The purpose of this experiment is to investigate the responses of local Mental Health services under certain controlled circumstances. It is hoped that the data emerging from this experiment may confirm or refute the hypothesis that people who work in MH services demonstrate a high prevalence of behavioural traits that can be classified as ‘difficult-case-avoidant’.
A range of local MH professionals comprising General Practitioners, Consultant Psychologists, Staff-Grade Psychiatrists, Art Therapists and Nurses specialising in the treatment and management of those with MH problems have been exposed over a period of several years to an annoyingly intelligent, articulate and treatment-resistant patient. The patient (who shall be referred from here on in by the pseudonym ‘Aethelread’) has been passed from service to service and from individual to individual in a manner that conforms to the classic ‘failure-to-treat’ model first elaborated by Nutter et al in their seminal 1991 paper ‘Failure to Care in the Community: A Critique of Emerging Mental Health Treatment Models’.
One unlucky professional, a staff-grade general psychiatrist, has been left ‘holding the baby’, as he accepted a re-referral from a Nurse Specialist colleague without realising that all other referral options (including the desperate, last-resort, ‘maybe drawing a pretty picture will help you feel better’ option) had been exhausted. He has deployed a number of strategies for encouraging Aethelread to disengage from MH services. These include: being a bit of a twat; attempting to scare Aethelread by threatening sectioning; demonstrating himself to be the pharmaceutical companies’ bitch; attempting to demoralise Aethelread by informing him that he is not mentally ill; being a lot of a twat. In accordance with standard experimental protocols, Aethelread has responded to all of these tactics in a manner intended to imitate the behaviour of a disappointed patient somewhat frustrated by being made to jump through various hoops like a performing dolphin who doesn’t even get rewarded with any fish.
As of 11:20 on Friday August 7th 2009, however, Aethelread has activated the ‘second stage’ of the experimental procedure. In this stage, he will attempt a sudden and silent disengagement from MH services. This has begun with a simple failure to attend a 6-monthly ‘review’ with the aforementioned staff-grade general psychiatrist. Over the coming days, weeks and (potentially) months, Aethelread will continue to ignore any and all attempts to contact him, and will not attend any appointments, assuming any such appointments are offered.
Potential responses to this second stage have been classified as follows:
The ‘thank fuck for that’ response: the staff-grade general psychiatrist will update Aethelread’s notes to indicate that he has failed to attend an appointment, write a brief discharge letter to Aethelread’s GP, then forget about it all with a grateful sigh of relief;
The ‘better make it look like we’re going through the motions’ response: the staff-grade general psychiatrist will contact Aethelread by letter, noting his failure to attend the appointment, inviting him to respond within a set period, and informing him that if he fails to respond within this time period he will be discharged back to his GP;
The ‘actually doing our jobs’ response: the staff-grade general psychiatrist and others will make repeated and genuine attempts to contact Aethelread, in order to establish both his reasons for failing to attend the appointment, and to ascertain his current state of mental health;
The ‘Defcon One’ response: the staff-grade psychiatrist will arrange for an immediate section as a ‘precautionary measure’.
It is anticipated that the response offered by the staff-grade general psychiatrist will fall into one of these four categories. Should a wholly unexpected response occur, the list of potential responses will be updated accordingly, with a full description offered at that time.
It is intended that interim reports will be presented in these pages from time to time, reflecting those occasions when there is significant activity to be reported. A full summary of the experiment, together with a detailed description of all results and pertinent concluding remarks, will be published once the experiment has been completed.
Yes, I know I should have gone. Yes, I know I should have gone because it would be the best thing for me. Yes, I know I should have at least cancelled, because just not turning up is a criminal waste of limited NHS resources. Regrettably my state of abject panic this morning (have you heard there’s a plague on? and that places like psychiatric hospitals are perfect breeding-grounds for the infection?) didn’t allow any other response.
Bad Aethelread. Go straight to gaol. Do not pass Go. Do not collect £200.