I knew it wasn’t going to be a quiet day when I found a pink paper with a written recommendation for a Section 3 from one of our doctors sitting on my desk next to the ASW Duty Book – a book in which we note any Mental Health Act Assessments that are done by our team.
It was an assessment that needed to be done on one of the wards. The patient was an elderly man who did not speak English. Currently having a diagnosis of late on-set psychosis and expressing some worrying paranoid thoughts about members of his family (that he had lived with since his arrival in the UK a decade ago) wanting to poison him and wanting to catch the first flight back to his home country where he had no family, no remaining contacts under 80 and would not have access to (free) medical treatment. He had been an informal patient for a couple of weeks and was improving according to the medical staff and his family – but improving enough to have the ability to actually book a flight and leave.
I haven’t carried out a Mental Health Act assessment with an interpreter. It introduces a slightly different dynamic into the assessment. This interpreter was very professional. He knew the patient – having been brought in for ward rounds weekly. He seemed to have a good rapport and was able to explain to us some of the issues regarding the cultural background of the patient being assessed before the assessment and particularly issues regarding the family dynamics that he had observed and was aware of. He had also been present during a number of Mental Health Act Assessments so he knew the process and the procedure.
There’s also something about paranoid beliefs though that makes me uneasy. I’ve experienced it working with someone else for whom I was the care coordinator. Mr A (who I worked with a couple of years back) had a number of beliefs which involved his neighbours targeting him (he also had some beliefs about government conspiracies) but we found after some time, that these beliefs about the neighbours were actually based on the truth. His neighbours -were- targeting him. I visited his house and found faeces (probably dog but I didn’t check too extensively) and shattered eggs on his door.
He was still unwell but some of the perceptions and assumptions changed markedly.
It has always made me very wary of some of the assumptions we make about paranoid beliefs. To me it was a salutary lesson in the dangers of assumptions. I’m always very cautious with paranoid beliefs now, enough that some of the ward staff think it is verging on the comical.
Anyway, we considered and pondered a little before making a decision.
It never seems to get better, this weight of decision. I hope it doesn’t either.
It just feels, when you stop and think, so counter-intuitive to all the other work I do. I strive to maintain rights and dignity – I want work with strengths and areas of growth. I know very well that sometimes enforced hospitalisation is necessary – it can be the best decision to make – sometimes. It makes sense in the long term. I wonder if I am saying that to justify it to myself. It is also increasingly important to remain constantly aware that it is not the only decision to make either. Independence remains the key.
In some senses, in this assessment, I felt more like a social worker than I did in some of the others, because there were potential alternatives that could be discussed and planned for. We had a long discussion about alternatives and possibilities which mostly revolved around alternative accommodation in the local area. We could look at a way through the hospital admission and out the other side. It couldn’t be speedy though, alternative accommodation never is.
So however it is framed, it isn’t just another care-planning meeting. Not at all.
