A very good friend called me on the weekend to tell me about something he and his son had gone through during the week. The boy’s mother has long been diagnosed with bi-polar disease, or what used to be called Manic-Deppressive Disorder. To use his words, “It’s one of those illnessses that tell you you don’t have it, like alcoholism.” I interpreted that to mean that she hadn’t been taking her medication, which I understand is cheap and effective, though nobody seems to know why. Or she had been drinking copiously, which is sometimes her wont. But no, there was a lot more to the story.
About six weeks ago the mother had a psychotic (i.e. manic) episode that needed her to be sectioned, though there is no equivalent word in the Spanish Mental Health lexicon and therefore doesn’t appear to exist as such. In the event, she was finally persuaded to go into treatment voluntarily, albeit through promises to the contrary made by her sisters. But in order to get to that stage, added my friend, their son aged thirteen and her mother aged 80-plus and very deaf, had been trying to keep her out of trouble, most of the time ineffectively. It was, and always is, an exhausting business. My friend does not intervene in such cases as this seems to provoke considerable violence from the ‘patient’ (knowing him, this is understandable, as he’s pretty much at the end of his tether with it). This part of the story ends at the mental health unit of the Punta de Europa Hospital in Algeciras, which she has attended many times, though not before her sisters had made a considerable fuss at the local health centre, where a doctor is the only person able to certify that there is a problem. The whole thing needed several visits from the Local Police, the Guardia Civil and the ambulance service – but the patient had to be taken to the hospital in a private car, from which she has been know to throw herself on previous occasions.
Six weeks later, the patient calls her mother to say she has been released for a few days. Several calls, in fact, some quite desperate. The poor woman couldn’t find anyone willing or able to drive her to the hospital to pick up her daughter, so she had to hire an expensive taxi, in which she also took the patient’s son for support. There was no call from any doctor, nurse or even a cleaner from the mental health unit, so the whole thing could easily have been a hoax from a wily patient -another symptom of her disease. But who’s to know? This was on a Friday afternoon, i.e. reluctant week-end duty for an intern, probably.
As it happens, says my friend, by Monday the woman was obviously taking a turn for the worse. She was walking around her small village in bare feet and chanting, turning up on people’s doorstep expecting to be let in with a very large Irish Wolfhound – and so on. Still in charge, as well as they could, were mother and son. The same again on Tuesday. By Wednesday, matters had got much worse.
On the night of Tuesday/Wednesday my friend was woken up by a phone call at 1.35 in the morning. It was the local duty doctor trying to find his son, who was fast asleep beside him. “We need (the boy) to come down to the health centre and give his mother the key to her house, which she lost.” The child being absolutely exhausted from running around the village all day after his mother, there was no way he was going to wake the boy up, and he told the doctor so. In any case, the key was not on his ring. The doctor then gave forth that she was doing the ‘job of a social worker’ and it wasn’t her problem. In that case, said my friend, get her into the hospital right now, from where she should never have been allowed out in the first place. The doctor couldn’t do that, either, though she didn’t explain why.
By morning, my friend was seriously concerned for the safety of his son, who was reluctant to say much about it, very likely thinking his mother would be ‘taken away’ again. But there was one incident that really alarmed him: “I tried to keep him away from the situation as much as possible -I’ve never stopped him from seeing his mother, except when she’s been at her very worst- and that day after lunch, when I was trying to help him get things off his chest, he said very calmly, ‘You know, Dad, I have a rope ready to hang myself with. I just can’t take it anymore.’ He’s said that sort of thing before, as teens often do, but always almost hysterically. This time he even described the slip knot on the rope in great detail. This could be manipulation, of course, but it’s my duty to listen.” My friend was shocked, to put it mildly, and tried very hard to persuade -an ‘order’ would not have been in order- the boy to do something else instead of seeing his mother that afternoon. To no avail.
That Wednesday evening, my friend gets a hysterical call from his son: “My mother is biting me very hard and has just pushed Granny!!!” The boy was incoherent with fear. Imagining the worse, my friend swiftly dials the Local Police emergency number, only to be told that they were in another village and unable to attend. The local Guardia Civil number was answered by a recorded message at the station in Algeciras, asking him to dial another number – he slammed the phone down in exasperation and drove like a madman down to the Guardia Civil station in his village, Jimena. Closed. On his way up the hill to rescue his son, still driving like a maniac, he encounters one of the village’s Councillors, who gets an earful of abuse for which my friend had later to apologise. By the time he gets to the house where ‘the incident’ was taking place, the Guardia Civil was already there, his son having been much more sensible and called 112, the general emergency number.
