Wednesday, January 28, 2009


Even though it is late there is still some light left in the sky, a watery smear of slate gray at the vanishing point where the coastal road becomes the horizon. A ripple of blue marks a spot just down from there. It swells with definition as we get closer, and then separates. A police car, with its scene lights illuminating a group of four on the pavement: a woman and a policeman sitting on a low wall; a woman and a policeman standing. Frank parks the truck. I jump out and walk over to the seated couple.
‘Hello. My name’s Spence.’
The woman is sitting with one leg hooked over the other, bouncing the foot about, resting forward on the knee, using it as a smoking prop. Steve, the policeman beside her, seems professionally relaxed. He is studying his hands, turning a wedding band round and round whilst the woman blows out smoke and smiles at me despite her eyes. I feel like I’m interrupting a couple having a discussion about the state of their relationship at a party.
‘I’m fine,’ she says, tapping off the ash from her cigarette. ‘Honestly, there’s nothing wrong with me.’
‘Okay. Good! But you know, the message we were given was that a woman had tried to throw herself under a car.’
She laughs bitterly.
‘Oh for goodness sake. This is ridiculous. Look – I’ve had a bit to drink. Obviously. I’ve had a bad day. People do. Things were getting a little bit on top of me. I tripped on the pavement and I found myself in the road. And that – is – it. That’s all. What have I done wrong? Where’s the crime in that?’ She takes another pull on her cigarette and squints at me through the smoke.

Steve straightens up. Some policemen are burdened by their own equipment, but Steve seems lighter, more adaptable. He has the quiet self-possession of a craftsman who would only pick up a tool exactly when he needed it.

‘Hilary. We’ve been called, these ambulance guys too, because you threw yourself in front of a car. It was only your friend here that stopped you from succeeding, as well as that other guy who came over to help. They had to wrestle you to the ground. Do you remember, Hilary?’ He looks at me and says as an aside: ‘Amazing, the guy helping like that. Don’t know where he went to.’
‘But I’m fine.’
‘You’re not fine, are you, though? You’ve got to admit, none of this would look fine to a reasonable person. I mean, we all like a drink. But we don’t tell the person we’re with we want to die and then throw ourselves into the road.’
‘But really. Honestly. It’s a misunderstanding.’
‘No, listen to me, Hilary. What we’re all here to do now is figure out A, what happened and B, what we need to do next. Our main concern is you don’t do yourself any harm tonight. We need to get that sorted. So - as a first step - I suggest we get off this wall, go onto the ambulance and have a chat in private, out of the cold. Okay?’

Hilary flicks her cigarette out into the road and watches where it lands. Then she leans forward to tap the side of her boot.

‘I’m fine. Really. I twisted my ankle a little, that’s all.’

Steve gets to his feet. I take one step forward to help her up. At that moment she suddenly sprints off to the side, snapping away like a dog after a stick, her handbag slipping off her shoulder and flying up, her coat opening out like wings. Steve is ready for her, though. He intercepts her in one stride, and scoops her into his arms. As soon as he has hold of her she gives up, and when they’ve both found their balance, slowing down like a couple after a drunken waltz - she stands neutrally. Steve releases his hold. She repositions the strap of her bag onto her shoulder.
‘Let’s not be silly about this, now.’
‘I don’t want to go on an ambulance,’ she says, with the glittering tones of someone explaining a faux pas. ‘I want to go home.’
‘Come on, Hilary.’
He leads her to the truck. We sit her in a forward seat, and then take up positions around her. After the damp road the ambulance smells aseptic, anonymous. The light’s too bright and the trolley creaks when the two policemen sit on it. Hilary’s friend leans forward and touches her on the shoulder.
‘You so need help, Hillie,’ she whispers. ‘I’ve seen you bad, but not this bad.’
‘And what do you think they’ll do for me at the hospital? Hey? What would they do for me? You know exactly what they’d do for me. They’d say: let’s sober you up and see how you are. Let’s keep an eye on you and keep you waiting for fucking hours. Let’s give you some diaze-fucking-pam and send you home at five in the morning. There’s nothing they can do for me. I’ve been there and done that. God knows I’ve been there and done that. There’s nothing anyone can do for me. I lost my licence because of the last time. Six months. How did that fucking help? I just want it all to end.’

And more awful than the tears that run down her cheeks is the polite smile she dredges up from beneath it all.

‘I manage a large business,’ she says. ‘I’m fine. Really. I just need to go home, get some rest. I’m always like this when I drink. I’ll be fine in the morning.’ She pats her face with a wad of tissue. ‘I’ll go to work and no-one will know.’

Martin, the other policeman, is standing at the back of the ambulance. He takes a notebook out as if he’s going to write something down, but then stuffs it back inside his jerkin. Hilary’s friend sits absolutely still.

