Watch it and Weep

 Usually I aim for funnies on this blog, but not today, however good the latest episode of Richard Herring’s AIOTM  is. Today is for thinking about abuse, and how it happens, and even how it can be fed by the best of people. All of this was prompted by the Panorama investigation into a ‘hospital’ for people with learning disabilities, uncovering abuse that looks like torture from my place on the sofa. If you’re in the UK and haven’t seen it, have a look if you can stand it, but not just before bed.

The program raises lots of questions. Who abuses? Why? What about management? Regulators? Training? How to ‘manage people with challenging behaviour’? I don’t have the answers, but I’m ready to tell a story of abuse. It’s true, but names and places are changed for confidentiality.

It was the part of the ‘90’s before we had Brit Pop, football for the middle class, and laddism. No one I knew had a mobile phone or had heard of the internet. It was my first job as a support worker. I was on a challenging behaviour unit working with a group of men who because of their history of ‘severely challenging behaviour’ were the last to be released from hospital to the community. It wasn’t their own place though; it was officially hospital premises, led by nurses who had worked at the hospital. The support workers were local women some with hospital experience but most not, of whom I was the youngest. There was no induction or training, support workers were unqualified, gaining unofficial seniority through length of service or strong personality. We worked to a number of rules and routines that weren’t subject to question. I cleaned skirting boards twice daily and was unable to display the service users’ drawings because the notice board in their kitchen was for staff. Walls were putty coloured and chipped, furniture was vinyl upholstered, and there were no curtains. I had to face early shifts. There was a lot not to like, but from the first day I loved the men and their families and felt I had found my vocation.

Harold was one of the men I worked with. He would have been in his forties at the time, tall slim and muscular he was always active. His chief loves were to be outside scratching in the bushes with his tough fingers, or to follow staff about, joining in with what was going on chiefly by cheekily disrupting it. His speech comprised a few words he had made up, although he understood a bit more. There was a kindness about him, he could tell if someone was upset and would approach and attempt to cheer them up, ‘Awww’ he would coo, and then tug an ear and dart away laughing ‘ekky, ekky’. He exhibited the behaviours of people who lived at the old hospitals: a love of sweet tea and a fear of keys which before my time were brought down on the knuckles of people as punishment. Don’t get me wrong though, Harold was hard on the nerves when he pestered for what he wanted which was often difficult to determine. He was bruisingly rough and when focussed inwardly saw no danger or self-control. One time, he ran into a busy road unexpectedly after a leaf. Three of us couldn’t stop him, or persuade him to get up from his kneeling position as he turned it in his hands, precious as it was to him.

At the time, the senior management were looking for us to be seen to do more activities with ‘the gentlemen’ as they were called. This can be hard in learning disabilities work because people may struggle to concentrate for more than a moment, there can be issues of safety, there are never enough staff to take people out (or if there are, there’s no transport), and what with shift patterns and gossip and notes and meetings, well….. At the time, the patients’ money was tightly controlled to the extent that when the dentist suggested to me that one of them could be more independent in cleaning his teeth if he had an electric toothbrush I had to go to a panel with the dentist’s recommendation in writing and three quotes. Some of us began to cook with people, looked through books, did drawing, and turned things like cutting fingernails into manicures while the old guard watched in astonishment – what about the skirting boards? Some of those old timers, catching on to the new ‘activities thing’ had a brainwave. They revived the unused allotment area on the grounds of the unit. That way, they could get away for a smoke, grow a few potatoes, and need only take the ‘easiest’ of ‘the gentlemen’ with them. If I seem unduly cynical about all this, I will own that at least ‘the gentlemen’ got to eat organic home grown veg when it was only available from health food shops.

It had been a sunny afternoon. I had been working alone in the house while two of the older support workers had been up at the allotment without a service user. Sometimes it’s easier to do things for people, and John, who they might have taken with them, had stretched out on his bed when offered the activity ‘fk-ovv’. I didn’t mind. Harold and I had been cleaning (me the windows and Harold my arms), I had been singing line by line while he made up a chorus in rhythm ‘ee oo eea’. If I stopped he would demand ‘singy singy’ and we would go on.