The ambulance turned up twenty minutes later, with doctor (a different one than the night before) and nurse. The patient was now being charming and chatting with the Guardia, as though nothing had happened. Again, not an uncommon trait among bi-polars. Having been apprised of the situation by my friend, the doctor gets on her mobile phone, hiding around corners so as not to be heard (by whom? the patient? my friend? his son?). Finally, after a lot of speaking into her phone, the doctor approaches the patient and apparently persuades her that it is best for her to go into hospital, for her own sake and that of her son. Needless to say, the tactic backfires somewhat. The patient goes into her mother’s house to pick up a box, sits back down where she had been and says she’s not going. At other times, according to my friend, this has been when she’s made a dash for freedom and not been seen for days, only to turn up in places like Granada or Seville, lost and helpless. Okay, who wants to be locked up voluntarily?
Well, she was finally persuaded -cajoled?- to get into the ambulance, ringed by the Guardia Civil, the nurse and the ambulance driver. The boy did most of the cajoling while his father lurked in the shadows so as not to provoke any reaction that might have turned everything tits up. And off they went to the mental unit at the Punta de Europa Hospital in Algeciras – again – or so everyone thought. On Saturday, with time in between for recovery, the boy calls that hospital only to be told his mother isn’t there. Where is she, then? “Oh, maybe in Jerez. Or Puerto Real…” They had no idea.
In fact, the family still has no idea as I write this, midday on Monday. [A litttle further on in time: a sister finds out by sheer chance that the patient is in the mental health unit at Puerto Real. But that's another story]
A dark cloud of questions arises: Is it right for a mental patient to be left in the charge of a thirteen-year-old and an 80-year-old who is deaf? Is it right for a mental patient to be released without any communication at all from her doctors? Is it right for a mental patient to be released into ‘community care’ without a ‘community’? If the local health centre has the numbers to call the patient’s family all over the district in the middle of the night, as they did to find a key and thus get some sleep, can’t they be bothered to pick up the phone and call at least one of those numbers in order to let someone know where the patient is? Why was the first doctor unable to have the patient ’sectioned’, or the Spanish equivalent, always supposing there is one? And why couldn’t she give a reason?
Should a doctor (albeit a week-end substitute) at the Algeciras hospital have called someone in the family -they too have the numbers- to let them know that the patient is about to be released, or to find out what the situation at home might be? Would they toss a terminal cancer patient out like that?
If the questions above are in a jumble, imagine the state of a young boy’s mind after a week of attending to his mother, her doctors and his grandmother, who understands very little of what is being said.
The state of mental health care is not good in most of Europe. In the UK, I’m told, it is really bad. And Spain is obviously thirty years behind that.
(c) Alexander Bewick 2008
About six weeks ago the mother had a psychotic (i.e. manic) episode that needed her to be sectioned, though there is no equivalent word in the Spanish Mental Health lexicon and therefore doesn’t appear to exist as such. In the event, she was finally persuaded to go into treatment voluntarily, albeit through promises to the contrary made by her sisters. But in order to get to that stage, added my friend, their son aged thirteen and her mother aged 80-plus and very deaf, had been trying to keep her out of trouble, most of the time ineffectively. It was, and always is, an exhausting business. My friend does not intervene in such cases as this seems to provoke considerable violence from the ‘patient’ (knowing him, this is understandable, as he’s pretty much at the end of his tether with it). This part of the story ends at the mental health unit of the Punta de Europa Hospital in Algeciras, which she has attended many times, though not before her sisters had made a considerable fuss at the local health centre, where a doctor is the only person able to certify that there is a problem. The whole thing needed several visits from the Local Police, the Guardia Civil and the ambulance service – but the patient had to be taken to the hospital in a private car, from which she has been know to throw herself on previous occasions.
Six weeks later, the patient calls her mother to say she has been released for a few days. Several calls, in fact, some quite desperate. The poor woman couldn’t find anyone willing or able to drive her to the hospital to pick up her daughter, so she had to hire an expensive taxi, in which she also took the patient’s son for support. There was no call from any doctor, nurse or even a cleaner from the mental health unit, so the whole thing could easily have been a hoax from a wily patient -another symptom of her disease. But who’s to know? This was on a Friday afternoon, i.e. reluctant week-end duty for an intern, probably.
That weekend went along relatively calmly, with her son making sure the patient took her medication. But, to quote father quoting son, “I’m never sure she’s not putting the pill under her tongue and spitting it out later.” Fair enough, the son loves his mother in spite of it all, and wants her to be well – is desperate for her to be well. But is it right to leave a thirteen-year-old in charge of someone who can turn violent with the greatest of ease and the slightest perceived provocation?
As it happens, says my friend, by Monday the woman was obviously taking a turn for the worse. She was walking around her small village in bare feet and chanting, turning up on people’s doorstep expecting to be let in with a very large Irish Wolfhound – and so on. Still in charge, as well as they could, were mother and son. The same again on Tuesday. By Wednesday, matters had got much worse.
