Friday, 5 June 2009

The Mental Health Patient

I'm on patrol with one of my PC's on the Utopian Proactive Unit. There's just the two of us but there should be eight. The other six have been sent on aid to facilitate a conference in which well-to-do members of the local business community will be attending. It's funny how the police service 'facilitates' events for rich people, but will 'police' festivals and events for the remainder of the community, the likes of which you and I attend. A call comes through that a black male has been seen acting suspiciously in one of the affluent enclaves of Dystopia. He's walking in and out of gardens and looking in windows. It seems like a decent call to go to, considering that many of the occupants will be at the business event my officers are 'facilitating'.

We arrive in the area and sure enough see the male walking out of a garden. What unbelievable luck, to actually come across a Billy Burglar whilst he's in the process of checking out what property to enter. We get out of our vehicle and speak to him. "Hello mate, do you live in that house you've just walked away from?" He says nothing. "Mate, do you live there?" No response. His eyes dart between us. He's looking our uniform up and down, eyes quickly scanning our equipment belts, flat caps, I already feel uneasy. I can see he's sweating profusely. It's hot, but not that hot. Why is he sweating? He wasn't sweating that much when we stopped him. It's something to do with us.

My colleague tells the man that he's going to search him and takes hold of his arm. With that, the man wails and strikes my colleague in the nose with the back of his hand. Instinctively I dive towards him, rugby-tackling him around the waist and forcing him to the ground. My colleague appears over my shoulder and applies one handcuff. I've hold of his other arm but he breaks free and grabs me by the throat. There's no officer safety training anymore, just a natural instinct to survive. His grip forces the last breath from my lungs and I can hear myself gasping. I hate him now. I hate that this man wants to do me harm, serious harm. I hit his arm at the elbow with my fist, it bends, and I head butt him in the face. Stunned, this allows enough time for my colleague to fully handcuff him. I look at my colleague, my friend, and see that he's bleeding from his nose. Now I really hate this man.

We arrest him and call for a van. We take him to the station and open the van doors. He's shaking uncontrollably. It's genuine fear. Real, deep, petrifying fear, the like of which I've never seen before. My feelings towards him change and I begin to feel some sort of sympathy rising in me, but I don't know why. Slowly he stands and leaves the van. From the darkness of the cage and into the daylight, I now see that amongst the sweat streaming down his face there are tears. We take his arms, my friend with the broken nose, I with the impression of his fingers around my neck. "Come on mate, we'll sort you out. Come on, there's nothing to worry about." The custody sergeant assesses him, or tries to, but he won't speak. He just stands there, shaking, sweating and crying.

The Force Surgeon decides that a mental health assessment is required, so we telephone for the local NHS Assessment Team to come and speak to him. We find his passport on him. They have checked their records, and he is known to them.

A doctor, social worker and nurse arrive. They want to go into the interview room to speak to him alone, but the Custody Sergeant will have none of it due to the violence he meted out to us. I volunteer to sit in whilst my colleague gets his nose treated. The doctor stops me as I follow, and asks me to take off my protective vest and epaulettes. Please could I also leave my equipment belt, "You know, to try and not look like a police officer." There is evidently a reason for this request, and so I agree.

I sit in the interview and listen intently. The man says nothing but listens as intently as I. "Do you still get flashbacks Cesar?" "Do you think you're back in prison?" "Are you having another episode? You seemed to be getting better the last time we spoke." "Cesar, can I see your back? Will you take your t-shirt of for me?" I'm really intrigued now. It's like nearing the end of a murder-mystery novel. I'm skim-reading the words, wanting to know the outcome, but losing the detail in the process of doing so. Cesar undresses. His chest is covered in scars. Deep pits cover his upper arms and stomach. Only gouging by a sharp instrument could have caused those injuries. And those burns? They're cigarette burns. I think, "He has serious mental health problems, how can someone self-harm like that?" They ask Cesar to turn around, and I can see his back. More scars, different scars. Scars where the flesh has been ripped in long strips from his back, caused by, caused by...a whip? He's been whipped. The doctor tells Cesar they will take him back with them. They'll help him.

They tell the Custody Sergeant of their decision. Cesar doesn't have mental health issues. He suffers from Post Traumatic Stress Disorder. He was a political prisoner back in his home country, imprisoned for dissenting against the government. He was arrested and tortured - done by men in uniform. He's been at the hospital before to receive therapy, but it doesn't work. They know it doesn't work and never will. They'll say he has mental health issues so the Trust's Directors won't query his presence. It's safer for him to be at the hospital. It'll be a couple of months before they run out of reasons to keep him there. It's an act of kindness that touches me and one that I will never forget. It's quite at odds with the perception that the NHS has lost its soul.

I wanted to visit him during the days soon after. I don't know why. I guess I could see that there wasn't an ounce of badness in him, and I am sure that there never was prior to what happened to him in his homeland. A brave man broken.

I never did go and see him and I have never seen him since. Five years on and I still think about him now and then, hoping that his life somehow got better, but knowing it never did.
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  1. His life may actually get better, and he may recover. My own Significant Other, possibly the kindest and most generous woman in North America, is a licensed clinical psychologist. She is one of the few with an actual success record - that is, her patients got better and moved out of the State hospital, found a job and rejoined society. She's helped people like this man before.

    You did an excellent job with this man, far and away better than many police in the US. I thank you for your help.

  2. Thanks Jack. I suppose the point I am trying to get at is that, as police officers, when confronted with irrational violence we have to determine what proportionate level of force to use. Sometimes we get it wrong, and I have just read about some officers being 'suspected' of causing death by asphyxia when restraining a man suffering psychosis. Excited delerium is also a killer. Their physical strength is unbelievable, and the force used to restrain them when combined with the physical effects of that condition, almost always result in death. It saddens me that when, after dealing with people who have mental health issues, you learn that they were suffering a crisis. They have good relationships with their doctors, they are probably the only people in the world who genuinely care for them and have an interest in their well-being. When you listen to them talk to heir doctors, you see the personality, the fears, the pain of social exclusion in addition to their mental health condition. As a police service, we have a long way to go before we can adequately learn how to respond to their needs.

  3. Nice Post - summing up that each case like this has an individual human story. We don't really do mental health well .. empathy does help