Blog, homeless, psychiatry

Mental illness and street violence

Having a mental illness does not mean you should endure being homeless and beaten by street gangs

Imagine if someone in your family was diagnosed with a mental illness. Would you be happy to find them living on the streets, being bashed by street gangs and too terrified to go to the police?

A man came to a public hospital Emergency Department. He was unshaven, wearing dirty clothes and smelt strongly of cigarettes. He had blood on his face.

The triage nurse at the front desk had seen people like this before. She asked if he was homeless.

He shook his head, silently.

The triage nurse signed, took his obs then told him to wait on the plastic bench seats.

Emergency staff see cases like this all the time

An nurse called him into the Emergency Department and escorted him to a cubical. As she sat him on a trolly bed 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 his 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 Emergency nurse tried to get information about the man’s family. She had also seen people like this before.

“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, 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, shave and put on a pair of ill filling green hospital pyjamas. His smelly, torn clothes were thrown out.

A social worker was called to review him. She spent two hours talking to him quietly.

It turned out that man had schizophrenia but was seeing a mental health clinic and having regular antipsychotic 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 General Practitioner 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 an all male shelter.

Nowhere to go but back on the streets

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. 

The man was subsequently discharged back to the same hostel where he had originally been assaulted.

Wikihospitals 2014

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