Mandy’s flat is at the top of the block – so much so that the lift doesn’t extend there, and we have to walk the last two flights. It makes me think of an osprey’s nest, a junky bundle of sticks wedged in the uppermost branches of a pine. The nest is made up of old music magazines, Janice Joplin posters, empty cans, unpaid bills, unopened nutritional milkshakes, and the osprey itself is a haggard, featherless old bird, smoking a roll-up, staring unblinking over the city.
‘I’m a singer’ Mandy says, her voice so broken she can hardly talk. ‘Or was. ‘scuse the mess.’
She offers us a seat – a dirt-shined cushion in a sixties wicker chair, and a spot at the end of the crapped-up sofa. Standing isn’t an option, but at least this is the last job of the day.
‘Thanks’ I say, and we both – slowly – sit down.
I hardly know where to start. We’d come to see Mandy as a double-up as the notes on her file described how she’d been hearing evil voices telling her to tear herself and other people up.
‘But don’t worry. A and E did a risk assessment,’ said the co-ordinator. ‘No history of violence, and they don’t think this was a psychotic episode, as such.’
‘No. More to do with alcohol withdrawal. So doubling up should cover it.’
I’ve never really understood the doubling-up rule. The way I see it, it doesn’t matter how many people you send in, someone’s going to get hurt. If anything, having other people with you only acts as a distraction. Although it does make me think of that joke about the two rangers walking in the forest, talking about the danger from grizzly bears. ‘Because they run pretty fast, you know.’ ‘Yeah?’ says the other. ‘Well I don’t have to run faster than a grizzly bear, Chuck. I just have to run faster than you.’
But I suppose it means there’ll be a witness
The other thing frustrating thing about this particular call is that Mandy goes out. A lot, according to reports. She gets drunk, then spends her time wandering the corridors of the block shouting and causing trouble. There’s an on-going spat with an ex-boyfriend who has recently moved in with another woman on fourteenth. And any number of substance abusers scattered through the block mixing things up – socially as well as chemically. All in all it sounds like a recipe for chaos, and not something that’s going to lend itself to regular, well-apportioned community care. At a time of severe underfunding, it seems crazy to throw resources at a patient who has the capacity to decide whether they drink or eat or take drugs or not. It’s a lifestyle choice – however severe that choice works itself out in practice.
But our community health team doesn’t have the latitude or leverage to protest. The referrals come in, we go out.
The brief is to establish regular contact with Mandy. To get carers going in every day to encourage her to eat and get her used to some regularity in her life.
‘It’s only until a more regular provider can pick up’ says the Co-ordinator.
‘I’m sorry I wasn’t in earlier,’ say Mandy. ‘I had to go to the doctor’s.’
‘Oh? How did you get there?’
‘Taxi,’ she says. ‘Well they’re not going to come here, are they?’