One thing I have learned as an AMHP is never to show patients that you are scared. I have been in numerous situations over the years where I have anticipated danger or been threatened with harm, but have in reality been physically assaulted only rarely, and generally when I have misjudged a situation.
Derek, however, was really scary.
I was doing an out of hours shift in the early 1990’s when I got a call fairly late in the evening from the city police station.
Derek, a man in his mid 40’s, had been detained under S.136 after behaving bizarrely and aggressively in a public place and I was called to assess him under the MHA. He was apparently an intelligent man, with a degree in engineering, but had convictions for a range of violent offences.
From the comparatively bright and inviting reception area at the police station, I was led down several flights of stairs to the custody suite, which was in the subterranean bowels of the building with no natural light.
Derek had already been seen by the duty doctor, who had left a medical recommendation for s.2, and while I waited for the s.12 psychiatrist to arrive I decided to see him.
I followed the custody sergeant to Derek’s cell, at the end of a long corridor lined with heating pipes and ducts with the cells opening off. The custody sergeant looked uncomfortable.
“You’d better watch this bloke,” he said uneasily. “Don’t trust him.”
Long before we reached Derek’s cell, I could hear a loud and regular pounding sound echoing down the corridor. The custody sergeant’s unease was rubbing off on me. As we came nearer, I could see water flooding out from under the cell door. What on earth was going on in there?
Derek was monotonously pounding his cell door. The officer called through the grill to him to back off and then unlocked the door and opened it. Looking into the cell, I could see that Derek had tried to flush his shirt down the toilet in the corner of the cell, blocking it and causing it to overflow, covering the floor of the cell with water.
Derek had his back to us when we entered. Since his shirt was halfway round the U-bend, Derek was naked to the waist. He turned round and glared at us.
I felt a surge of shock. He only had one eye. He stared balefully at me with this one eye, but where the other should have been was just an empty pink socket.
My first thought was that he must have flushed his eye down the toilet. This did not help me to maintain my composure. My voice probably sounded a little shaky when I introduced myself.
He put his hand in his pocket and brought out his second eye, which was made of glass. He popped it into his mouth, sucked on it for a moment to remove any fluff, and inserted it into the empty socket. He then examined me more closely, as if this action had improved his vision. Although this went some way to improving his appearance, it was hardly reassuring.
The officer led him to an interview room. I stood on one side of the desk, with Derek and the officer on the other side and tried to interview him. He was hostile and asked me who I was. He did not appear impressed when I explained. He was clearly agitated and his mood was elevated. At a guess (I did not have access to his medical records) I thought he might have bipolar affective disorder and was probably hypomanic.
“Derek,” I began after I’d introduced myself to him, “Could you tell me what led up to you being here?”
He leaned across the desk to get his face as close to mine as possible.
“What business is it of yours?” he snarled. “I’ve met your sort before. You just want to lock me up. Because you’ve got no bottle.”
He raised his fist and made as if to punch me in the face, stopping just centimetres from my nose. I don’t know how I didn’t involuntarily recoil.
I asked him about his eye. He seemed happy to tell me that he had lost it at the age of 12 while trying to make homemade fireworks in his bedroom. This seemed to amuse him, and he continued to rattle on at some length about his childhood exploits.
As I continued to interview him it became clear that it was not possible to keep him on track, and his thought processes darted tangentially from one subject to another, often without any apparent relevance to what I was asking him.
“You’re going to section me aren’t you?” he concluded. “I’ve slit bigger bastards than you, and I promise you won’t get away with it.”
Deciding to conclude the assessment, I indicated to the officer that he could return Derek to the cell. I was relieved that I had survived the process without needing a visit to A&E. When the officer came back to me, I could see that he was trembling. It didn’t actually help to know that a police officer was even more scared than I was.
“I can stand a bit of aggression in this job,” he confided. “But these mental ones – they really put the wind up me.”
Once the psychiatrist had seen him (I decided not to take part in that interview) we were in no doubt that he needed to be detained under S.2 for assessment. In view of his volatility and potential for aggression, it was decided to transport him in a police van. He was not happy about this, and swore at me as he was led to the vehicle, each wrist cuffed to a police officer, with two others as escorts.
I went on to the hospital to alert them to his arrival, and got there before him. I stood back as he was led down the corridor, but at least felt safe, since he was handcuffed and flanked by two big policemen. I made sure that I was far enough away to be out of danger should he decide to lunge at me.
But as he passed, he turned to look at me balefully.
“Bastard!” he hissed, and spat full in my face.
I hadn’t anticipated that.
It turned out I got off lightly. A couple of years later I was talking to a social worker who worked in the regional secure unit. I discovered that Derek was a patient there. He was detained under Sec.37/41 (a form of detention imposed by the criminal court for serious offences, which means that a patient can only be released with the consent of the Home Secretary). He had blinded someone by throwing acid into their face.
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