Thursday 13 December 2007

Social Care

It's not often that I recommend that a patient is detained under the Mental Health Act 1983, but this week I had cause to do just that. That makes 3 patients detained this year, not bad for a full time Consultant Psychiatrist and less than my colleagues, but I'm still conscious that it's loss of liberty and choice for 3 people at a distressing time in their lives.

This week it was a gentleman who's thoroughly confused but has never been seen by mental health services. He's been living in squalour for months. Social services visited him, he declined help, they left him. This seems frankly criminal, given the state he was in. His fridge didn't work and had only rotten food that was composting down in it. Milk bottles were full of solid milk. Items on the floor were shredded by rodents. Dead mice and mice droppings littered the rooms and stairs. Urine and faeces was soaked in to him, his clothes, his furniture. He was unkempt, unwashed for months, had debris stuck to him and his clothing and smelt of the urine and faeces that he'd been generating and sitting in for months. Broken glass was on his lawn, porch and stairs. He had no heating and we discovered the reason his fridge wasn't working and he was sitting in gloom was because he had no electricity. Now I know I'm just a medic and not a trained Social Worker, but this does seem a curiously suboptimal state of social wellbeing to leave a chap in.

I've no idea if he's toxic through infection or if he's cancer that's metastasised to his brain (he's had cancer in the past that was cut out but he never attended follow up), if he's nutritional deficits (I can't imagine he hasn't, though) or if he's dementing. So he's now on my ward, detained under section 2, a month after social services visited his home then left him in this state.

I don't believe a Social Worker could necessarily have prevented his confusion but they could have organised the social care he needed and deserved.

Much badness.


Disillusioned said...

Glad this gentleman is now getting some help and care. I would hate to be "sectioned" - but, at the same time, if I were in the position you describe here, I hope someone would have the necessary compassion to ensure I did receive the help and support I clearly needed.

BenefitScroungingScum said...

Excellent post. Its desperately sad to hear that you've had to use the Mental Health Act to ensure someone receive the care they need, but from my own experiences of Social Services this kind of situation is all too common. I would like to feature this post on my blog if you don't mind? Bendy Girl

Elaine said...

It is a good thing that there are still some professionals around who care, but a pity that so often it is not the Social Worker.

As this gentleman becomes clean, warm, clothed and cared for, he may well improve.

I don't think you have any cause for concern about having "Sectioned" him

The Shrink said...

Disillusioned, taht's pretty much what it came down to . . . detaining him was the only practicable way to promptly get him the care he needed.

Bendy Girl, by all means, go right ahead, it's all in the public domain now :-)

Elaine, intergration with Social Services unsettles me. Health (medics, nurses, all of us) have a different ethos to social care staff. And, being a Consultant, I think I'm right and they're wrong ;-)

Mousie said...

Absolutely disgraceful.

Social workers are always telling me about how their "thresholds" for such things as abuse and neglect (of oneself and/or one's children) are so much higher than everyone else's (i.e. mine) because they see so many bad cases...

But surely if your "threshold" for this kind of self-neglect is high enough to ignore it, you are clearly not cut out to work in social care.

Fiona Marcella said...

To me this is linked with the "patient" vs "Service User" question.

This gentleman is now firmly a patient - he's an Inpatient, and bad that it is that you had to take away his liberty in order to provide him with care, he obviously wasn't exactly enjoying it, was he?

I presume that he was offered the chance to become a "service user" in the sense that someone from the social services came round and asked him whether he'd like to be put on the waiting list for a home help, and that the second word was "off".

That seems to me to be one of the differences between an older medical model and a more social model of care - the social worker offers the patient a service but gives him or her the responsibility of taking it, many medics seem to think they have a duty of care whether the "subject" tells them to "f off" or not.

Calavera said...

You know, the way they make it seem in the social and ethical medicine part of my medical degree, is that every other Tom, Dick and Harry in A&E needs sectioning under the MHA. Seriously, we learnt everything about the act, discussed its pros and cons in great detail and were examined on it as well.

It's nice to see that apparently, in real hospital practice, it's not really used that much.

The Shrink said...

Cal, it's good that the med school's teaching you 'bout the MHA 1983 and about application of statutory instruments to get patients the care they deserve in an ethical fashion. Odd that A&E was discussed significantly, though.

Firstly, the MHA 1983 is only used as a last resort when every least restrictive option's been exhausted.

Secondly, medics need an awareness of the MHA 1983 but only mental health folk (medics, nurses, PAMs, SW) need to know a lot about it.

Thirdly, there's vast chunks of it I don't know.

Fourthly, it's not that useful for you in A&E. It could be that police use section 136 (if they're a danger and are in immediate need of control) to bring someone to a place of safety, i.e. A&E that they're already in, which obviously isn't achieving a whole heap. Section 2, 3 or 4 can't be applied by folk in A&E (unless they're section 12 aproved), section 5(2) can't be applied lawfully at all. Overall the use of the MHA 1983 in A&E has to be pretty modest in the really real world, outside of med student exams :-)