Introduction

Living on the front line of psychiatry in the community I have witnessed the social problems that only a dual diagnoses psychiatric patient could see. I am not trying to moralise or blame, only to report accurately to understand what has happened. Having said that there is nothing here that is not typical of the world of the care in the community patient so hopefully what I have written will raise awareness by dispelling ignorance and attendant prejudice.

Liz Brown

Liz Brown was very slight of build and could not have been 5 foot tall. Her face resembled that of Fuchsia Groan, the heroine of Mervyn Peake’s Gormanghast. As a teenager Liz had been treated at the Priory Ticehurst House in Sussex, in the adolescent unit. As an adult, Liz was a patient at Orchard House Psychiatric Unit at Joyce Green Hospital, and at Little Brook Hospital. I was working at a local care home as a part time gardener when one of the staff noticed that Liz and I had a common interest in art. I noticed that she had her own compartment in the fridge, and that she would sometimes sketch in the garden. Liz accepted a move to the more independent PSYCHE housing project where she rented one of the flats in the house where I was staying. PSYCHE was once mainly run by and for the middle aged and elderly long term mentally ill men and women who at the

time made up the majority of national health psychiatric patients. These patients, usually suffering from depression following divorce or bereavement, often exasperated by keeping up the working class or middle class pretence, were legitimate patients who required only basic supervision and posed a minimal or no threat to safety of health workers. The 1990’s care in the community programme put the emphasis on short term financial savings. Everyone knows that the old hospitals have closed down but few understand the disruption caused by the closure of the day facilities, the day hospitals. Occupational therapy departments at the day hospitals rehabilitated and restored confidence to many patients who attended who were then able to return to work or find new employment.As a result local Social Services were forced to dump patients who needed a higher level of support than a mental health charity could provide on PSYCHE’S doorstep. So instead of having to cope with large majority of sad depressed but unchallenging patients, PSYCHE are now expected to cope with patients with more serious psychiatric conditions, conditions that often require in-patient or day patient treatment that stopped with the closure of the old asylums. To make matters worse, to coincide with the care in the community programme Kent County Council saw fit to close the group homes, shared houses that had accommodated the long term mentally ill living in the community. As if this situation was not bad enough, the Giddon Hill social service mental health team were advertising for more social workers and besides being understaffed, were and still are overworked. The previous occupant of Liz‘s flat, Michael, had been

transferred to Broadmoor following his conviction for stabbing a local GP in 2000. This incident was reported in the national press, on the front page of some newspapers. At his trial a year later Michael was reported to have said that ‘they had been winding him up’. I wondered if the staff knew something as one of them had told me that Michael was upset about a month before the incident. Around that time another of the PSYCHE housing officers, Alison went drinking at a pub in Gaol Lane, then driven her Citroen Deux Chevaux to the local woods and hung herself. A third housing officer, Georgia told me that she could not believe the attitude of some of the staff at PSYCHE Westbridge before she left. Shortly after Michael been sent to Broadmoor, John M, then head of PSYCHE Westbridge left to start another job. Westbridge PSYCHE employed Mary, who had only worked with the mentally ill for a year. Prior to that and for ten years previous she had worked with criminals. Previously she had run a probation hostel. The character attributes of a probation hostel manager are different from those needed by the manager of a local branch of PSYCHE. Those responsible for employing the new manager may have thought that the Michael incident would happen again which goes to show how out of touch they were. The Fundamentalist Christian staff, Julia and Don left the housing staff. Mary replaced them with Norma and Jenny who were given a job with no specific agenda because the government kept changing the mental health service never presenting a clear plan. The government seemed more concerned with reassuring the public and transferring responsibility to the charities. As a result the staff were obliged to invent their own work plan. They informed us that they would be holding monthly health and

safety checks. With an electronic thermometer their symbol of authority they would test the tap water for Legionnaire’s disease. We were told that this was a requirement of the housing association. When I telephoned the housing association they had no knowledge of such a requirement. These inspections were erratically timed and often at a few days’ notice. Liz hated these intrusions. Anyone who is involved in creative work knows that privacy is often essential to the process. Artists usually want to show only finished work if at all. The visits were disruptive, but the staff argued that no-one turned up to their house meetings, and that left on their own patients would not only deteriorate but they would neglect the property as happened with a previous tenant who after refusing to admit visitors for a year was found to have covered the entire floor surface of his flat with rubbish and litter, enough to fill twenty bin liners. In the change from the more supportive atmosphere of the communal care home, Liz was allowed more freedom, and though she was able to continue with her creative interests she was also free to not eat and become more anorexic. It was clear from the start that PSYCHE were not able to cope with the situation, soon Liz was obviously underweight but when, soon after she had moved in, she attended a Summer Fayre run by the local PSYCHE office. No-one seemed to notice let alone care, and for the first time I had to notify the social services myself, a pattern that was to repeat itself many times. Subsequently when I did ask PSYCHE for help they actually refused to notify the social services merely adding ’what can we do?’ leaving Liz’s fate in my hands. Living in the same house as Liz for the last years of her life I

