, and was detained under the MHA several times over the
next few years, always after stopping his medication. On the last occasion, he was
discharged on a Community Treatment Order.
After being made subject to a CTO, he remained well and did
not require any further acute admissions. In fact, when the time came to
consider extension of the CTO on two subsequent occasions, he made it clear to
me that he liked the security of the CTO and wished to remain on it.
There’s no clear moral to this story. Even though John may
have been mentally ill at the time of that public meeting, the anger of the
local people did not in itself justify taking action to detain him under the
MHA.
It’s often the role of the AMHP to unpick what’s really
happening when complaints from members of the public are received.
But people are
allowed to be unusual or eccentric, or even mentally ill, as long as their
behaviour is not putting themselves or others in danger.
It was only once John stepped over that line, from being a
nuisance to posing a real danger, by possessing an offensive weapon in a public
place, that it became appropriate to consider use of the MHA to protect John
and the public from the consequences of his actions.
