The people caught between fractured service provision

This was particularly so with Yusuf (not his real name) as at the point of transfer he had been admitted as an in-patient to a mental health unit at a nearby hospital.

Having undertaken a placement at a mental health day centre as part of my social work qualification and having had supervisory space to participate in forensic casework presentations, I had also attended a lecture by a renowned mental health campaigner whose work I had found a wonderful guide to practice. I had written down one of his many insightful offerings that had engaged me: 'without compassion, relationships between people are like dry leaves in the wind'.

I therefore felt professionally equipped to manage any unforeseen scenarios that might arise in preparing for my introductory visit. It had been noted in correspondence that Yusuf had been violent towards nursing staff.

On arrival at the hospital I was briefed by the ward manager that Yusuf was anxious to meet me as he believed that I would be able to secure his early discharge and facilitate a quick return to the family home. The index offences related to assaults on family members. This increased my own professional anxiety and I sought reassurance that nursing staff would be nearby to offer assistance should the interview become unsafe to continue.

When I entered the interview room, Yusuf approached me in a very unsettling manner. He voiced some incoherent statements, mouthing that the 'courts put me here' and unnervingly paced around the chair I was seated on. Although I felt ill at ease, I tried to connect with Yusuf by imagining what sense he was making of my presence and wondering if this was an intelligible response to his very troubled family history. A slammed door nearby alerted nursing staff who looked in. I murmured 'I'm fine' and Yusuf then sat down in what appeared a restful pose.

Yusuf asked plaintively if he could leave with me. For the next hour or so the meeting moved at a pace suited to his mood and I was able to convey to him that although the probation order remained in place, his detention was reviewable and I would offer my own professional input.

As I got up to leave, he grabbed my arm, in a non-threatening manner, and smiled without uttering a word. On the journey back to the probation office I mused on that final gesture, imagining my own reaction to an involuntary stay in what was a rather grim institutional setting. I also noted that his family felt unsafe when Yusuf was not compliant with his medication, and were uncertain about offering him a chance to return to live at home without adequate safeguards.

I next met Yusuf when he transferred to a therapeutic unit in a secluded setting some miles away, after the mental health section had been extended. This time the journey involved travelling out of London. His manner and presentation were wholly different when we greeted one another. His journey to recovery appeared to be well managed and he positively engaged noting that some of his 'destructive thinking' had 'gone away'.

I asked how this new environment compared to his previous setting. 'I am a patient here, not a prisoner', he quipped, although I could not shake off a residual feeling that the atmosphere was one of dark restriction and restraint. The order expired at a point in time when Yusuf was still at the hospital, albeit he had agreed to remain there as a voluntary in-patient until suitable accommodation could be found. He had indeed spent the bulk of his probation order in some form of enforced seclusion and his discharge plan was now within the purview of the local social service department.

Sometime later his brother rang me to enquire when Yusuf was likely to be released. To my astonishment, he had remained at the hospital awaiting the allocation of a social worker to oversee his aftercare, under what was Section 117 of the Mental Health Act 1983. It appeared that he had been 'overlooked' as the social work department mistakenly assumed he was still under the supervision of the probation service!

I mused on the immense gap between the offer of supportive discharge provision for Yusuf outlined during his order and the stark reality of fractured service delivery now on offer. When Yusuf had voiced, 'Can I leave with you?' he was prudently thinking ahead to this gap between the boundaries of the different 'helping professions'.

Maybe more recently published guidelines for sentencing defendants with mental disorders under probation supervision will make such an outcome less likely.

Mike Guilfoyle is a retired probation worker