Jane has a long history of mental health problems. She has had a diagnosis of schizophrenia in the past, but due to her inability to engage with services and a precarious housing situation, she had fallen through the gaps. Jane has been unmedicated, untreated and unsupported for a few years now. As a result of her ‘challenging’ behaviour her tenancy was at risk, and she was very close to losing her flat due to anti-social behaviour.
Jane has been open about the fact she has mental health problems, however she dislikes the stigma attached to schizophrenia, has had bad experiences of services and medication. It was clear that she was struggling with unwanted thoughts and the actions these provoked so I made enquiries about getting some assistance for Jane. She was not registered with a GP, so the options were very limited. The first port of call would be to call for an ambulance if she was presenting a risk to herself or others. If she was deemed to be too high risk for paramedics, she would have to be removed by Police officers, who would then escort her to specialist cells in Wakefield. Neither of these options would address Jane’s ongoing problems, and would be likely to cause her a great deal of distress.
I made further enquiries with the Mental Health crisis team. Again they were unable to help whilst she was unregistered. Even once registered, the crisis team will only respond to a person currently under their care and who is not under the influence of alcohol or other substances. This is further compounded by the fact that they will only visit at a known address and the response time can be up to 4 hours.
So Jane was again at risk and vulnerable, the one service she needed to access had no duty of care to her and the only other route risked making her feel criminalised for actions beyond her control.
Jane agreed to register with a local GP, although this took a lot of encouragement. She is wary and sceptical about professional services, so this was a big move for her. I accompanied her to the new patient assessment. She was quite guarded with the GP, but with some prompting it was clear from her mannerisms and speech that she was in some difficulty. A referral was made for a full mental health assessment, a move in the right direction, but this process would also take some time.
Whilst waiting for this referral to be processed and a Community Psychiatric Nurse to be allocated, several incidents occurred which further jeopardized her tenancy. As no up-to-date diagnosis had been made, the local authority housing had little option other than to continue eviction procedures as normal, they needed a diagnosis in black and white before they could consider the situation to be anything other than anti-social behaviour.
All these factors, the threat of eviction, the upcoming Mental Health assessment and past traumatic experiences meant that Jane was really struggling and her mental health was deteriorating. It took a concerted effort and numerous phone calls to the assessment team before she was flagged up as an urgent referral. It was a relief when I received a phone call from Jane’s allocated CPN. She had made her first home visit and had immediately admitted Jane to a psychiatric ward for assessment.
The whole process has taken weeks, during this time Jane had little support, no-one to advocate for her and little prospect of receiving constructive help. The very service she needed to access was surrounded by barriers, successfully gate keeping support from a person who desperately needed their help.
Jane has now spent a couple of weeks on the ward. She is making slow progress and is on her way to receiving appropriate support and treatment. This can only be maintained by pulling together a number of different agencies, to ensure that when Jane returns to the community, she won’t be allowed to fall through the gaps again.
I’ve worked with Terry for about 2 years now and for most of that time he’s been an entrenched rough sleeper. Terry was in care from an early age and soon resorted to crime – namely car theft and joy riding – to fill his time and stunt his boredom. The outcome of this was a trip to the local Young Offenders Institution where he started experimenting with drugs!
After a few years of smoking weed and doing recreational drugs Terry’s mental health suffered and he tried to commit suicide by jumping off a railway bridge. He was hurt, but not dead and was then sectioned by the local authority and diagnosed as schizophrenic. When Terry was discharged from the psychiatric ward he went into supported housing in Bradford, it was here he started using heroin.
He turned up in Leeds and was brought to the attention of our organisation; this was about 4 years ago. Throughout this time Terry had been in and out of hostels, but mainly rough sleeping due to his drug addiction. We, as an organisation, never gave up on Terry. He was often incredibly difficult to engage with and refused to have anything to do with specialist support services. But we persevered and knew that if we maintained contact with him there was always an opportunity for positive change even if in the short term that was simply buying him a sandwich or just a chat. Consequently through long term planning and getting Terry to recognise the need for small steps towards his desired outcomes we managed to secure drug treatment for him which he’s doing fine and is stable. He’s also just signed for his own tenancy with the local authority and we’re working with Terry to get him moved in and settled.