Steve says: ‘I’ll be perfectly honest with you, Hilary. Going home tonight is not an option.’

She makes a gasping noise as if he’s punched her in the stomach, but he says: ‘Just hear me out, Hilary. It’s not an option and I’ll tell you why. Our first responsibility is to see that you don’t hurt yourself. We all care about you here. There’s no way any of us would say “Okay Hilary, off you go” if there was a real chance you’d put yourself under a car or throw yourself off a cliff, or whatever.’
‘You just don’t want it on your conscience,’ she sniffs, rubbing her eyes with the heels of her hands so vigorously it’s like she wants to rub them clean away.
‘It’s nothing to do with consciences, Hilary. We’re doing our jobs, and that’s it. So. The options are: you go with Spence and – who is it? – Frank, here, to hospital, and get assessed by the medical team there, or I arrest you and take you to the cells. What’s it going to be?’
‘I’m fine. This is ridiculous. I just want to go home and go to bed.’
‘Hospital or the cells, Hilary?’
She drops her chin and whispers: hospital.

Steve tells Martin that he’ll be riding up in the ambulance, and that he should follow in the car. With a timid inclination of the head, Hilary’s friend agrees to come along, too. Whilst I put a seat belt on Hilary, Frank puts the step up, shuts the door and gets into the cab to drive.

We move off.

I ask Hilary her last name. She mutters a reply, seeming more interested in picking fluff off the front of her coat. When I ask her to speak up, she raises her chin slowly and looks at me, a wide and watery look that doesn’t see me at all, but rather seems to suddenly process the fact that the ambulance is moving.

And in one movement she unsnaps the seat belt, throws open the door and makes to leap out. But Steve is already behind her, both arms around her shoulders. I grab her round the waist, and between us she screams and kicks and pushes out the door whilst the ambulance lurches to a halt, but she’s slight and drunk and desperate, and we keep her on board. I can see the reflection of the blue lights of the following police car flicker up, guarding us from the traffic.

When Martin appears at the door, Steve simply says: ‘Cuff her.’ And then: ‘Let’s do this sensibly, Hilary. Arms in front, please. And then a nice, calm walk out to the car.’ He begins to explain what will happen to her – how she’ll be taken to the cells, stripped, searched, assessed by a doctor.

As Martin unclips the cuffs from his belt, Hilary looks round at her friend and shouts: ‘I hope you’re proud of yourself.’ But her friend says nothing in reply. Instead, she stares fixedly at her hands and wets her lips with her tongue.

Then Hilary seems to weaken. She shrinks back into her seat as the black and silver bracelets clack and snap round her wrists.

Martin produces a tiny key on an extendable line, and locks the cuffs into place. He gives them a little jangle for security and comfort.

Hilary looks straight at me. Her face is radiant with despair.

‘I was only going out for a drink,’ she says. Then she presents her hands out to me, gently wagging them backwards and forwards, as if to say: ‘Happy now?’

Martin stands to the side of the door, Steve moves up behind her, and I make room for them all to leave. The night gathers in around the doorway, thick and cool with the threat of more rain. She stares out into the darkness for a moment, sighs, then glances back at me.

‘Have you any idea,’ she says, pleasantly, ‘any idea at all - how difficult it is to kill yourself?’


Anonymous said...

Poor woman. She sounds like she was desperate to kill herself.

I don't understand why they decided to arrest her, though. The last place a person with mental health problems should be is a cold, empty cell with unsympathetic custody sergeants 'looking after' her. At least in A&E she would be looked after by people who are trained to care.

Spence Kennedy said...

Hi Anon

Unfortunately, arresting her (forcible detention under Section 136 Mental Health Act), was the only viable option. Hospital isn't a safe environment. The staff don't have any powers of restraint, so she could easily have said that she didn't want to be treated and walked out. In her state, she would almost certainly have made a serious attempt to kill herself straight away. So what the nursing staff would've done would've been to ask the police to section her as soon as she'd left the premises, and she'd have ended up in the cells that way, too.

Of course, the other thing to bear in mind is that Hilary was definitely a danger to others. It was lucky the car she threw herself in front of didn't end up swerving and ploughing into oncoming traffic etc. If she absconded from the hospital (easier to do than from a cell), she might have caused someone else some harm.

She'd only be in the cell for 72 hours max (prob much less) - and then, if she's thought by doctors/ASWs to be a risk, they'd apply for a Section 2 to arrange further (involuntary) treatment.

I agree, though. We're very poorly set up to deal with these mental health crises. Hospitals are overstretched just dealing with the physically sick, and the police are there for public order / crime. Neither have the time or facilities (certainly round here, at least) to provide a safe, secure and sympathetic environment for these patients.

Thanks for the comment :)

uphilldowndale said...

She could easily have injured you and Steve as well. Mental health is a poor relation in health care.

Like the new look Spence

Spence Kennedy said...

