'schizophrenia'

- a carer's journal

Taking a break for a while.

Hopefully Sam will be safe while we are away - but often there are problems then. We'll see.

Though we had a mental health crisis with a partner of another close family member last night. More people needing more support. It is a bad time to be going away. Or perhaps a good time.

We'll see.

Must pack.

Jane got a call from the ward yesterday.

You remember I told you how secure this ward was? Not quite machine gun emplacements and watchtowers with searchlights - but going on that way! At least seven locked doors between the ward and freedom. The outside area has a wire fence at least fifteen feet high and patients are only allowed outside with a member of staff.

Well it seems that yesterday a nurse leaving at the end of his shift saw Sam some distance away as he drove past in an industrial area. Until then they did not even know that Sam was missing. I'm not sure of the details but they managed to get him back safely.

How did he get out?

It seems that Sam went outside with a member of staff but that the member of staff then went in and left Sam alone there. Sam piled two chairs on top of each other, climbed upon this structure, leaped in to the air to grasp a more easily accessible part of the fence then climbed up the rest and over it.

He was in bare feet and had a badly sprained ankle (fell off a chair!)

At a meeting today the RMO (consultant psychiatrist) looked out of the window and declared it impossible. A Social worker who knows Sam well from another placement confirmed Sam could do it and the ward doctor recognised he wasn't a good enough climber to do it but declared it possible. And they haven't even seen the picture of Sam climbing in South Africa that I published early in this blog!

It reminded me of Sam's first escape when he climbed out the first time he was sectioned. They didn't believe he had escaped either even though he had rung us from the bus station. That escape was when he had a plaster cast on his leg and was using crutches.

Perhaps I should have called this blog "The Great Escape"!

I visited Sam this afternoon.

He's in a secure setting owned and run by the same company who ran the last more secure ward he was on. As I got no reply when I buzzed to get in I imagined we might come up against some of the same problems. But on the second buzz someone came to fetch me and I was invited to wait in a reception area.

While I was waiting a member of staff unlocked a door to gain access to a toilet. Shouldn't a toilet in a reception area also be available to visitors?

Soon someone collected me and delivered me through the rest of the locked doors onto the ward. At least we are allowed on to the ward here. The similar setting Sam, was in before would not allow us on to the ward and left us waiting outside for ages.

Sam was quiet, confused, unhappy about being where he was. he was positive about other people but negative about the atmosphere. He hates all male acute and secure wards. I don't blame him.

The nurse who brought me in said he was bored because there was nothing much happening. Perhaps he'd have preferred a fight? Sam and I were in a quiet room in the middle of the ward. Through the door I could see nurses pacing the corridors keeping an eye on things. if they were bored why didn't they engage with the patients? perhaps act like nurses not like jailers?

Jane visited a few days ago and had a chat about Sam's progress and medication with his named nurse. She seemed to have a simplistic view about medication. So Jane has made an appointment to see the consultant on Wednesday. At least that was easy to arrange. The previous one refused to meet with us until we made a complaint.

On the way out today the nurse in charge asked to speak with me. She had clearly totally misunderstood something Sam had said to her. Her English was not good and it took me some time to explain the misunderstanding.

There was a call from Sam this morning. When I say a call - the phone rings and it goes "beep-beep-beep-beep ....". The number is wherever Sam is - on the payphone. So we call back.

He sounded not too well then ...

"Do you love me?"

"Yes, Sam, of course."

"I don't think you wanted me ..."

And so the conversation went on for some time until he seemed reassured that we both loved him - then he hung up.

I phoned back to talk with a nurse. It took me some time to get through - the line was either engaged or not answered.

When I did found that Sam was discussed at ward round yesterday. His medication has been left unchanged. His leave though has been cancelled. It was felt that he was currently presenting with florid psychosis.

His sudden decline is I am sure partly to do with the change and partly to do with being on a more stressful secure ward. Both of these things tend to affect Sam adversely.

Later in the afternoon Sam tried to phone again. But I couldn't get back through to the ward. No reply ...

We visited Sam in the afternoon on the new ward. At least he should be safe there. We had to go through seven sets of locked doors - including two sets of double doors - to get in and out.

Though when I say he should be safe it turns out there is another patient on the ward who Sam knows well from two other wards. Sam thinks of him as a friend. However he assaulted Sam so badly on the last ward they were on together that Sam needed medical attention and the police were called.

Sam seemed quite well but not particularly contrite. He still doesn't get it and thought we could get him out when we visited. He also refused to apologise. All he would say was that he'd had fun. He is twenty eight and has been ill for over eight years I think. His youth and all the fun he should have had have been stolen from him by illness. He still can't understand why he is locked away. He just wants to live his life - like we all do. So he'd gone for some fun. He thought it was his right and why should he apologise for it?

