The Crippen Diaries - 2008 : May (1)

What do you want to do when you grow up...

May 2008 (1)

Amy is 29 and lives alone in sheltered accommodation that has been specially provided for the mentally ill. One of the odd anomalies of the area in which I work is that, although we have poor psychiatric services, we have excellent sheltered accommodation both for the mentally ill and the elderly. Amy has what is called a “borderline personality disorder”. She was badly sexually abused as a young teenager by an uncle who is now in jail. You don’t want to know the details. She gets flash backs to that and so there is another label, post-traumatic stress disorder (PTSD) on her notes. She suffers from at times severe depression, sometimes with psychotic elements. Her mother died two years ago. Her father is still alive somewhere, but she has not seen him for years. There is a caring grandmother but she is now old and frail and in the early stages of dementia. 

Amy has not seen her psychiatrist for over six months and, when he did see her, she did not feel she could talk to him so went into “very well, thank you” mode which he chose to take at face value. It’s easier. I have lost count of the number of overdoses Amy has taken; half a dozen at least. Usually her anti-depressants. She will take a good handful. She never takes paracetamol because, her care-co-ordinator says, she knows that would be dangerous. When she is depressed (frequently) she cuts herself on the forearms with a razor blade. Never deep enough to sever tendons but deep enough to cause permanent scarring. Her forearms are a mess. 

Her CPN is good but has a large case load and so only sees Amy once a fortnight. She has told Amy that if ever she is really desperate, she should take herself to the local A and E department. She has done that once. She was told that there were no psychiatrists on site (there aren’t – the psychiatrists only provide a 9 to 5, Monday to Friday service) and the psychiatric nurse was at the other hospital. She was advised to go home and “see you doctor tomorrow.” So she did. She will not be troubling the A and E department again.

I have known Amy a long time, and she will talk to me. So I have been seeing a lot of her recently and I hope I am providing her with some support. But what about the psychiatric services? She has been under their care for years. Which of them is looking after her? No one, really. Starved of funds, the CMHT is dumbed down and not helpful. The government would say I am exaggerating. They would say there are three “health care professionals” involved with Amy. Her CPN, who does see her occasionally. And then there is her “care coordinator” - someone who works in social services though is not a trained social worker. It is a grandiose title and a classical bit of New Labour flummery. Amy is not getting much care, and so little “coordinating” is needed. I have seen Amy more than any other doctor, and no one has ever attempted to coordinate me. Finally, there is Sharon. Sharon works with several “clients” in the same accommodation. She does shopping, and some cleaning, and is usually around to have a coffee if Amy wants to talk. Sharon is kindness itself. She is a patient of mine. She is not a doctor or a nurse or a social worker. She has no qualifications in mental health, and would not dream of making diagnoses or interfering with medication. Because she is the least qualified member of the “team” it is essential in the modern world of New Labour that she has a title. Sharon is therefore Amy’s “key worker.”

Thus, Amy is a success for the mental health services. She has both a care-coordinator and a key worker.
 

What more could some one with serious mental health problems want?