Tuesday, October 02, 2012

why tell Charlie?

As hostels go it slots right in, the only thing to distinguish it from the rest of the Georgian buildings in the crescent being a computer screen and cork notice board visible through the front window. Charlie, the duty manager, is waiting for us under the portico on the black and white tiled steps, smoking a cigarette and glancing anxiously behind him. He waves as we pull on to the forecourt and dabs out his fag amongst the geraniums in the box to his right.
‘Thanks for coming,’ he says, rubbing his chin. ‘Josh’s been staying with us a couple of weeks. He’s just come in and asked me what he should do about the overdose he’s taken. So of course I say what overdose and he says a couple of boxes of paracetamol. So I say for a start I’ll be calling the ambulance. But then he starts getting edgy, saying he doesn’t want to go to hospital. I explained that I couldn’t let him back in the hostel after all those pills, but he’s still being difficult. I’m on my own here tonight. I can’t just let him back to his room and keep an eye on him. It’s not that kind of place. Anyway - see what you think. He’s in the hallway. I don’t really know Josh that well. He’s only been here a couple of weeks.’

The wide, black door’s standing half open. Charlie goes ahead of us.
‘It’s the ambulance, Josh.’
The hallway has been partitioned off, a security door with meshed glass in front of us controlling access to the rest of the property, and a double-locked office to our left with a serving hatch cut into it. Josh is standing in the corner over by the security door. A tall, stringy kid in his early twenties, he leans up against the wall with his jeans at half-mast, a track-suit top with the sleeves bunched up at the elbow. His hair is cut in a feathery black crop, strikingly contrasting with the pallor of his skin. There’s something curiously inert about him, every aspect; even his clothes can’t seem to keep a grip.
‘Hi Josh. My name’s Spence. We’ve got Rae here, too. How are you doing?’
‘What do you mean, how am I doing? I’m tired and I want to go to bed.’
‘We understand you may have taken an overdose tonight.’
He doesn’t respond.
‘Some paracetamol? Is that right?’
‘I didn’t call you.’
‘No – I think Charlie did. Charlie called us because you’d asked him about this overdose, and really – what else can he do?’
No response.
‘How many paracetamol have you taken, Josh?’
He shrugs. ‘Thirty-four or so. Two packets. Something like that.’
‘That’s a significant amount, Josh.’
He looks at me, then without any change in expression, turns to look at Charlie. It’s a strangely absent gesture, his black eyes flat, without expression.
‘I want to go to bed. Just let me in so I can go to bed.’
‘Can’t do it, mate. Sorry.’
‘I just want to go to bed.’
I hug my clipboard.
‘Why don’t you come out with us to the ambulance, Josh? We need to take you up the hospital to get this overdose treated – and get you someone to talk to you about the reasons why you did it? Yeah? Come on. Charlie can’t just let you go back to your room, can he? Not after what you told him.’
‘I just want to go to bed. You have no legal right to stop me.’
‘Can’t do it, Josh,’ says Charlie.
‘I’ll sleep rough then.’
Charlie shakes his head. ‘Come on, mate. Please can you just go with the ambulance people here? It’s the only sensible thing. I wouldn’t be doing my job if I just said yeah, fine, whatever – would I?’
Josh suddenly pushes himself upright and strides past us out of the lobby, down the steps and out onto the street. Rae goes after him a little way, but ultimately all we can do is watch him hurry off down the road.
‘Can I use the phone in your office, Charlie? Have you got his details? I’ll get the police involved, pass a description. They should probably be told.’

I’m in the office a little while; Rae has gone back out to the ambulance to sit in the cab and text.
Whilst I’m on the phone to Control telling them what’s happened, the front door opens again and Josh walks in. Charlie stands at the door to the office to talk to him. Josh starts shouting, repeating the same thing over and over again: Let me in. I want to go to bed. Let me in. You have no right.
‘He’s come back,’ I say to Control. ‘As you can probably hear.’
Charlie tries to reason with him, but Josh kicks the door.
I’ll smash it down if you don’t open it. Now!
‘Can we have the police along, please?’ I ask Control, and ring off.
Rae has followed Josh in. Between us we have him penned in the corner by the security door. His brief burst of violence subsides, and he assumes the same position as before.
‘I’ve called the police,’ I say to him.
‘They can’t touch me.’
‘Josh – all we want is for you to be well. You’ve taken a dangerous overdose of paracetamol. You can’t just go to bed and forget about it.’
‘Why not? It’s my life.’
‘What sort of people would we be if we just left you to it?’
No response.
‘Why did you tell Charlie about the overdose, Josh? You could’ve just stayed in your room, swallowed the pills and no-one would’ve been any the wiser.’
‘Let me in,’ he says, without looking up. ‘I want to go to bed.’
‘I think you told Charlie because unconsciously or not you wanted someone to know and do something about it. Which is good! That’s a good sign, Josh. That’s why we’re here. To help get something done.’
‘Let me in. I want to go to bed. You’ve got no right to stop me.’
‘It’s a significant overdose, Josh. You could seriously damage your liver. It could kill you.’
‘You’ve got no proof I took anything.’

