The Heartland by Nathan Filer

Author:Nathan Filer [Nathan Filer]
Language: eng
Format: epub
ISBN: 9780571345984
Publisher: Faber & Faber
Published: 2019-06-06T16:00:00+00:00

Three o’clock on a Friday afternoon

He stood outside the ward, clutching a single black bin bag containing everything he owned.

The door was locked behind him.

He was terrified.

It had been a long time coming. Seven months on the acute ward; a further six months on a mental health rehabilitation ward, situated in a normal house, where they aim to get people with chronic mental health problems ready for independent living. ‘Teaching basic skills like how to cook a meal, how to live socially, how to sign on, how to go shopping, how to not nick your housemate’s milk.’ Finally, seven months back on an acute ward, after it became clear that Joe’s drinking was spiralling out of control. And after hundreds of cigarette butts were found on his bedroom floor and he was deemed to present a fire hazard.

He’d been tried on a fourth antipsychotic medication. This was clozapine. It was significant because it’s used for ‘treatment resistant schizophrenia’, as the final medication that gets tried if none of the others have worked, but it’s recommended not to be mixed with alcohol as this can increase side effects. The nurses on the unit were, as Clare recalls, frightened on Joe’s behalf. They were giving him medication that they had serious reservations about; anxious that, given the huge amounts Joe was drinking, the risks to his health were simply too high. Joe’s psychiatrist arrived at the same conclusion and the treatment was stopped. In a confidential investigation carried out by the NHS Trust after Joe’s death, it was acknowledged that ‘There is evidence of confusion in referring to substance misuse services for input.’ Joe’s mental health issues and alcohol dependence were treated, according to Clare, ‘completely separately’, though she believes them to have been inextricably linked. That’s why she considers that the contract Joe was required to sign during his final weeks in hospital was ‘setting him up to fail’. It was a contract whereby he agreed that if he continued to drink he would be discharged.

Many of the nurses on the ward who worked most closely with Joe, who recognised his vulnerability and were fond of him, resisted the decision. This too was acknowledged in the Trust’s own confidential investigation:

The decision to [use a] contract, with discharge being the negative outcome, appears not to have been wholeheartedly supported by all staff. The decision is not documented as having been clearly risk assessed: Mr H— was 19 years of age and had spent the last 18 months as an inpatient with no experience of independent living, had poor daily living skills as assessed in his earlier rehabilitation placement, no clear address (including hostel accommodation) was located and he continued displays of aggressive behaviour on the ward. No alternative care plan was identified for any precipitated discharge.

The decision to discharge on a Friday afternoon left no time to put in place any support immediately post discharge.

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