The British ‘care in the community’ policies have often commendably supported aspects of the patient’s rights movement from broader civil rights campaigns and encouraged the development of community care. [The Mental Health Act 1959, Mental Health Act 1983, Community Care act 1990 etc] But one can’t help wondering on occasion if it is for merely political and economic expediency and budgetary slash and burn of the NHS that such people end up on the streets and coming to see us of course. All of this means that many of the people using the Gap as a drop-in for food, warmth, shelter, washing, showers, toilet facilities, activities; art, music room, IT suite and housing referrals and general support are suffering a huge variety and range of various aspects of mental health.
The week has been stressful and we have been trying to accommodate a vast range of client need.
Jose is one such example and before you complain that I have infringed his human rights to have his picture taken, I asked him and he said it was OK –“ If you give me a copy of the picture.” [He has asked me every day since!]
This is Jose. He is quite lucid, not to say articulate, fluent in Spanish and often engaging to talk to if one spares him the time, does not appear to be violent and has recently been using the Gap. He needs feeding and though he chooses not to use the washing facilities we do have a tendency to not allow him to stay on site. He is brought drinks [hot or cold] and his meals and he eats then on the street. Prejudice? He seems to prefer this. And yes, OK so do we. Why? Jose has told one of our staff, the much-loved Miguel, that he suffers from Diogenes Syndrome. This caused me to look it up on’t t’Internet and it is best explained as follows: the adoption of a reclusive and squalid lifestyle, expressive of a hostile attitude to and rejection of the outside community. Sufferers often live in restricted spaces, hoard what observers might think of as rubbish and wear peculiar clothes. The syndrome is characterised by the refusal to accept all offers of help, rudeness, anti-societal behaviours and very poor levels of self-care. Interestingly sufferers of Diogenes Syndrome have often been previously very high-functioning and can be possessed of IQ’s in excess of the high 80’s and above.
Some staff are of the belief we should ‘Call the police! Call the police! Its disgusting!” but we have a more enlightened approach don’t we?Jose and I had a conversation on Monday about photography and he clearly has something of the artist’s vision as he looked at objects around him and we discussed aspects of form, colour, shape, juxtaposition and so on. He suggested to me he might be given a camera as “I see things differently you know?” I have seen things which you can only imagine” and I am working on that one.
The only SLIGHT snag, as you may have realised by now, is that Jose has the compulsive need to collect detritus.
He does this much as Pigpen in the Charlie Brown cartoons of Charles M Schultz appears to gather dirt and dust. It seems a process of osmosis is at work. One can watch him and see him rearrange things in his possession, you can even observe him going through the waste bins on the street but somehow he always seems to have accumulated more than one imagines possible.
I leave the project to engage Jose in conversation about the stuff he has accumulated and having contacted the mental health team and the Elmore Team who have a duty of care towards him, I try in my best person centred way to engage. I presume from my therapeutic training; valuing, acceptance, conflict management and client attunement that much of what he has gathered must in some way be valuable to him.
“So Jose, all your stuff there is it in some way precious to you?”
Now, Jose gives me a somewhat quizzical look at this point as if trying to work out exactly which planet I may be from and retorts
“ No of course it fucking isn’t. It’s a load of old shit, isn’t it?!”
We make him a deal that he can come in tomorrow if he tidies up the collection which by now has reached the level that all his collection is housed in two of the largest Sainsbury’s trolleys overflowing with well, rubbish.
“No problem, it’ll be easy!” Jose responds.
It takes the following three hours for Jose to sort through the contents bit-by-bit, item-by-item, dog end, cup, and carrier bag by KFC box. So that actually he reduces the two trolleys full to the one. Half way through we bring him a cup of tea, the contents of which he decants into a beer bottle, he decants this into a Remy Martin bottle and pours it back, drains a couple of local coffee shop cardboards cups of their contents and yes, you guessed it, proceeds to sip the mixture as he works. We contact the City Refuse Service, the Anti fly-tipping Bureau, the County Refuse service and indeed Sainsbury’s to see if the wish to collect their trolleys, explaining that a mentally ill person has built up quite a collection of refuse and will they come and collect it. Interestingly the departments are extremely gifted at referring us round and round the system [system? Ha!] so that one is stuck in a never ending circle of phone calls that presumably would disappear up their own fundament if left off the hook but the experienced project worker knows when to hang-up, if not give up. It is collection day anyway and the trolley and several bulging bin bags later are all arrayed by the council refuse bins we normally put out.
So by close of business the front of the project is looking fairly presentable again and Jose disappears into the evening safe in the knowledge that he will be allowed in again tomorrow. Where does he sleep I hear you ask? Why he has his own flat or room. The Elmore Team inform us it is currently the subject of an order to re-house him. Why?
Because in Jose’s own words “It’s full of shit!”
“They need to sort it out, I can’t be expected to live in those conditions”
And you know what? He’s right. The fact that it is entirely of his own making is neither here no there as it is clearly a matter of Public Health and Safety as Jose seems keen to point out. So maybe he will sleep rough tonight but I doubt it. Probably just snuggle up on a bed of Tesco bags and several week old food boxes from the bins of Oxford.
They staff member who wanted the police called starts ‘making a book’ with us as to the state we will find the project in tomorrow. “You wait, he will have scattered the contents of all his bins back all over the front of the place again” presumably as some kind of defiant statement against our fascist restrictions.
I arrive the next day with trepidation and low and behold the front of the project looks FINE! Much the same as we left it and we start the day front of house ushering in the waiting hoards for breakfast and to start the day.
But wait…Team Leader has some bad news
The back garden is full of rubbish! Several bins of refuse have been scattered all over the garden, not only that but there is ample evidence that some has defecated all over the garden. In at least five different locations and ‘can someone lend a hand?’
We don our rubber gloves and ever the one to show willing that in my role I am not above unblocking the toilet (it usually requires a broom covered in bin bags. technical stuff!) or fixing a light bulb, re-booting the IT suite so that the porn links aren’t working anymore, etc etc. So we set about picking up all the rubbish, and I hold the bin bags as we shovel up the faecal matter from around the garden borders. What feels like several tons later we focus on removing the rest of the rubbish, card boxes, bags and paper and waste and a rather fetching umbrella covered in white polka dots dumped down by the back boiler room. This includes 12 foot lengths of used toilet paper and as the contents of the garden’s decorations are shovelled into the bin bags I am religiously holding open, it occurs to me that here I am on lovely sunny October morning shovelling shit!
Note: not you understand that I'm accusing Jose here. No, no. I wouldn’t make any such assumption, as we need evidence of any such act before we go around accusing anyone. We let the mental health team know he is currently barred from the project and that at present he is ‘plotted up’ on the steps of the architectural award winning carbuncle of the Oxford Said Business School building, part of the university, with his by now several bags of rubbish [he’s only been gone a couple of hours so hasn’t got into his stride yet.] The person from the mental health team says
“Oh dear that’s quite posh over there isn’t?”
I say well, I suppose you could call it that
“Well they won’t be happy about that will they?”
No, I dare say they wont
“Well, I’d better do something about that”
Within a couple of minutes two police officers are seen engaging Jose in conversation.
When I next take a look he has gone, no sign of him at all, not a trace, not a wrapper or a dog-end and we haven’t seen him since
Postscript: As I leave for some well earned annual leave, I take a look back at the building that is presently the Gap and there nestling in the drain at the foot of our drainpipe from the roof is a large milk carton, you know the sort plastic and the biggest container of milk Tescos can supply. Two litres or half a gallon! It is FULL of a curiously familiar yellow liquid!