There is a whole chapter in the Mental Health Act Code of Practice on the conveyance of patients to hospital. Two of the particularly cogent paragraphs are as follows:
"11.2 Patients should always be conveyed in the manner which is most likely to preserve their dignity and privacy consistent with managing any risk to their health and safety or to other people.”
“11.21 AMHPs should not normally agree to a patient being conveyed by car unless satisfied that it would not put the patient or other people at risk of harm and that it is the most appropriate way of transporting the patient. In these circumstances there should be an escort for the patient other than the driver.”
The Masked AMHP has of course read these paragraphs, and has taken due notice of them. He does, however, consider that there are situations in which it is appropriate, or necessary, for the AMHP to take the patient to hospital themselves. Sometimes, there just does not seem to be any alternative at the time.
In both of the following cases, in which the Masked AMHP found himself in difficult osculatory situations, the patient was not formally detained under the MHA, but was being transported as an informal patient. I would submit that the Code does not specifically refer to informal admissions.
I have mentioned Leroy before on this blog. He has a very long history of bipolar affective disorder, which is frequently exacerbated by his fondness for amphetamine.
Leroy had been an informal patient, but when allowed leave off the ward, he had not returned. I was asked to visit him at home to check him out, and see if he could either be persuaded to return to hospital, or whether he might need assessing under the MHA.
I went out with Pam, one of our nurses, and knocked on his door.
He came to the door and beamed at us.
“Thank God you’ve come!” he said. “It’s terrible – the TV’s talking to me, and I can’t stop it! I’m begging you, please take me back to hospital!”
We couldn’t really argue with that, and made the decision to take him back straight away.
However, during the journey back, in which I was driving, and Pam was sitting next to him in the back, we began to regret this decision.
Leroy was clearly very high, with marked pressure of speech. He was also patently psychotic.
“Masked AMHP,” he said, “You’re scaring me. You’re speaking with the voice of an alien from Alpha Centauri! Stop it please.”
“I’ll do my best, Leroy,” I said, and decided not to speak at all.
At last we reached the hospital. I took him down the corridor towards Bluebell Ward, keen to get him into a safe place.
Halfway there, he suddenly stopped.
“I’m not gay, or anything, Masked AMHP,” he said, “but I really want to kiss you. On the lips.”
With that, he put a hand round my throat and pushed me against the wall, his lips wide open and his tongue moving rapidly from side to side like a conga eel searching for prey.
I could suddenly see my whole life passing by. Could I survive a kiss from Leroy?
I managed to extricate myself just as he was about to launch himself on me, and hurried on down the corridor, with Leroy in close pursuit.
Once we were on the ward, I suggested that Leroy might need to be detained under Sec.5(2), so that we could arrange a formal assessment.
Florence was a lady in her early 60’s. She, too, had a long history of bipolar affective disorder. I had assessed, and detained her, on several occasions in the past. Her typical presentation was to become hypomanic, with grandiose ideas, and spending money on irrational things.
Her long suffering husband called us, to let us know that she had “gone off” again. I went out to conduct an initial assessment with Dave, her community nurse.
Her husband met us at the door. He was a lot older that Florence, and the strain was telling on him.
“She’s bought a one way ticket on Concorde to the USA,” he said in despair. (This was a few years ago, when Concorde was still in service.) “She wants to see the President to give him some advice.”
We found her in the sitting room, drinking a tumbler of sherry and watching a pornographic video on the TV.
We politely asked her to turn the TV off.
“It’s just getting to the good bit,” she said, taking a swig from her glass.
We eventually persuaded her to turn off the TV. She abruptly got up and wandered off into the kitchen. We followed her there.
She was quite plainly unwell, and her husband was unable to keep up with her.
We tried to talk to her to assess quite how unwell she was, but she kept jumping from one random topic to another.
I suddenly caught a glimpse of something peering out from the side of their fridge. I pulled the fridge out to be confronted with a fairly large furry animal, which looked up at me with appealing eyes.
“What is this, Florence?” I asked her.
“That’s my new chinchilla,” she said. “I got it yesterday. I was wondering where it was. I’m planning to start a chinchilla farm.”
On this occasion, we managed to persuade her that it would be a good idea to go to hospital. This time, Dave drove, while I sat in the back with Florence.
Florence seemed to take a liking to me. She took off her shoes and put her stockinged legs on my lap. Then she began to sing.
“Somewhere, over the rainbow, skies are blue...”
She continued to sing a medley of songs from 30’s and 40’s movies.
I decided to humour her with a rendition of my own. This was a mistake.
“You must remember this, a kiss is just a kiss –“ I began.
Florence looked at me with sudden affection.
Very well, my dear,” she interrupted, licking her lips, and suddenly lunged forward and planted her moist lips firmly on mine, attempting to thrust her tongue down my throat at the same time.
“Need any help in the back there?” Dave enquired, seeing a commotion in his rear view mirror.
But I was not at that moment able to reply.