Tuesday, 19 August 2008

Down at the nick

This afternoon I went to a meeting at the main police station in town. The last time I went there I was a spotty teenager required to produce his driving licence as I hadn't had it on me when stopped by the police. That was over thirty years ago. The place hadn't changed, except for the bullet-proof glass at reception.

One of my patients has been causing a nuisance for quite some time and the police have been involved on many occasions. She has an emotionally unstable personality disorder, and when under stress she acts rather like a toddler with a tantrum and does bizarre things. It's not her fault, poor thing - she had a difficult childhood and failed to learn the normal coping mechanisms for stress. But her bizarre actions alarm and upset people, and can confuse police officers who tend to bring her back to the station under Section 136 of the Mental Health Act.

The meeting was helpful, I thought. As well as the GP there was her Community Psychiatric Nurse, someone from the Psychiatric Crisis Team, someone from Housing and more police officers than you could shake a truncheon at. The health workers were able to explain that she does not have a mental illness, and pointed out that she seems to respond to being set firm boundaries. Various aspects and options were discussed. The police were keen to learn and are going to alter their strategy for dealing with her accordingly. I learned something about how they deal with problems and the legal framework within which they operate. Above all I was impressed at their concern for her, and their wish to avoid getting her entangled with the criminal justice system except as a last resort.

As a middle class professional I am of course on the side of the police. But I was pleased by the evidence from our meeting today that we have a good bunch of coppers here in Urbs Beata.


Bright-eyed said...

Hi, I was just interested at the distinction between a 'personality disorder' that you mention the woman had, and 'mental illness', which you say she doesn't.


Anonymous said...

Bright-eyed, I was always taught that a personality disorder was a "mental condition" as opposed to a "mental illness". Someone will be along with an ICD-10 or DSM code at any minute I expect.

Elaine said...

I found it rather heart-warming that the police were prepared to listen and learn - it gives a better, and probably more accurate, picture of them than they tend to get in the press.

The poor lady - I hope she does learn some more coping mechanisms.

The Shrink said...

Cliche though it may be, many police now look prebuescent to me and have the certainty of youth.

As Oscar Wilde said in 1894, "The old believe everything; the middle-aged suspect everything; the young know everything.

I'm not young enough to know everything now, but a few young police I cross paths with still cling to such youth (and such youthful folly). They therefore dichotomise such presentations as "She's ill, it's a 136 job and for Health to deal with" or "she's not ill, so she's delinquent, so she's nicked and it's for the criminal justic system to deal with."

Older police in my corner, who don't know everything, temper management with discussion and common sense in a similar fashion. But I've yet to meet with a GP in such case conferences . . . very laudable, Dr Brown!

Dr Andrew Brown said...

Bright-Eyed: When you prepare your psychiatric "formulation" you should state not only the patient's illness (depression, schizophrenia, etc.) but also the patient's underlying personality (introvert, extrovert, gloomy, relentlessly optimistic, fastidious, easy-going, and so on).

Personality consists of those personal attributes which determine how we perceive and react to the world. There is a wide range of "normal" personalities, but some people with extreme characteristics persistently behave in a way which causes trouble to them or other people. These are the personality disorders. Such disorders cannot be easily treated, but people can be helped to modify their unhelpful behaviours. Unfortunately my patient does not wish to accept such help.

The Shrink: Your laud is most welcome, but I must confess that this was the first such case conference that I have attended.

Bright-eyed said...

Thanks for the answers.