A dangerous prisoner became psychotic. He was transferred to a high secure mental hospital on a S37. After some fighting he was treated with anti-psychotics and became well.
NB it didn’t alter his dangerousness one whit. That wasn’t driven by his madness, in fact madness made him more disorganised and less dangerous – to his target victim group, at least.
He wanted to go back to prison. He may have appealed it, I can’t remember, or that could have happened on one of the subsequent occasions of ping-ponging between pokey and bin. The benefit of returning to prison is release once your sentence is up. The benefit to the hospital is a freed up bed. Being treated and recovering from being psychotic didn’t result in him recognising his illness, i.e. what we call insight. He went back to prison, refused his medication, relapsed into psychosis. Section 37 was re-applied for and he came back in. Madder.
Now, at this point I should say that when someone relapses, when they recover (if they do) they never return to the previous level of functioning. They always lose something and often it’s quite a lot of things together.
1. General loss of functioning. Patients who were taking courses, at Uni, holding down jobs, having non-mental patient friends, can’t keep it up like they could. Drop out, resign, get sacked, become isolated and lonely.
2. Negative sx worsen. Patients lose the motivation and purpose they had before, don’t find things they used to enjoy pleasurable anymore. They might lose interest in their appearance, dress like Worzel Gummidge when they didn’t before. The public notice, shun and avoid the obviously weirdo mentalist.
3. Brain damage in the form of atrophy and tissue loss.
4. Medication often works less well second and third time around. Some symptoms don’t reduce or remit like last time. Stronger doses are prescribed. That’s a double-edged sword but can’t be avoided. Sometimes the patient becomes treatment resistant, i.e. even stronger doses don’t get him well. There’s one last-chance saloon treatment for that, Clozapine. More on that another day.
It’s important to emphasise the illness is to blame, not the patient.
This unfortunate fact perfectly demonstrates why the happy-clappy, be kind, she’ll be right, ‘how simply horrid of you to want to control people’ approach is stupid, shortsighted, bone idle and drawn up by someone who thought seeking evidence, testing ideas out first or the scientific method simply did not compare with what her feelings told her was noble and I’m-more-righteous-than-thou. Emoting gushingly about mentally ill people’s ‘parity of esteem,’ ‘right to self-actualisation’ and pretending chronically mentally ill patients are secretly perfectly rational, self-interested utility-maximisers capable of making long-term decisions does not pass the real-world ‘I smell bullshit’ test. OSMN TM
Relapsing doesn’t magically produce insight like systemic shocks affect other people. e.g. when an alkie hits rock bottom and is forced to re-evaluate their life, a US prisoner receives their second-strike sentence or a battered wife wakes up in hospital. Psychosis isn’t clouding/outshouting/confusing those people’s memories and thinking.
From memory, the patient relapsed and ping-ponged four times, deteriorating each time. Eventually the doctors realised they had to stop the cycle and got his section changed. Too late though. He returned a shuffling, chronic burnout. Forever. It couldn’t happen now, doctors are switched on and have tools to address the problem.
A long time ago, there was a UK wide emphasis on how critical it was to prevent relapse by (among other methods) identifying the prodromal sx that precede relapse. There were buckets of papers on it, with screening tools and questionnaires attached, all aimed at catching a relapse before it happened. I simply don’t hear about these today. My educated guess, i.e. I can’t prove it, is –
a) staff time is already spread too thin (I’ve shown/am showing you how) for them to find any extra to spend on doing that and
b) assessing for early warning signs and prodromal sx is far, far too hard to write a target for, so management choose other things that are easier and make them priorities instead.
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