I step outside. Rae takes my place. Maybe she can find a way to persuade him.
The police arrive. I explain the situation at the bottom of the steps.
‘I don’t know there’s much we can do,’ says the first officer. ‘If he’s competent, he’s within his rights.’
‘I know,’ I say, glancing up at the door just to check we’re not being overheard. ‘To be honest, when he absconded I thought that would be it, but now he’s come back and just keeps saying he wants to go to bed. Obviously Charlie the warden can’t let him through, so we’re a bit stuck. He’s already threatened to kick the door down, and I think there’s a real chance he’ll get violent.’
‘Let’s have a look, then.’
We walk back up the steps together.

The scene is exactly as it was – Josh, leaning up against the wall, Rae to one side and Charlie to the other.
‘Hello, Josh,’ says the first officer.
Josh folds his arms more tightly. ‘You can’t lay a finger on me. I know my rights. I didn’t call the ambulance. I don’t want you here. I’m tired and I want to go to bed.’
The police officer speaks to him patiently, evenly, each phrase ending with a gentle ok-ay, and then a pause to judge the effect. The second officer seems edgier, offering up a tougher kind of logic whenever the moment allows. Between the five of us we have most angles covered – medical, social, safety, legal – but nothing has any effect.
‘You can’t touch me,’ says Josh. ‘I haven’t done anything wrong.’
‘I understand you kicked the door and used a threat of violence against Charlie here. Is that right?’
‘Let me in. I want to go to bed.’
‘Of all the things that might happen tonight, that is definitely not one of them,’ says the second officer.
‘Come on,’ says the first. ‘O-kay? Let’s go outside and talk about it there. You can’t stay here tonight, and we can’t stand here talking to you all night.’
He puts a hand out to guide Joshua to the door. Joshua lashes out. The two officers grab his arms and they all wrestle to the floor.
‘I’m arresting you for breach of the peace,’ says the first officer, struggling to speak whilst he grapples for control of Josh’s left arm. Despite his slim build, Josh is surprisingly strong. He screams and swears, kicking his legs, twisting and butting his head – anything to get a purchase, an angle. Charlie backs away into the office, appalled. In the confined space of hallway the whole business is lumpen, messy and violent. The three of them are squashed up in a heap between a radiator and the security door. We do what we can to help, holding down Josh’s legs, whilst the first officer eventually manages to free up a hand to put out a call for back-up on his radio.


At the hospital, Josh is handcuffed to a trolley with the two police officers standing right and left. He has resumed his inert posture again, completely uncooperative, sullen and withdrawn. I can tell he’ll be refusing any treatment, all the while looking for a chance to escape.
‘Sorry to bring him in,’ I say to the charge nurse. But she smiles, seems quite sanguine about it.
‘If he doesn’t want help, we can’t force him,’ she says.
‘No. I don’t suppose we can.’
 ‘He’d have turned up eventually, after a day or so, with the abdo pain, the vomiting, the jaundice...’
She signs my board with a flourish.
‘Thank you,’ she says.
Whilst I’m in the reception office, photocopying my sheet, I try to imagine standing in the hallway back at the hostel, watching Josh wander through the security door and off to bed, sleepily tidying away the scattered blister packs into the bin.  
I drop the copied sheets into the tray, and head back out to the truck.


jacksofbuxton said...

Not a lot you could do there Spence.

Strange to think that the only way you could treat him was by having him arrested first.

Spence Kennedy said...

This whole area of competency / best interest is fraught with difficulty. Apparently, you can't deduce a lack of capacity from someone who's attempted / attempting suicide. If you lay a hand on them, it's assault. But on the other hand, you have a duty of care to make sure that they're being rational, and not acting under the influence of anything they've taken / the stresses of the situation. Which on scene is fairly impossible. In this case, the police arrested Josh for breach of the peace. The only reason they took him to the hospital was because of the overdose - not something they'd be able to do anything about at the custody suite. But then - he'd be quite within his rights to refuse treatment, as he's not under section. At least at the hospital he could be seen by someone from the psych team, who'd have more expertise in the subject.

Difficult and frustrating. All we can do is the best we can, given the circumstances, working in good faith. I'd rather make a technical error like this, than feel guilty that maybe I'd neglected to give someone a chance.

One thing that confuses me, though - at inquests into suicides, they often talk about a person taking their own life 'while the balance of their mind was disturbed' - a retrospective judgement, which seems to suggest that a suicidal act is not the result of a balanced mind, i.e. you could infer mental health issues from the very threat of the act itself.

Like I say - a legal minefield. And out in the real world, not something we have much time to think about.


Wordfiend said...

I would have thought that his clear statement to the warden would satisfy a court that he had suicidal intentions and was a danger to himself.

And I think you nailed it, Spence, when you pointed out that, on some level, he wanted to be rescued. The suicidal brain is irrational.

Spence Kennedy said...

Absolutely - but as far as capacity goes, I think it's the case that you can't assume a lack of it just because someone has expressed suicidal thoughts / made an attempt. The only grounds for intervening is if you think there's some reason the person isn't able to act rationally - influence of drugs, for example. But I completely agree. All this is fine when you're away from the situation with the luxury of discussing the legal niceties. In the moment, I can't imagine anyone simply standing by and watching as someone attempted to hurt themselves. It just doesn't sound reasonable - or humane!

Thanks v much for the comment, Wynn.