On the night of Tuesday/Wednesday my friend was woken up by a phone call at 1.35 in the morning. It was the local duty doctor trying to find his son, who was fast asleep beside him. “We need (the boy) to come down to the health centre and give his mother the key to her house, which she lost.” The child being absolutely exhausted from running around the village all day after his mother, there was no way he was going to wake the boy up, and he told the doctor so. In any case, the key was not on his ring. The doctor then gave forth that she was doing the ‘job of a social worker’ and it wasn’t her problem. In that case, said my friend, get her into the hospital right now, from where she should never have been allowed out in the first place. The doctor couldn’t do that, either, though she didn’t explain why.
By morning, my friend was seriously concerned for the safety of his son, who was reluctant to say much about it, very likely thinking his mother would be ‘taken away’ again. But there was one incident that really alarmed him: “I tried to keep him away from the situation as much as possible -I’ve never stopped him from seeing his mother, except when she’s been at her very worst- and that day after lunch, when I was trying to help him get things off his chest, he said very calmly, ‘You know, Dad, I have a rope ready to hang myself with. I just can’t take it anymore.’ He’s said that sort of thing before, as teens often do, but always almost hysterically. This time he even described the slip knot on the rope in great detail. This could be manipulation, of course, but it’s my duty to listen.” My friend was shocked, to put it mildly, and tried very hard to persuade -an ‘order’ would not have been in order- the boy to do something else instead of seeing his mother that afternoon. To no avail.
That Wednesday evening, my friend gets a hysterical call from his son: “My mother is biting me very hard and has just pushed Granny!!!” The boy was incoherent with fear. Imagining the worse, my friend swiftly dials the Local Police emergency number, only to be told that they were in another village and unable to attend. The local Guardia Civil number was answered by a recorded message at the station in Algeciras, asking him to dial another number – he slammed the phone down in exasperation and drove like a madman down to the Guardia Civil station in his village, Jimena. Closed. On his way up the hill to rescue his son, still driving like a maniac, he encounters one of the village’s Councillors, who gets an earful of abuse for which my friend had later to apologise. By the time he gets to the house where ‘the incident’ was taking place, the Guardia Civil was already there, his son having been much more sensible and called 112, the general emergency number.
The ambulance turned up twenty minutes later, with doctor (a different one than the night before) and nurse. The patient was now being charming and chatting with the Guardia, as though nothing had happened. Again, not an uncommon trait among bi-polars. Having been apprised of the situation by my friend, the doctor gets on her mobile phone, hiding around corners so as not to be heard (by whom? the patient? my friend? his son?). Finally, after a lot of speaking into her phone, the doctor approaches the patient and apparently persuades her that it is best for her to go into hospital, for her own sake and that of her son. Needless to say, the tactic backfires somewhat. The patient goes into her mother’s house to pick up a box, sits back down where she had been and says she’s not going. At other times, according to my friend, this has been when she’s made a dash for freedom and not been seen for days, only to turn up in places like Granada or Seville, lost and helpless. Okay, who wants to be locked up voluntarily?
Well, she was finally persuaded -cajoled?- to get into the ambulance, ringed by the Guardia Civil, the nurse and the ambulance driver. The boy did most of the cajoling while his father lurked in the shadows so as not to provoke any reaction that might have turned everything tits up. And off they went to the mental unit at the Punta de Europa Hospital in Algeciras – again – or so everyone thought. On Saturday, with time in between for recovery, the boy calls that hospital only to be told his mother isn’t there. Where is she, then? “Oh, maybe in Jerez. Or Puerto Real…” They had no idea.
In fact, the family still has no idea as I write this, midday on Monday. [A litttle further on in time: a sister finds out by sheer chance that the patient is in the mental health unit at Puerto Real. But that's another story]
A dark cloud of questions arises: Is it right for a mental patient to be left in the charge of a thirteen-year-old and an 80-year-old who is deaf? Is it right for a mental patient to be released without any communication at all from her doctors? Is it right for a mental patient to be released into ‘community care’ without a ‘community’? If the local health centre has the numbers to call the patient’s family all over the district in the middle of the night, as they did to find a key and thus get some sleep, can’t they be bothered to pick up the phone and call at least one of those numbers in order to let someone know where the patient is? Why was the first doctor unable to have the patient ’sectioned’, or the Spanish equivalent, always supposing there is one? And why couldn’t she give a reason?
Should a doctor (albeit a week-end substitute) at the Algeciras hospital have called someone in the family -they too have the numbers- to let them know that the patient is about to be released, or to find out what the situation at home might be? Would they toss a terminal cancer patient out like that?
If the questions above are in a jumble, imagine the state of a young boy’s mind after a week of attending to his mother, her doctors and his grandmother, who understands very little of what is being said.
The state of mental health care is not good in most of Europe. In the UK, I’m told, it is really bad. And Spain is obviously thirty years behind that.
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