Communications as always in these places was bad. We're still not sure who his named nurse is, what the arrangements are for visiting, whether he will be allowed leave, if they are changing his medication, what his doctor's name is, what the ward manager's name is ...

or anything else at all really. For a couple of days I think we'll just rest from the weekend before we take up cudgels again.

We need a break too. It is so emotionally draining.

Thank you for all the mail I have received recently.

If I haven't got back to you all, forgive me please.

There have also been some kind comments here on Tenuous at Best which I'm sure you will find an interesting read.

The following morning we phoned the ward to fin Sam was back there safe.

Nell and I drove to the pound where the car had been taken to pick it up. It was over an hours drive and we had some trouble finding it. We eventually found it and paid a release fee of £105. Then we found out that it was ut of petrol.

So Nell and I spent another half hour finding a petrol station, buying a can and filling it up. Back to the car which now started - though I noted he had a charger attached. Some of the electrical guages seemed to be behaving a little erratically but otherwise it was driving OK.

I drove out of the pound and stupidly switched off the engine whilst I spoke with Nell and phoned Jane. Of course when I tried to star it again the electrics seemed dead. I tried to get back into reception to get some help but it was past five o'clock now and they had closed. So Nell set off back whist I rang and waited for the AA Breakdown service. In the end it turned out to be just a flat battery. Sam of course had left the headlights on.

When I spoke to Jane though there were a couple of worries. Firstly Sam was being transferred to a secure ward that evening. This was no real surprise but they had moved very quickly. More worryingly Sam's nurse had said that Sam told him that he'd had an accident and knocked someone down. He wanted the log number to inform the police.

We've heard since from Sam's pscychologist who has spent some time with Sam that Sam now says that was not the case and may have been a misunderstanding. We certainly hope so. I don't know if he has been interviewed by the police yet.

I apologise to regular readers if you have been worried about Sam. He is safe.

It has been a busy and emotional time though - so I am sure you will excuse my tardiness at posting.

We were very worried yesterday. There was a good chance that Sam might have crashed the car either deliberately, through incompetence, because of bravado, forced by thoughts in his head, confused - or just because he couldn't see where he was going. (He should wear glasses but of course always loses them so now has got into the habit of seeing the world through a haze.)

Given he was in a car and that there are car numberplate recognition cameras on all the major roads we hoped there would be some quick news. We knew the car had been registered on the system. But it was six hours after he had gone missing before we heard any news - and we had phoned the police in the interim.

In that time of course we feared the worst. He'd perhaps had his nine lives. Always before he came back relatively unscathed with an infuriating grin on his face.

Then we heard. They had found the car abandoned on a street in a town about sixty miles from us. It was where Sam used to go to university. It was where he first became seriously ill. None of his friends are there now.

I can remember bringing him back from college. Twice. And another time when he went back for a visit and ended up on the streets and sleeping in a park with vagrants before ringing us in the early hours of the morning and we drove to pick him up. I was still working then and went in to work the next morning.

We were relieved at the discovery of the car. We felt it was more like the usual times Sam had gone missing now. The danger of the car had gone. It was just the usual worry.

But that worry too continued for a few more hours.

Until we got a call from a woman.

"Hello - I've got Sam here to talk to you."

A woman - was she a police woman? What was this?

"Hello Mum!"

It turned out Sam had knocked on a door. He had bare feet and was soaked by the torrential rain. He told her not to worry he was not going to rape her. The sensible response would have been to shut the door in his face and perhaps call the police. Perhaps others had already done that. But this woman listened to him and got him the phone to call home.

Jane explained and asked her to keep him there while we called the police. She was sensibly unsure but reassured by Jane's explanation. Jane heard Sam in the background having wormed his way in ...

"Can I put the stereo on?"

"No!!!"

Her daughter was asleep upstairs.

She was reassured. Sam was safe. Then we called the police.

We gave them the details of where Sam was and asked them to tread gently - not to wake and upset the daughter in the house. They too will have had their priorities but they eventually picked Sam up several cups of tea later.

The woman rang us back later to tell us that Sam had been collected by the police. That there had been a poiliceman and a policewoman. That they had been kind and reassuring to Sam. She clearly wanted to talk about her experience with Sam. She was lovely. So kind to accept a mad stranger into your house, barefoot and dripping with water from the torrential rain outside. There are few of us who would do that. I worry that I am one who might not. The kindness though of strangers always brings me to tears.

She told us of their conversation. Sam had opened up and explained some of his history and troubles. She was clearly the kind of person who could listen in a genuine way. Sam can recognise such people.

We were of course relieved at Sam's safety.

But we knew there would be repercussions.

The nice policewoman has just left having taken lots of statements.

She remembered having come here once before and the lovely smells just before Christmas. That was another time that Sam had disappeared. This time though he hasn't just disappeared but he has taken his grandfather's car keys from his coat pocket and stolen his car.

The last time Sam drove was several years ago. He had stolen his mothers car during the night and managed to crash it and write it off. Since then he often talks about having died then and come back to life.

