Sod that Dr. Crippen – he's only gone and posted on what I'm writing on today.
Now, I have to be careful how I write this as I have sent various official documents to people about this incident. Also, should I need to make a statement I can just print out this post…
We were sent to 'psychiatric patient – feeling violent' and as he was known to carry weaponry we decided to hang back until the police got there – they have much better kit for dissuading people from stabbing them than us.
The police were there first, so we walked into the house – our patient was sitting in a chair looking very distressed, but thankfully not violent.
I spoke to him and he told me that he'd been discharged from the local Mental Health unit the week before. Now he was wanting to go into the street and beat someone up, and then kill himself.
He was crying as he said this – so I let him know that we would look after him and take him somewhere safe.
When asked if he would be kind enough not to beat me up, he couldn't guarantee it, so a police officer would travel with me in the back of the ambulance, with his partner following in the response car.
During transporting the patient he told me that he was seeing things, and that he was hearing voices. On several occasions he became very agitated and it was only the complicated seatbelt that stopped him from leaping around the back of the ambulance.
He then told me that if he were to be taken to the A&E department he'd probably 'kick off' as the department is too crowded and too noisy with people who don't 'understand him'.
I've mentioned in the past how an A&E department is a completely inappropriate place for people with mental health problems – so I could see his point.
As we can't take people straight to the mental health unit I would have to take him to A&E. But then I had a cunning thought of a way around the problem.
We would park outside the A&E department, my crewmate would go into the department and phone the mental health unit to see if they would directly assess the patient.
It came as no surprise when the Mental Health unit told us that they wouldn't accept the patient unless he was under a Section, and that A&E would have to see him.
My patient was still in the ambulance refusing to enter the A&E department and looking more distressed.
I turned to the policeman.
“This place is accessible to the public”, I indicated the open doors to the ambulance, “and anyway, if he leaves the ambulance he won't enter the A&E department”.
The policeman agreed, I think he knew what I was getting at.
“How about we Section 136 him here, then he can get to the place where he needs to go?”, I suggested.
The policeman agreed, he went to his partner, had a quick discussion and started filling in the Section 136 form.
A “Section 136”, allows the police to take someone who is mentally ill and in a public place (and is a danger to themselves or others) to a 'place of safety' for assessment.
So we let the mental health unit know that we would be bringing in a Sectioned patient for assessment and drove the 200m up the road to the unit.
We rang the bell and waited, and waited, and waited…
Finally a person who I assumed to be a psychiatric nurse came to the door. He took one look at the patient and sighed loudly, “Oh. It's him! Take him to A&E”.
I explained that the patient warned me that he would become violent in A&E, but that he wouldn't if he were in the care of the Mental Health unit. I explained that he was seeing and hearing things and that there was no physical injury to himself.
The nurse then accused me of lying about the patient's symptoms, “He never said that”, he told me.
The nurse then turned on the policeman, “I don't believe that you Sectioned him in a public place – I think you did it in his house”. The nurse was accusing the policeman of (a) Breaking the Law, and (B) Lying.
When the policeman pointed this out, and pointed out that he could be seen filling the form in on the unit's own CCTV the nurse backed down a little.
“He's drunk”, the nurse said, “he always is when he comes here”.
Now, admittedly, the patient had drunk two cans of lager during the morning – he'd admitted it to me, but there was no way he was 'drunk'. As one of my mates put it, “Two beers is breakfast for a lot of folks 'round here”.
So now the nurse began accusing the patient of lying about how much he'd drunk, about the symptoms that he was having and of the need to call an ambulance.
By now I was severely tempted to punch this nurse on the nose for the instant, horribly incorrect, assessment he'd made of the police, the patient and me.
As an aside, I'm aware that when someone starts to get me angry I start to pace, and flap my arms about like a stereotypical homosexual from an early eighties sit-com. The flapping is because I want to punch the person annoying me, while knowing that I can't. This is why I was gripping the handrails of the ambulance very tightly.
But somehow – possibly because I asked the nurse his name for the complaint form, the clinical risk form and for the form where I think that a hospital has had an 'untoward incident' – he accepted the patient.
The police officer and I had a quick 'debrief'. Then it was back to station to fill out the forms and have a quick chat with a Station officer over the phone who congratulated me on not punching the nurse.
He also confirmed that I had done the correct thing all the way down the line.
This is nice to know as I have the same tendency towards pig-headedness as the next person.
Anyway, my boss talks to the boss of the mental health unit on a regular basis, so I expect that this incident will be mentioned.
In thirteen years of working for the NHS I've only once known a referal to a mental health team go as expected. Like GPs, I know there must be good ones out there – but it seems that I never get to meet them.
Zarathusa – if you'd like to pitch in I'd like your take on this.