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Having a mental illness should not mean being homeless and bullied by gangs

An man with blood on his face came to the hospital Emergency Department. He was unshaven, wearing dirty clothes and smelt strongly of cigarettes. The triage nurse at the front desk asked if he was homeless. He shook his head. The triage nurse signed, took his obs then told him to wait on a bench. When a nurse called him into the department and escorted him to a cubical she started asking questions.

What had happened? Had he been in a fight? When did this injury occur?

The man had difficulty answering her. He either shook or nodded his head, or mumbled incoherently. He seemed passive and accepting of the situation. The nurse cleaned up his face with saline and gauze and noticed extensive bruising, down one side of his face. She put him into a hospital gown, packed his smelly clothes into a plastic bag, did a set of obs then told him to wait for the doctor to review him.

A doctor came over to the cubical and introduced himself.

“Hi, I’m David. What’s been happening?”

The patient mumbled back. The doctor asked the man to talk clearly, open his mouth and move his jaw back and forth. The man was unable to do any of these things. The doctor ordered an X ray.

It showed the man had a broken jaw, and severe bruising. An IV line was put in, bloods were taken, he was fasted and prepared for theatre. When filling out forms, the nurse tried to get information about the man’s family and friends.

“Where do you live?” she asked. “We need to let people know you will be staying in hospital for a few days”. Eventually the man gave his address as a temporary men’s shelter. However he insisted that nobody from the hospital contact the shelter. When the nurse wanted to ring them, he became agitated. The man insisted that he “did not want to cause any trouble”.

The man went to to theatre and his broken jaw was reset and wired into place. He was then sent up to a general ward for several days. He could only drink liquids through a straw. His mouth had to be rinsed out twice daily with chlorhex mouthwash. The ward nurses were exasperated by his smell and made him shower thoroughly, shave and put on an ill filling pair of green flannel hospital pyjamas. His smelly, torn clothes were thrown out. A social worker was called to review him. She spent two hours talking quietly.

Homeless man on ground

Homeless man on ground

It turned out that man had schizophrenia but was seeing a mental health clinic and having regular anti psychotic medications. A GP was contacted who confirmed that the man was compliant with his medications and was shy and non threatening.

The problem was, the GP pointed out, that the man had no where to live. ‘I can’t find any permanent accommodation for this man. The government has closed all the psych beds. Where is this man supposed to go? And what is the point of giving him medication, if you don’t give him a safe place to live as well?

After making numerous phone calls, the psychiatric clinic case worker was located. She advised that the man had ended up homeless, and had recently been placed in male shelter.

After a few days of regular food, warm clean clothes and people being friendly, the man began to open up. He admitted to nursing staff that he had been beaten up by a gang of young hooligans at the shelter. They had told him, that they did not “like” people with mental illnesses. He had been attacked, punched in the face and thrown down the stairs. He was also warned “not to tell” or he would be killed.

His psychiatric case worker was contacted, but she could not find any other accommodation. His GP had already tried and couldn’t find any where for him to live. The man was subsequently discharged back to the same hostel where he had originally been assaulted.

© Wikihospitals 2014

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