The staff came back, one of the nurses arrived, there was chatter in the kitchen and tea to drink. A support worker had picked a bunch of cabbage and it lay in its roots and soil on the worktop. There was talk about the crop, and pride at the successful growing season. Harold had been listening in, leaning on the wall, unnoticed. Unexpectedly, he strode across the kitchen, pushing the women aside to reach the cabbage ‘ooo oooo mmm’. He clasped it to himself. At that time, emphasis was placed on teaching people things. Someone had picked manners, partly I suppose to get ‘the gentlemen’ better socialised, but also (and this had been made explicit to me) to get them to acknowledge the authority of staff. They should ask before they had things, thus Harold should have said ‘ple’ which was his word for ‘please’ and have pointed to the cabbage before picking it up. Immediately the shouting started, ‘Harold, Harold you give that back and say please…Harold put that down now…no, you can’t have it’. All three women at once, surrounding him with high pitched sound.

Harold held on to the cabbage that had come from his allotment, picked by his support worker for his dinner. There were no risk assessments then, but if there were, we’re talking a non-harm-causing, non-harm able cabbage. ‘Nah, nah’, Harold shook his head. The nurse assumed charge; she pulled at the cabbage, calling to the other staff to pluck his fingers to release it. Harold was screaming now, backed into the kitchen cupboards. Eventually, he threw the cabbage to the floor, shoving past us and running to the adjacent living room.

Kitchen and lounge were linked by a serving hatch with doors that we normally kept closed. The lounge was the nicest room in the house, it had the TV, vinyl sofas, a coffee table and a dresser. Room length patio windows led on to the grounds that went downhill to a stream and weeping willows in the valley. Harold began to pick things up and tap them, first a book ‘na na na’ in a sing-song voice like Three Blind Mice, tap tap tap. The nurse pursued him telling us to stay where we were as she would ‘make him behave’. Harold went for a brass ornament, banging it louder, still singing, then the end of the coffee table. Things by now were looking risky, and we all knew from past experience that Harold would not now easily be calmed. The nurse, still shouting at him to put things down and behave began to pass things to us through the hatch. It was a room of few knick knacks, soon emptied. Harold rushed about looking for things he could bang ‘nah nah nah’, bang bang bang. Having run out of things, he tried to leave. The nurse barricaded herself and Harold into the room using the sofa.

Still more distressed, spit flying, his head tilted upwards, Harold began to spin on the spot, He was caught up in his rhythm now, oblivious to calls, and to the nurse's attempts to hold him still. I remember his sudden movement, but not what prompted it. He made a last attempt at the blocked door, shifting the sofa a foot then turned and ran at the patio door, punching his hand through the glass.

Time slowed down as it shattered (it wasn’t safety glass), shards holding in place as he pulled his hand back and looked down at it, a six inch cut bleeding heavily . Then, he sank to the floor, holding the hand as he had first held the cabbage ‘ekky, ekky bad ba’.

While Harold was at the hospital getting his stitches, we sat down to write our witness statements. I wrote what I was told to, with the story starting at the door to the lounge and omitting the sofa barricade. It was concluded that ‘that’s Harold and it couldn’t be helped’.

I learnt a lot, but I’ll leave you to your own analysis.

The window was repaired before Harold’s hand, the glazier told me he had been out twice before when patients had put them through and he always replaced the broken ones with safety glass. There were twelve panes in total. I had enough courage to ask the boss if all of them could be replaced to save further injury, but was told they could not and that ‘the gentlemen will learn from their experience’.

Harold healed (slowly because he was forever removing the bandage to look at the cut, bad ba), and I moved on. I kept in touch for some years after as his team changed around him. Before long, all of the staff bar the nurse (who now worked on another ward) were new to me. The place got curtains and fresh paint, better food and carpet. Harold got a holiday photo out of his pocket to show me. One Christmas, a nice member of staff asked me where the scar came from. She held it out to me as she did so. He snatched the hand away , running a thumb across it soothingly ‘bad ba ba’.