Locked away but not forgotten

While reading of the multiple institutional challenges that assailed Lucy Jo Matthews in her courageous efforts as a service user to negotiate a pathway to psychological health in Jane Winstone’s comprehensive collection on the difficulties for those with mental health needs caught up in the criminal justice system, I reflected on my professional experiences with Sam (not his real name), when I had statutory responsibility for him whilst he was under probation supervision.

From the outset of his order, imposed for public order offences, it seemed to suggest a propensity for him to act in a troublingly threatening manner in public, when under emotional pressure. I was aware that his extensive forensic history, albeit of more historic offending, nonetheless meant that proper scrutiny was needed to try to forestall any likely deterioration in his mental health (in the contemporary parlance, ‘manage risk'). For this reason, sensitive professional engagement was very much at the foreground of our meetings.

A local specialist housing provider assessed Sam as suitable for one of their supported accommodation projects.  This provided a reassuring platform on which to begin to ensure that any triggers that might recur were recognised, and he was enabled to assume a greater degree of self-control and positive self-direction.

During our early meetings at the probation office, Sam was diligent in his compliance and would often arrive early for our planned appointments. At times our sessions could be fraught and I sensed a marked reluctance in him to offer a measure of incremental trust in what, for him, had often been fractured relationships with figures of authority.

But this professional negotiation was something that took time, effort, energy and affirmation (does not all habit-transforming change?), and as such had to be very much earned. My efforts to secure his consent for a home visit I believe put our developing relationship in peril, simply because Sam was insistent that his accommodation was 'not ready' for such a visit, but he relented and I was relieved when such arrangements were put in place.

I was a regular habitué of the area where Sam lived, as it contained one of the highest percentages of bed and breakfasts in London. When I met with Sam at his address, I could better appreciate his evident reluctance for me to see him at home. ‘Remember Mr Guilfoyle, this is only temporary', he quipped and aiming to be sensitive to his obvious discomfort in a very cramped living space, unnervingly close to a vertical drop, we were able to canvass the strength of his application for permanent housing and his efforts to better support himself in independent living.

During our meeting, I was alerted to what I believed to be former 'criminal ' associates, afforded by unavoidable proximity in an area of high offending and stressed social provision, who he casually referenced before my departure. 

Although this aspect of expressed concern at what I perceived to be his drifting into negative peer pressures was flagged up, he appeared to be managing to retain a critical relational distance, 'I know that they are under observation’ he demurred. Favourable progress was noted when we reviewed the mid-way point of his supervision. Infrequent but important familial links, in particular with his formerly estranged son, offered an added informal restraint (social capital!) on likely behavioural lapses. 

I was sorely disappointed to hear via one of my court colleagues before our next planned supervisory meeting, that Sam had been arrested and remanded in custody for what was described as a 'sexual assault on a female'.

When I managed to obtain more information on the nature of the offence and the context in which it had occurred, I spoke at length to his defence advocate and she mooted that in light of the nature of the offence (unsolicited attempts at kissing an unknown adult female in a public place) that she would be seeking for a psychiatric assessment. I concurred and opined that the nearby forensic psychiatric team might be better suited for this task prior to any condign sentencing. It was a worryingly lengthy process to identify a forensic psychiatrist who would agree to assume this task (the familiar refrain being inevitably volume of work) and when I spoke to him, he was in the throes of arranging a prison visit (again another month in setting up).

I contacted the health care wing at the remand prison and was notified (after what I experienced as unhelpfully obstructive communication) that Sam was receiving 'suitable treatment', and that arrangements for the psychiatric assessment were well advanced. It was clear that supervision in such circumstances remained in abeyance but I retained contact by liaison in the manner detailed. Following the psychiatric assessment, the designated clinician indicated that his report would take another month to complete (having averaged two full pre-sentence reports a week whilst holding a caseload in excess of 60 meant that I viewed such deliberations with something akin to jaundiced annoyance!).

I was also mindful of the uncertain relationship between offending and diagnosable mental disorder.  But initial indications suggested that an application under Section 38 (MHA 2007) for an interim hospital order was being explored. The psychiatric assessment was a very comprehensive document and duly acknowledged contributions from allied professionals, the value of collaborative practice being integral to positive outcomes, and included a response to supervision. What was more of a loaded issue was the availability of a hospital bed.

I had little inkling when this was proposed that the demands on specialist beds in the forensic unit would result in a prolonged and intractable delay. I spoke to Sam on the wing from the probation office when his psychological health was characterised as improving but could do little outside of determined advocacy to chivvy the area coordinator into some action (which frankly amounted to little more than weekly unanswered calls!).

It reached a point in his remand period when Sam's recovery, from what was deemed to be a transient psychotic episode, was such that the need for a bespoke hospital bed could, it was stated, be better offered to a person in more urgent psychiatric distress. Someone who was in need of acute admission and the whole enterprise, the psychiatric equivalent of the Gordian knot, appeared to unravel! 

Sam was subsequently sentenced to a short period of custody, the need for the community to feel safe from such behaviour was stressed by the court as well as the many endeavours of criminal justice and mental health services to resolve what the court noted as ‘blockages' during his remand period, and he was almost immediately released due to his time spent in custody.

After our last meeting when he had a safe space in which to reflect on a very troubled period in his life, I asked how the future looked for him, Sam noted ruefully ‘Mike, I don' t need more treatment, I did wrong - glad you didn't forget me when I was locked away'!