decided to keep my distance early on, only talking to her when I ran into her by chance when I was leaving or returning to the building. If I noticed that she was sick or that the lights had not been on in her flat for a couple of days I notified the social services and often she received help as a result. I told her I was doing this and she had no problem with this. I soon found that if I was persistent the social services would visit her and put her back in touch with the appropriate health workers, specifically the Red House eating disorders unit at Maidstone who would take her in as an in-patient or day patient. Friends and Family untrained charity workers, even trained professional mental health workers are no more able to cope with the anorexic patient than perform heart surgery. Liz was devious, her illness made her so and she had learnt how to fool anyone close to her long ago. This meant that even if she allowed regular visitors they would be met by a highly rehearsed and practised act involving clothing skilfully worn and adjusted to conceal weight loss and a manner and conversation so polite and a disposition so sweet that she could delude almost anyone, but coming from a background of psychiatric care where her act would have been immediately seen as transparent, and not seeing her on a daily basis I was usually lucky enough to notice when Liz was drastically underweight. The Supporting People initiative was part of the nationwide response to the disasters that the Care in the Community initiative had brought. In part the idea was to make care agencies accountable for their action and was a safeguard against unscrupulous landlords who ran hostels for the mentally ill for profit, exploiting the patients. But the council

now wanted evidence of staff patient participation, requiring PSYCHE to create projects to support their claim for finance.

In the spring of 2005 PSYCHE housing staff had been full of enthusiasm for a new resident Colin. As soon as he arrived I heard him say ’Liz and David they look so ill, I don’t care if they die.’ He ingratiated himself with PSYCHE by building a garden structure with the fancy decking seen on improve your garden television programmes. Though at least half the residents including Liz were against these improvements PSYCHE insisted that the modification of the garden go ahead and then said that they would be putting in new flower beds around the structure. I warned the staff that the garden would become unmanageable with no other residents apart from me interested in gardening, and only a weekly visit from a part time gardener, but Jenny insisted. A landscape gardener was invited to visit and give an estimate. I had net curtains that allowed me to see out but stopped those outside looking in. Jenny told the landscape gardener that one of the residents was a ‘poof’. Jenny decided to give the job to Colin. I was told by a PSYCHE staff member that Colin’s father had money. His father would give him a large sum of money if he got a job. I don’t know if the work in the garden counted towards this deal. He needed a home for his children while he waited for a court decision regarding their custody. If he could not put them up for the three days a week that he was allowed the court might not be so favourable toward him in their judgment. Having donated his time and effort into ’improving’ the garden, he then set about moving his children, two girls of junior school age, into his flat on a part time basis. He charmed Jenny and Norma

into allowing his children to use one of his rooms as a bedroom and installed bunk beds. Norma and Jenny visited Colin regularly, giving this clearly quite capable patient support that might have been better directed elsewhere.

You can imagine the noise and disruption this fellow caused, with his children and garden project, in a house meant for the mentally ill. Colin was desperate for partial custody rights for his children, and allegedly for his father’s money. The desperation caused stress the stress in turn manifested in his behaviour. Colin became for a while the life and soul of the party, encouraging female residents to drink, offering Liz alcohol all the time knowing that these residents were on medication and that alcohol is contra-indicated. The garden project was not just an example of favouritism toward Colin by Jenny and Norma. The garden structure would, while the flower beds were weeded and full of new plants, provide a fine example of a staff led project when the staff renewed their application for the Supporting People grant they needed to claim a hundred pounds a week for looking after the residents. Colin did not need much support. He had a girlfriend and seduced one of the female residents he had befriended. To be fair it must have been harrowing for him to have to look after his children, feed them put them to bed then get them ready for school the next morning from a house full of long term psychiatric patients. But then, seeing as a patient had already been referred to Broadmoor from here it could be argued that he was putting his children at risk. Though he was desperate he was a patient and good father but he was not able to show the same qualities to all the residents. The garden project was a

