Tollesbury Time Forever (19 page)

DR WEEPY
- I am Dr Weepy. I am Simon’s Responsible Medical Officer.

Responsible. Indeed
.

PETER MIDDLETON
- I am Peter Middleton. I am a solicitor from Middleton and Fowlers. I am here today representing Mr Anthony.

Wonderful Peter the middle son of all the flowers of this earth. Presented to me from the tillers of the fields. Wonderful Peter
.

SIMON ANTHONY
- Hello. I’m Simon.

PENNY SHORATON
- And I’m Penny Shoraton. I am a Staff Nurse on Crimson Ward. I am also Simon’s Keyworker.

Beauty queen oh beauty queen. I am the grim son you never had. Lord l’m so keen it hurts.

DAVID CROMWELL
- I am David Cromwell and I work for the Blackwater Community Mental Health Team.

Too much monkey business. Deep dark purple and a shade of grey. Colours in the sky of the pie high high.

IRIS PEARSON
- Thank you. Just to let you know, Simon, that the other person here, over there with the notebook, is Donna. She is the Mental Health Act Administrator for this Unit and she will be taking notes of the session.

Now she is barmaid nice and blibs and blubs. Cheeky reds and Thelma orange roll-neck jumper as expected and dejected. Wink at me and wink at you. Castigate and flush, ruminate and vegetate. Like you. Like you a lot.

SIMON ANTHONY
- Hello.

IRIS PEARSON
- Now if we can begin with you Dr Weepy. Could you please talk us through your report? When you have done so, the panel will ask any questions they would like answered and then Mr Middleton will have an opportunity to question you on behalf of Mr Anthony.

Cough up doctor. Clear the throat and smote the groat, Sing it loud and proud from the heartstops of your thuddings and the needlings of your knowledge. Go doctor! Go doctor!

DR WEEPY
- Thank you. I will give a summary of Simon’s background history before going onto the current admission and the treatment plan that is currently in place.

Simon was born in Dagenham, Essex in 1958. He has no brothers or sisters and both his parents are deceased. He was delivered by caesarean section and, as a child, met all developmental milestones. The family moved from Dagenham to Tollesbury when Simon was very young. His father, who was an alcoholic, left the family home two years after the move to Tollesbury and Simon was thereafter brought up solely by his mother. Simon attended Tollesbury Infant and
Junior School, towards the end of which, at around the age of nine, there are reports of aggressive behaviour towards fellow pupils. He was also at times reported to be incontinent of urine. This continued until his early teens. Indeed, night-time enuresis has continued to be a problem for Simon throughout most of his adult life. He left school at the age of sixteen with no qualifications.

Simon’s first contact with mental health services was in August 1975, at the age of seventeen, when he was brought into Blackwater Mental Health Unit by the police. They had found him lying on the pavement in Tiptree High Street, screaming. He became aggressive towards them when they attended and they needed to use handcuffs and a van to bring him in. He was detained under Section 25 of the Mental Health Act (1959) and diagnosed with Paranoid Schizophrenia. During that first admission, Simon spent almost a year in hospital, finally being discharged in June 1976.

Subsequent admissions followed, the majority under section, over the next three years. Between 1979 and 1985, Simon was maintained in the community, although his mental state remained brittle throughout and he grew heavily dependent on alcohol. In 1980, he got married and in 1982, he had a son. The boy had Down's syndrome and evidently was cared for very much by Simon’s wife, Julia.

When his mother died in January 1986, Simon suffered a further relapse and was detained in hospital under Section 3 of the Mental Health Act (1983). During that admission, consideration was given as to whether a return to the family home, now in Tiptree, would be beneficial for Simon, or indeed the child. He spent seven months in a rehabilitation unit which addressed both his insight and his dependence upon alcohol. During this period, his relationship with his wife deteriorated, but she continued to visit on a regular basis and remained in constant contact with the care team.

On discharge Simon returned to live at the home once owned by his mother, in Tollesbury. He continues to live at that same address to this day.

In June 1989, following a suicide attempt where he had taken an overdose of his prescribed medication, Simon was admitted once more to hospital under Section 3 of the Mental Health Act (1983). He had been found by the milkman who had been alerted due to the front door being open. During that admission, Simon had his first course of ECT. A period of stability followed, largely due to Simon being compliant with his Depot medication and he began to see a psychologist on a weekly basis. It was during these sessions that the sexual abuse perpetrated by Simon’s uncle was revealed. The uncle had shared the family home in Dagenham and had worked with Simon’s father at the Ford’s plant. It is not clear as to whether Simon’s parents had ever been aware of the abuse, which continued until the move to Tollesbury in the early Sixties. It is my opinion that Simon’s mental health problems and subsequent addiction to alcohol have their base in this sexual abuse.

Pause and take a sip good doctor from your water glass of water essence. Let it soothe and cool and rest your soothings. Replace the face of fractured flubbing. The monster of Ford's is in and out, here and now and broken flax that wheels and burns from top to trim, heating and blurring the visions of breath. Take a sip good doctor. Take a sip
.

Simon had two brief admissions to hospital, both under Section, in 2001 and 2004. It seems that as time has gone on, he has gained a degree of insight into his illness when stable, which has allowed care in the community to be more effective. I will now go on to the details surrounding the most recent admission and detention.

This admission began on 5th July 2008, when Simon was brought to A&E following a suicide attempt. A passer-by walking his dog had discovered Simon face down in the marshes in and around Tollesbury. Simon received emergency treatment at the scene. When roused, there was a larger than normal degree of alcohol in his blood and it was clear, judging by his reported speech content, that he was suffering from a relapse of his paranoid schizophrenic illness.

