BRIEF ENCOUNTERS
MR TOOK
evidence-based treatment is Cognitive Behavioural Therapy. And as with any talking treatment, you can lock a patient up from now till Kingdom Come but if they donât want to engage with it, youâre wasting your time. You can lead a hoarder to the doctor, but you canât make him rethink.
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Something small, quick and mouse-coloured skittered past my left shoe. I wished, with hindsight, that Iâd gaffertaped the bottoms of my trouser legs as the social worker had advised.
he door swung open as I knocked, but only far enough for someone who wasnât too fond of pies to squeeze past. I sucked in my Fray Bentos paunch and slid myself into the hallway, calling out âHello?â in my best professional voice. The walls on either side of the entrance were piled to the ceiling with newspapers and pizza boxes arranged in tidy columns: One column was only Shropshire Stars; the next only Chronicles; the next only Dominos. I pulled a Chronicle out at random: it was six years old and the headline read âLocal School Has Three Teachers Named Daveâ. I pushed it back and the structure wobbled unnervingly. The hall gave onto what must once have been a kitchen. Not every inch of the lino was covered in dismantled machinery; the bits that were clear would possibly have been enough for the floor of a phone box. Over the top of a gutted crankshaft my clientâs head bobbed up. He waved a sheaf of papers at me: âThis report says Iâve got twenty motorbikes in here! Absolute rubbish â Iâve never had more than twelve. Plus the lawnmowers of course.â Mr Took was a man in his late fifties. He had lived until two years ago with his mother, who had been both his carer and a kind of human shield against the world. Since she had died, the wheels, so to speak, had started coming off. I gazed mournfully at the empty front forks of a Triumph 850 Tiger Sport. My client was sitting on a camp chair wedged up against the gas cooker. All four rings were lit, and as he gesticulated, the psychiatric report brushed perilously close to the naked flames. âI told the bloody doctor I was going to sort it all outâ, he complained, more offended than angry. âHow can I get on top of it if Iâm in the bloody hospital all the bloody while?â
I didnât blame the authorities for sectioning Mr Took. The National Assistance Act s.47 used to allow for the removal to a safe place of persons who were âunable to devote to themselves, and are not receiving from other persons, proper care and attention.â But it was rarely used and was replaced in 2015 by the Care Act, which takes a much less paternalistic approach. So when a person is living in conditions which go well beyond bohemian eccentricity but arenât quite at the pitch of insanitary squalor which would animate the Environmental Health Authority, there arenât many powers available. Mr Took certainly didnât welcome intervention in his life. There was brown paper taped over his windows and a sign on the front door saying âNO CALERS OF ANY KINDâ. To arrange my visit I had to ring his land-line eleven times before he answered. All he wanted was to be left alone. The next day the Tribunal did discharge him, finding that although he needed help, detention for hospital treatment wasnât it. Mr Took told the judge he would be âbrutalâ in clearing enough of the clutter to allow a swift exit in the event of a fire. After months of agonising, he managed to fill three Bags for Life and put them outside the back door. A couple of weeks later they were back inside. â Andy Howarth is a Solicitor in the Mental Health Department at GHP Legal solicitors.
Mr Took was on âsection 17 leaveâ â that is, he was still detained under the Mental Health Act, but he was allowed home for a few hours or days at the discretion of his consultant psychiatrist. This is often referred to as âtesting outâ; in practice it means that the patient can still be required to accept medication against his or her will, and if things go badly wrong he or she can be whisked back into hospital at a momentâs notice. Assuming somebody else isnât in their bed. So although Mr Took was at home, he was still liable to be detained, and he had to return to hospital the next day for his Tribunal hearing. He wanted the Tribunal to discharge him and I thought we had a pretty good case: Yes, he had a mental disorder â hoarding these days is recognised in both the ICD and DSM systems â but was there a hospital treatment that would make it better? No. The NICE guidelines (which still lump hoarding in with OCD) say that the one SHROP SHIR EL AWYER 9
