Argus title : A plea for ones who slip away

Sue is a small, dark haired woman with a smile that lights up her face. She is concerned about injustice and war and wants to change the world.

There are probably many things she and I could talk about, many things she could say that I might want to write down. But she contacted me for a particular purpose. She wanted to talk to me about her dead son.

When we met, she was composed and dry eyed. She said she’d been expecting his death, even predicting it, but that it could have been avoided.

Her son, Yannick (38) died by heroin poisoning on an unspecified date in early November. He had a long history of mental illness and in May had been discharged from a 5 month stay in a local psychiatric hospital. He was placed in bed and breakfast hotel accommodation and there he died. The inquest finding was “Accidental Death”.

He was last seen alive on the evening of 3rd November. Three days later on the 6th November a hotel employee, who was investigating why there was no hot water, knocked at Yannick’s door, but received no reply. Hearing water running, he let himself into the room and discovered Yannick’s naked and already decomposing body blocking the entrance to the shower. He had collapsed face down in the shower wrapped in a bed sheet.

His mother was not informed of his death that evening. The Hotel had no information about Yannick or his next of kin.

Sue said that Yannick had been a handsome man, but the manner of his death so damaged his face that she was advised not to view his body. Tentatively, she drew an old framed photograph from her bag. She said “I just wanted you to see what he looked like”. It was a lovely face, open and smiling.

She visited his room after his death and found a scene of devastation. There was dirt and rubbish everywhere, and evidence of heavy drinking. She’d grown used to such chaos. It was an indicator of descent into breakdown and she’d seen it all before.

But, the thing which shook her to the core was the fact that the sheet which had shrouded his dying body, and was still stained with his blood, had been left to lie on the floor. It was the final sordid indignity suffered by her unhappy, beautiful son.

It was not always this way. Yannick was, she says, a highly intelligent young man, who loved books and music and was an accomplished musician. He was devoted to animals and, when he was well, was extraordinarily warm, caring and generous. But his life was blighted by mental illness.

He was born in England, but after the break up of his parents’ marriage, lived with Sue in Denmark. On a trip home, at the age of 13, Yannick was sexually abused by a man well known to his family. He told no one at the time, but it had a profound impact upon him.

Despite his evident intellectual ability, he left school at 16 without qualifications. Returning to the UK, he secured a place at art college, but was unable to keep up the discipline of attendance and soon dropped out.

One day his mother entered his room and found him mute, able to communicate only by sign language. It was a major breakdown, the first of many. Schizophrenia was diagnosed and as breakdown followed breakdown, he was several times ‘sectioned’ (hospitalised and treated without his consent) under the Mental Health Act.

He refused to accept his diagnosis and often rejected prescribed medication. Like many people who have been abused and those who hear voices and have disordered thoughts, he used alcohol and other drugs to dull the pain.

He seems to have believed that by refusing anti-psychotic drugs and self medicating, he would gain some control over his life. In fact he was making things worse. Soon he had a dual diagnosis of paranoid schizophrenia and ‘poly drug abuse’.

His uncle offered him employment in his printworks, but he was unreliable. Sue said “There’d be a deadline and he’d go missing. His uncle would find him outside watching a butterfly. He couldn’t live an ordered structured life. He couldn’t cope.” Fellow musicians soon stopped asking him to perform with them. He failed to turn up.

A pattern was established. Yannick would break down, his life lapsing into chaos and drug abuse. His behaviour would become bizarre, and sometimes threatening and violent. He would walk in front of cars and talk to the voices in his head. On one occasion, he tried to extract his own teeth. He became convinced that the CIA and FBI were bugging his home and planning to kill him. Eventually he would be sectioned.

In hospital he’d be given medication but, according to his mother, be offered almost nothing by way of activity.

She says he’d live an unstructured life, little different to his existence outside, sleeping into the afternoon and remaining isolated in his room, where he would also eat. She described his hospital room as “filthy, little different from the places he’d lived in before he was hospitalised. He had nothing to do. He was an intelligent man. He should have had some stimulation.”

There was kindness, concern and medication, but no psychotherapy, group work, or other ‘talking therapies’. The sexual abuse he’d suffered in childhood – which research has shown can sometimes trigger psychosis – was not addressed.

Yannick had lived with Sue off and on, but his behaviour became threatening and violent. After his last period of hospitalisation, she knew she could not have him back.

She wanted him to be cared for in supported accommodation, such as a group home, where his day would be structured, his abilities and vulnerabilities recognised and issues relating to addiction and abuse addressed. He was never to be so fortunate.

Following his final stay in hospital, he was placed in bed and breakfast accommodation in Hove and offered external support by the Assertive Outreach Team based at Brighton General Hospital. He coped reasonably well. However, the establishment closed and he was moved to similar accommodation in Brighton. Here he began to deteriorate.

Sue says bitterly: “Bed and Breakfast isn’t supported accommodation. There were people misusing substances, drug dealers in the area and a sheer drop outside his window – four flights down. Why would they put such a vulnerable person in such a place?”

“They said they were trying to find supported accommodation. They should have kept him in hospital until they found it. Or set up an annexe for patients in his position.”

Sue alleges that despite his vulnerability and deteriorating state, he did not see a psychiatrist. “They kept saying they wanted to ‘move slowly’ to ‘gain his trust’. I could see he was deteriorating. He’d lost his ability to understand. I told them if they didn’t do something he’d be back in hospital or dead. I told them he was living in chaos and using drugs. I said ‘He’s slipping away from us, he’s going to die’, but it did no good.”

Sue has been told that on Friday 4th November the professionals met to discuss possible readmission. No immediate action was taken and by the end of that weekend he was dead.

Maria Crowley of Southdown NHS Trust, was unable to comment on this particular case, but said. “People with dual diagnosis are extremely vulnerable, but legally can’t be sectioned if their mental health problem has stabilised, even if they are misusing alcohol and drugs. There are many parents who ask us to enforce hospital treatment, but we can’t do it.”

She added: “What we need is more specialised support for people with dual diagnosis who can’t or won’t engage with substance misuse services. We also need more appropriate housing because in many cases housing services can’t accept people with very complex and disturbing behaviour.”

“We are working very closely with colleagues to try and improve services.”

Sue responded sadly: “My worries are now over, but there are other parents out there tearing their hair out or living in fear. Something must be done to provide help for their children.”

It is of course health and social services professionals who have the primary duty of care to people with severe mental health problems. But we all have a duty to ensure that these obligations are honoured.

Yannick died alone and in squalor. As we enter 2006, we should, as a community, resolve that we will permit no further deaths of this kind.

Our city has the highest rate of drugs deaths in the UK and this dishonours

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