We impressed on them how in the car he was a danger to himself and other road users. They seemed to be taking it very seriously and were treating it as an emergency. I could hear on the policewoman's radio about it being reported to other areas and other cars calling in saying where they had been looking. There are numberplate recognition cameras now on all major roads. But still we have no news of Sam

He's been gone nearly four hours now so I am getting worried at no news.

Sam rang again yesterday morning. He wanted to come home again. We said no. He'd started the conversation very friendly but became abrasive and put the phone down.

I was worried that he might decide to abscond as he clearly wasn't happy at the moment so thought I should phone the ward. I was put through to Sam's named nurse who we get on with.

I explained and asked if Sam was still on an observations schedule. If he was then that meant he was less likely to be able to abscond but might make him more likely to want to. I wasn't trying to make a point but just discuss it in a friendly way.

I was made to feel though that I was ringing to complain which was not the case. He made it clear that Sam was on "level 2 observations" - whatever that means - to make a point about his previous absconsions. To get him to recognise that actions have consequences. I would have thought that such observation schedules are designed as a response to a risk assessment not as a punishment or means of control. But I said nothing. I was also reminded that Sam had returned late the night before. Now why was that brought up? He also raised the issue about Sam being worried about us going away.

It seemed as if he was trying to attach blame to us for Sam's current state of mind whereas I wasn't trying to attribute blame on anyone - just talk around it to share information and get a better understanding. It felt as if he was having a go at us but I didn't understand why.

I put the phone down upset and anxious and wishing I hadn't bothered.

So much for working in partnership.

Sam rang again later in the afternoon. He was chatty and fine. I think he just wanted to make things right after the morning's conversation.

I'd had a long day.

I had taken my mum and dad to visit some close relatives who are unwell but who live some distance away.

It involved a lot of driving and the traffic was very bad on our return.

I got home to find that Sam was there. He'd rung Jane to ask if he could come home for the day. After consultation it was agreed. Of course then he didn't want to go back.

He's on close observations on the ward because of recent absconsions. There's also a new resident straight from prison who may be finding the transition difficult which can have an impact on the ambiance!

Perhaps these facts made the thought of return harder.

So he went to bed and pretended to be asleep and wouldn't respond to any entreaties. After an hour or so he finally came round and Jane took him back. It may seem a small thing but I find it very difficult and upsetting - especially I suppose when tired anyway.

I'd been out with a friend.

I'd invited him though I hadn't seen him in such a long while.

His younger wife has just died from cancer. Both his parents died before Christmas. He has two children just a little younger than Sam and Nell.

We went out for a drink. On our return Jane told me she'd had a call from the ward. Sam had gone over the wall late afternoon but they had nabbed him straight away.

At medication at 10.00 he seemed fine. But on a check fifteen minutes later he had disappeared again so the police were called. They returned Sam within the hour.

Jane spoke to Sam on the phone today. He said he went to a house and knocked on the door. When it was answered he said, "Would you call the police." So they did. And the kind policemen took him back to hospital. No problem ...

But what would your reaction be to a large young man knocking on your door late at night insisting you called the police as his eyes gazed straight at you ... ?

I picked Sam up on Sunday morning.

Jane was away for the weekend.

Sam seemed fine. He is always reserved but efficient in going through the formalities when I pick him up. Then quiet in the car. he often is. The transition from hospital to home must be difficult at times.

We stpped at a shop for some breakfast for Sam - he'd missed it as usual, the newspaper, some tobacco as he was clearly out.

Then on again towards home.

I stopped on the way at a local beauty spot that I knew he liked. He wanted to stop for a cigarette anyway. We walked for a bit. Mostly quietly. He seemed to be enjoying it and we site by the lake for him to have a cigarette. Then all of a sudden ...

" I want to go home now."

"Shall we finish walking round the lake?"

"No. I want to straight home."

So we went back to the car and drove home. Any attempt at polite conversation was met with a stony silence.

At home Sam was confrontational, beligerent, almost aggressive.

I was worried about having him home on my own.

They'd said that last week he had done so well...

What was happening now?

We got through to the afternoon. Sam managed lunch with me and I had managed to prepare lunch with him about. Then soon after lunch he said he wanted to go for a sleep in his bedroom.

He wasn't there long. I was disappointed. I thught the rest might do him good and it was a break from all the tension for me.

But he came down well. He'd managed to get all of it out of his system. Gone were all the confrontational comments. Suddenly here was an (almost) reasonable young man again. We played chess. He played badly but at least he could concentrate to play. He did some art work and was keen to comment on it. Then we drove out to another local beautiful area of countryside and walked and found some climbing to investigate. As we were strolling back Jane phoned. She was only half an hour away. She would probably get back before us.

Sam was fine now. He was fine with Jane. He went back well. Such improvement. Why had I been so worried in the morning?