When medically fit, he was transferred to Blackwater Mental Health Unit and admitted to Crimson Ward. He was largely incoherent in his speech and was reportedly disorientated in time, place and person. We restarted him on his depot medication on admission but both myself and Dr Nardy felt he had not shown sufficient insight to ensure he would stay informally. He had, for example, been given his depot injection without even giving any sign that it had happened. He spoke at the time only of horses and a boy with no teeth.

When I first saw Simon, he displayed elements of paranoia consistent with previous relapses and both myself and my colleague, Dr Nardy felt detention under the Mental Health Act may be inevitable. This was confirmed when he left the review prematurely, running back to his room with his hands over his ears. We placed him initially on continuous observations for a twenty four hour period during which we intended to discuss further whether he could be managed as a voluntary patient. This decision was made for us however when he absconded from the unit the following day. On his return to the ward on 15th July, having been Absent Without Leave for three days, he attempted to commit suicide in his room by hanging. Thankfully, he survived and was detained under Section 3 of the Mental Health Act.

Since his return to Crimson Ward, Simon’s mental state has steadily improved. We had planned for a course of ECT but it seems this may no longer be necessary. He continues to comply with his depot medication with an adjunct of an oral anti-psychotic and an anti-depressant. I am hopeful that he will continue to maintain his current progress.

Double eyes removed spectacular spect-a-cular. Close your mind good doctor and lap up the cooling air to brace your ice. Head so bow wow wowed and then retrieve your gusto and gaze upon your jury.

IRIS PEARSON
- Thank you Dr Weepy for that comprehensive summary. Now, if you don’t mind, I will ask the panel if they have any questions before giving the
opportunity to Mr Middleton to question you on behalf of Mr Anthony.

IRIS PEARSON
- Dr Khan?

Oh rise Dr Khan from your petal covered nub, flower and be seen whilst tingle touching your fingeroos.

DR KHAN
- Thank you Dr Weepy. As I understand it, Mr Anthony has been treated for many years on depot medication. Is that also the current treatment plan?

DR WEEPY
- Simon is on a Depixol injection every two weeks. He has been on a variety of depot medication over the years, but Depixol seems to suit. He is also currently taking 300 mg of Quetiapine daily as well as Venlafaxine, which, as you know, is an anti-depressant.

DR KHAN
- You alluded earlier to the fact that Mr Anthony had engaged in psychological therapies in the past. Is this something that is currently still under consideration, or are you content that medication alone will alleviate the current symptoms and sustain him in the community?

DR WEEPY
- Well, as it is, Simon is responding very well to the current medication regime. If he continues to be compliant with it, I am hopeful that he may remain well when he is eventually discharged from hospital.

DR KHAN
- Thank you, Dr Weepy. I have no further questions.

IRIS PEARSON
- Raymond?

RAYMOND LISTER
- Thank you madam chair. Dr Weepy, thank you for your summary and also for your report. All very informative, I’m sure.

DR WEEPY
- Thank you.

RAYMOND LISTER
- What I would like to know, Dr Weepy, is have you discounted the psychological therapy option entirely or is it something that you are still considering?

DR WEEPY
- One can never discount anything when it comes to mental illness. Simon Anthony is suffering, and has in fact suffered from, a severe and enduring mental illness that has blighted his life. Medication has helped him to achieve a certain level of well-being and in time, with appropriate psychological therapy, I feel he can look forward to a
relatively stable future. The importance of the timing of psychological therapies can never be under-estimated.

RAYMOND LISTER
- So you still have plans to pursue psychological therapies?

DR WEEPY
- Yes.

RAYMOND LISTER
- Thank you.

IRIS PEARSON
- Well thank you, Dr Weepy. Nothing from me; so Mr Middleton, you can address Dr Weepy with any questions you may have.

PETER MIDDLETON
- Thank you.

Pretty Peter pose and scribble. Sniggle it over to me. Well I see your words but not your point. I will nid and nod my head anyhow to smooth your brow and plaster your cast. Continue!

PETER MIDDLETON
- Firstly, Dr Weepy. Could you please confirm on what basis you are currently detaining my client. Is it in terms of Nature or Degree, or, if you deem it so, both?

DR WEEPY
- Simon is suffering from a mental illness, namely Paranoid Schizophrenia, which is of a nature that permits detention under the Mental Health Act. His illness is currently at the stage where recovery has only just begun. There has been little sustained evidence of insight. I would therefore argue that he is being detained on the basis of both Nature and Degree.

PETER MIDDLETON
- Nature and Degree?

DR WEEPY
- Yes.

PETER MIDDLETON
- You mentioned earlier the sexual abuse suffered by my client when he was a child. Could you please clarify whether the medication addresses the trauma that arose from that terrible experience?

DR WEEPY
- When people suffer such a trauma, mental illness can evolve. Some may experience periods of depression; others such as Simon, may experience hallucinations and delusions, which, although distressing, may in some ways protect the mind from facing up to what has happened to them. The medication seeks to dull the emotional impact of these psychotic features and thus limit the problems
they cause in day to day to life. From that perspective, I believe medication in Simon’s case has, and will continue to be, effective.

PETER MIDDLETON
- And in terms of addressing the deeper psychological issues?

DR WEEPY
- Well, that is a very long process. Simon needs to first accept that he is suffering from a schizophrenic illness before any progress can be made in that aspect. During this admission, he has been of the belief that he has been in Tollesbury back in the early nineteenth century or some such. He has had many delusions over the years which, when untreated, have made it impossible for him to live in the community. When a patient is disorientated to that degree, it is necessary for us to bring him back to reality with the use of medication before he can begin to explore what has happened in his childhood. Surely that much is obvious?