You're right about mental health being the poor relation - which is ridiculous, considering the high percentage of our workload it comprises. The pathways to care are just not clear, certainly for the ambulance, which often comprises the acute response (along with the police). It's one of the aspects of the job I find most difficult, as far as offering appropriate and good levels of care. But you make the best of a bad job, as always.
:) x

Anonymous said...

I agree the pathways we have for mental health patients is terrible. I think years ago there were dedicated mental health A/E units where you could pre alert an arrival and have them met by an appropriate professional............ we seriously need something doing about this huge short fall as it is a huge percentage of our work.

I just hope you get don't get 'That Call' for her one day.

Spence Kennedy said...

I don't know why they can't have dedicated 24/7 psych team provision. They find the money for all the medical/surgical stuff. Why is that side of things so poorly funded in comparison? Especially bearing in mind the huge numbers that experience mental health crises.

It was dreadful seeing Hilary carted off to the cells like that. Truly awful. Politics aside, as ambulance people we're the ones at the sharp end who the patient looks at and thinks 'you've let me down'. Difficult!

loveinvienna said...

Whilst I feel very sorry for Hilary... I feel more sorry for her friend. She must wonder if she did the right thing by calling the police and the ambulance, if her friend will benefit at all by her intervention. Obviously Hilary was having major problems and probably didn't mean what she said but I'm sure it will remain with her friend.

I also feel so sorry for you, Frank and the policemen. The accusing looks, the lack of understanding, the broken eyes which stare at you pleadingly. It made me feel helpless and as if I were the guilty party. There was a lady with severe depression at the Home and when she refused her anti-depressants, it was like this huge black cloud just descended over her. She would stare at you with these huge watery blue eyes and ask for help to 'end it all'. When you tried to cheer her up, she would call you heartless, unfeeling, b*tch, wh*re, whatever. She wouldn't move, she'd just sit there spitting these words at you from her armchair. I think what you saw would be much much worse, and what I saw was bad enough.

And naturally, the Mental Health people couldn't help. Not bad enough to be sectioned, not well enough to be at home and the family couldn't cope with her. And the psych wards were full to bursting. It's a real problem.

Liv xxx
PS. Love Innis' photos! Lovely!

Spence Kennedy said...

Hi Liv,
You're right, Hilary's friend must've felt the whole thing acutely. It's so difficult, intervening with force to stop someone doing what they see as a rational act, or at least something they really want to do. But everyone's acting in good faith, which is consolation of a sort.

Carol said...

Makes one realise how lucky one is not to feel so much despair that ending it all seems the only option left.

Spence Kennedy said...

It's unbelievably awful to think of Hilary being stripped, given prison clothes and put in a cell, even if it was just for 24hrs. I can't imagine the depth of despair she must have felt. It made me feel quite sick.

Katharine said...

Another great post Spence. Steve sounds like a seriously good cop, and I think all of you did the best thing you could in very difficult circumstances with very limited options. Hope Hilary gets the follow-up help she clearly needs, but I'm pessimistic on that, to be honest.

Anonymous said...

Once upon a time, not really so very long ago, there were institutions which made some attempt to deal with the Hilarys of this world. Then someone came along in charge who believed it was better that it should all be done "in the community". It didn't matter if it was mental health, disability, in the community was the buzzword. I wouldn't like to say whether the belief that it would be cheaper had a bearing. And then the next step was to take it away from the people who had proper medical training and had an idea of what they were doing. I think it's Dr. Crippen who has written about it recently. Want a job? Go and be a "mental care assistant".
And the true cost? The murders and suicides we've heard a lot about recently as a result of people who need proper care in the right and secure environment being denied access to it. If someone really wants to commit either they will do it sooner or later - but if the desire is because of an illness that could be dealt with they should have access to that right and proper care. And if not, then the rest of society needs to know they are not being put at risk.
I weep for what the British system has become. Mental health care is truely a poor relation, but the NHS itself is not to blame - it's the big boys (and a girl) who have interferred without knowing what they were doing and who continue to do so in so many other fields too. Nor is it any one political party - they're both culpable.

Spence Kennedy said...

Hi Anon,
It's difficult, isn't it? Whilst I wouldn't want to go back to a time when people with mental health probs were 'banged up', sometimes indefinitely, it does seem as if we've gone too much the other way in terms of community care.

As far as the ambulance goes, we're in a difficult position when it comes to dealing with acute cases. Hospitals aren't set up to handle them, and police cells seem to have become a holding bay.

I suppose funding is the key, followed by a cool appraisal of how things are working on a practical level.

I don't agree that it's so easy to walk into a mental health care position, though. I don't know that much about it, but in my contacts with the people who work in the day centres, secure units etc, they've always struck me as very professional and motivated people. A cliche, I know - but it's a tough job and I don't think I could do it!

Thanks for your comment.