Medication, medication

Reading it took me back to one of my supervisory encounters when working as a probation officer.

My first meeting at the probation office with Chima (not his real name) was one of my oddest client-based experiences. He had been sentenced to a period of probation supervision for a 'nasty' assault on a public employee. At the time of the offence, it was accepted that he had been mentally unwell. As such, a 'therapeutic disposal' was put in place, which required mental health treatment alongside probation supervision.

Chima arrived at the probation office well ahead of his appointment and persisted in remonstrating with the receptionist, to alert her to the fact he was "ready to see Mr Guilfoyle!".

When we sat down for our meeting, an oppressive silence ensued. Whatever I asked or queried was met with what appeared a mute entrenched hostility. After an half hour or so, having made limited headway, I explained to Chima that I would be meeting with his Consultant Psychiatrist at the Community Mental Health centre (CMHC) to discus the terms of his order. I invited him to comment on any pertinent concerns I might share at the meeting.

He blurted out "medication, medication", without any follow-up observations. Somewhat perturbed by this stilted interview, and struggling to explore supervisory inroads, I thought that I would await the CMHC meeting to glean fuller information and canvas possible treatment strategies to progress the order.

During my time as a probation officer, I had often attended appointments at the CMHC, aware that research suggested high incidences of mental illness and personality disorder on probation caseloads, which was often undiagnosed.

As I made my way to the centre along one of the Capital's busiest arteries, walking past Metropolitan Police tape blocking off an area in which a shooting that had occurred the previous evening, I reflected on the challenges faced by those under supervision in an area of high levels of street crime.

After a short wait, the Consultant Psychiatrist invited me into her room, informing me that we would be joined shortly by a locum Mental Health social worker called Richard. Chima had rung to say he would not be attending.

When Richard entered the room, a mirthful moment of instant recognition followed. "I know that reprobate from my days in probation", he gruffly noted. "How are you Mike?". I had got to know Richard professionally when we had jointly attended Napo (National Association of Probation Officers) conferences and had shared some lively convivial social events.

The clinical discussion that took place was full of measured and thoughtful exchanges. Chima had experienced and witnessed severe trauma in his country of origin, and the fall-out of these formative happenings had left him extremely vulnerable to violent mood swings and 'dissociative disorders'.

I shared my initial casework observations and the contents of the pre-sentence report with my colleagues and alluded to his reference to "medication" in our interview. The psychiatrist seemed mildly surprised at this and suggested she review the usage of psychotropic medication with Richard.

As we were leaving, I noticed Chima in the waiting room. Richard, a step ahead of me, engaged with him in an empathic manner. Much to my surprise, Chima was as voluble as I had ever heard him. "Mr Richard will help me and knows about my medication". I nodded sagely to Richard and returned to the probation office.

In the course of the next several months of supervision, Chima's persona seemed more equable and his level of engagement significantly improved. Part of this welcome development was, I believe, aided by a well-considered recalibration of his prescribed medication.

On one occasion, due to a confused communication on my part, I was en route to Chima's home when we passed in the street. He was under the impression we were due to meet at the probation office. In the event, a local park offered an al fresco opportunity to review his progress on his order. His attendant mental health concerns had been ably dealt with, prior to Richard's departure after his term as a locum social worker had expired.

At our final appointment , Chima said that "I would like you to visit my country, when the violence ends", a very fitting conclusion, I mused, on Chima's sometimes chaotic but rewarding period of supervision.

His parting words left me deeply moved. "Mr Richard and Mr Mike, you have been good friends to me".

I sometimes caught sight of Chima amidst the hurly burly of one of London's liveliest street markets. As for Richard , our professional paths alas did not cross again, although I remained in loose contact via mutual friends.

It was with considerable sadness that I learned of his recent passing aged 63 years.

Mike Guilfoyle is a retired probation officer.

This post is dedicated to the memory of Richard Matz.