I am called to visit a man in distress called George*. He has stopped contact with his care team and not seen his family for a few weeks because of social distancing. George’s neighbours have reported hearing him shouting and screaming and seen him outside during the middle of the night.
Due to concerns, it is agreed that my colleague would contact the court to request a warrant under section 135(1) of the Mental Health Act, providing the power to enter George’s home and remove him to a place of safety. Usually we would do this in person, but we currently have a system that means we can get these warrants by phone. It was tricky to set up initially but now it’s in place, it is actually a really efficient system and means that my colleagues who are needing to work at home can still support the AMHP hub.
The community mental health team (CMHT) consultant joins me on the assessment. I contact George’s GP. The practice reports that they have not seen George for over two years. The GP I speak to has never met George and is not able to come out, so I arrange for an independent psychiatrist to attend.
Weighing up risks
I contact George’s family to let them know the assessment is going ahead. I contact the housing office and asked them to arrange a locksmith to attend too. Having a warrant under section 135 means we can gain access to the property even if George refuses to let us in. Making a decision to gain entry to a property without the consent of the person who lives there is a really difficult decision to make and one AMHPs don’t take lightly. We have to weigh up the risks of the person’s mental illness alongside the infringement of their human rights.
When I contact the doctors, police and locksmith they all ask me for details around his Covid-19 risk. This is really hard for me to determine. I know that he has COPD, and his self-care is poor. As no professionals have seen him for quite some time, we don’t know if he has a cough or temperature and whether he understands the need for social distancing and hand washing.
I was worried. My manager had obtained personal protective equipment for us and I have some which I can use, although by law I will need to assess in a suitable manner. Will this be possible if I wear a mask? He won’t be able to see my face. How will he react? What will the the house be like; will we be able to maintain social distancing in his property?
When I arrive, I see the independent psychiatrist and provide him with some historical and current information from George’s electronic case notes. Usually we would sit in a car and have a confidential discussion about the planned assessment. We can’t do it today. The police aren’t there. I call them three times as I can’t get through to 101 initially. I speak to the control room. The officers are delayed. We wait.
Lots of neighbours come out of their houses. Somebody is filming me on their phone. One neighbor asks what I am up to.
Two hours later the police arrive. I am feeling nervous, there are so many bits of the assessment to co-ordinate and I am alone in doing this. It is a warm day; I start to sweat. I try to put gloves on, but my hands are sweating and the gloves get stuck. I am a social worker, there to represent the social care perspective and the local authority. It feels strange wearing PPE. There are now six of us outside, all wearing PPE and I am conscious that all these neighbours are watching us trying to get into George’s house. I want to maintain his dignity and confidentiality but it is incredibly hard in these circumstances.
We introduce ourselves and I explains why we are wearing PPE. George looks thin and it seems he may not be looking after himself. George appears quite distracted when we are talking to him and is talking to himself. George tells us he has been shouting at night because people have been coming into his flat; he is not sure who the people coming into the flat are and does not know how they have been able to get into the flat but thinks they have been coming in through an air vent which he shows us. There appears to be no heating in the flat and no food in the fridge or cupboards.
Both the doctors and I agree that it is necessary to admit George to hospital for a period of assessment under the MHA. George does not agree. There is a bed locally, however, the ambulance has been delayed. When I tell George the outcome of the assessment, he tells me he is not going to hospital. I try and explained to him what our concerns are but he does not accept or believe these. He gets really angry and starts to swear at me. He tells me I am not real and cannot control him.
The right decision
I explain that we have made the decision to admit him under the MHA. I try and encouraged George to pack some things to take to the hospital, but George refuses and starts to shout that he is not going. He tries to leave the flat, but the police officers stop him from leaving. The police would like to leave but I ask them to stay as I am worried that George may leave the flat. If he does, I will be unable to prevent him from doing so if I am on my own.
I try to explain George’s right to challenge our decision via the tribunal system, but he does not want to talk to me. The ambulance arrives and I made sure his property is secured.
George looks me in the eye and said: ‘Thank you – you made the right decision’. I am proud to call myself an AMHP.”
I have managed this assessment as best as I can in the circumstances available. It is never an easy decision to take somebody’s liberty from them, but I know that George will get the treatment and care he needs so his independence can be maximised in the future.
I contact the inpatient ward and give them a handover of the case. Usually I would travel to the hospital in my car and the ambulance would follow me. To minimise footfall on the ward, I don’t attend today but I call the ward and they confirm that George has arrived safely. I am relieved and my day is nearly done (three hours after my expected finish time). I drive home with my head spinning. My partner welcomes me at the door.
‘No cuddle yet darling,’ I say. My clothes go straight into the washing machine. I get in the shower. I make a cup of tea and get on with completing my report which informs the ward, the CMHT and George of how decisions have been reached today.
* Name has been changed. The author works as an AMHP in an English city. The article was written jointly with a colleague.