Rodney is a 35-year-old man whose parents were born in Nigeria, He has been described as having ‘a long history of schizophrenia and homelessness’. He has been ‘in and out of the mental health system’ for several years. On one occasion, he was held in a police cell because there were no beds available in the local acute mental health unit. He felt that the police officers avoided him when he was in the cell because he has mental health problems. The experience of being in crisis in a cell was a major trauma in itself for Rodney, and it has had the effect of making him suspicious of all institutional environments: ‘I was in total chaos; I had just tried to kill myself. I was in a prison cell. I had no belt, no shoelaces, no shoes, because they wouldn’t let me have them, but no one would talk to me. No one.’

Rodney feels that it is not just the police that lack empathy when dealing with people in crisis. The problem extends to professionals: ‘The sort of people you need when you are in crisis are the ones who still see you as a person, who remember you are not just a problem blowing up in their face; you need empathy, someone who sees you as a person.’

Rodney consistently declines medication, and is frequently described by practitioners as being ‘prone to delusions’ that mean he is unable to easily live around others in supervised settings. When the community mental health team (CMHT) began to work with him, they established he had some long-standing substance misuse issues, principally involving alcohol. However, he insisted that he had found his own housing and was managing well enough without their help. Rodney’s sister maintains contact with him and she liaises with the community team, encouraging Rodney to attend the drop-in sessions they run at a local café.

Subsequent team visits found him living in an abandoned caravan, where he had rigged up a supply of water and a wood stove for heating and cooking. The treatment team concluded that in spite of his unconventional living situation and persistent symptoms, he showed an ability to care for himself. This treatment team’s decision, however, is regularly questioned by some new members of the team. They assert he should be involuntarily hospitalised before he hurts himself or someone else.

(Based on an original case study, Mr. R, in Stovall et al., 2016)

With reference to:

the Stovall et al. (2016) article ‘Ethics and the treatment of the mentally ill, homeless person: a perspective on psychiatry resident training’
two other written sources
and other relevant materials (source of information doc.) discuss the following question:

What are the ethical issues raised by Rodney’s situation and how service users with complex care needs, like Rodney, could be better supported in the community?

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