straight transaction between staff and Colin. In return for working in the garden he and his children were given lodgings. The staff encouraged and supported Colin while Liz was left to deteriorate. Liz declined Colin’s offers of alcohol and friendship. She had her own friends. Liz’s self-harm scars on her arms had faded to white, indicating that she had been through that phase. I was shocked when Tom the caretaker told me that Liz had self-harmed recently, but not surprised. Something or someone was triggering Liz‘s negative behaviour. Tom asked Colin not to leave sharp tools lying around the common room. However Colin continued to do so, and turned up to a house meeting sharpening a chisel. Seeing that Colin had been allowed to move his children into the house, Liz’s upstairs neighbour Linda moved her boyfriend John in. Both these actions against the rules set out in the tenancy agreement. Colin held a garden dinner party to which only certain residents were invited. With loud music, wine and beer they sat in the structure until past midnight leaving bottles and glasses to be cleared up the next day and a bunch of house keys be returned from a garden table to the fellow’s door the following morning. With reluctance PSYCHE eventually moved Colin on though they have astonishingly elected him to their board of governors. He left behind him boxes of craft materials in the basement, open boxes containing modelling knives, scalpels, surgical blades and razor blades for all to see, as a leaving gift. I was left with the unpleasant task of disposing of these items as they were obviously a potential trigger to a self-harmer like Liz. One cut in funding had a particular devastating effect on Liz and at the end of the summer term 2005 she was told that her art course was to close

down. I believe that this would also cause Liz to reduce her intake of food. The situation in the PSYCHE flat Liz above didn’t improve either. The Linda’s boyfriend regularly shouted abuse at another female resident who dared to answer him back, and he used to watch the television into the early hours volume turned up contemptuous of the other residents adding to the mounting stress Liz was enduring. Not one to complain Liz took it out on herself establishing a diet regime which caused her illness to escalate until her immune system was compromised. PSYCHE staff were aware of tensions in the house but did little except organize the gardening project. The only other action they took was to continue with their monthly health and safety checks. In her sleep deprived state and subject to these disruptions it is no wonder her anorexia became life threatening. With unsuitable residents adding to her distress, Liz was too tired to face the day and continue with her artwork. Thus demoralized she responded the only way she knew how, by reducing her food intake which in the environment of an institution would have been enough to attract the attention of qualified staff. Not so in the community, where Liz was isolated, living on her own. She was visited by PSYCHE staff but managed to hide the fact that she was dangerously underweight. I was furious at PSYCHE and Colin for the disruption they caused with their garden project. I put my anger into my artwork, I had a chance to show work at the yearly exhibition at Hall Place with the user led art group Centrepieces, based in Crayford. There was enough negativity in the PSYCHE house to trigger Liz’s anorexia. Liz told me that she felt isolated in the

community. And what a community it is for the mentally ill to exist in. With society progressively more violent, more intolerant and more crowded the psychiatric patient is also expected to tolerate prejudice, usually under the influence of unwanted and unnecessary ‘medication’.Liz’s options were constantly being reduced. Leaving the house to visit the shops or the park was an ordeal for Liz. Though local residents have free healthcare and the benefit system to fall back on, they have been no different to the rest of the country in adopting the fashionable uptight and selfish attitude of the 21st century. Sadly the attitude of the community toward the care in the community patient has been deplorable. There has been absolutely no attempt whatsoever by successive governments of any party to educate the community as to what to expect from the care in the community programme. On the 18th of August 2005 social workers, accompanied by a psychiatrist rang my doorbell at 11 am. They said that they were seriously concerned about Liz and could they have access to the inside door to her flat. After checking their identity card, though I recognised them as mental health workers, I let them in but they were unable to enter the flat as they did not have a key. I advised them to contact PSYCHE office as I knew PSYCHE had a pass key, and left them to discuss the matter in privacy. About an hour later PSYCHE housing officers knocked at the door saying they had some bad news and I asked them if Liz was dead and they said she was and then I asked them if she had taken her own life and they said they couldn't say too much so I asked them if it was an overdose and they said pills were present but they did not know if it was overdose, accidental or deliberate. The Police were

investigating and had said there was no evidence of foul playA few days later I was asked to help assess the situation in Liz's flat, by a PSYCHE housing officer who said that she was too upset to enter the flat on her own; I discovered Liz's diaries, approximately ten journals, note books. I felt these journals, with the extensive collection of photographs were an important record of her life, even more relevant than her artwork. To me I felt that it meant that her life had not been such a waste after all. I managed to read a couple of entries in the diaries before I noticed the atmosphere in the room becoming uncomfortable. One of these read ’Am I pretty? ... cry myself to sleep for hours at night’, another merely described a day out. At the very least a professional health worker would be able to study this record and perhaps understand the nature of her illness an illness that is becoming more prevalent amongst young people.

Any differences were put to one side as Liz’s property was cleared from her flat. In hospital a psychiatric patient has few possessions. When discharged into the community often a patient will try to compensate by hoarding. Liz had spent the money she saved on food on art materials (which found their way to the user led art group), books, and distressingly, a wardrobe, draws and cupboards full of clothes from the catalogues which she used to hide her illness. All these along with her artwork and related resources had to be taken away and in the end the couple who had were clearing her flat asked in despair if they could leave a few of her remaining possessions in the flat as they found the task too distressing. I was worried for her artwork as so often such work is disrespected. I was informed by PSYCHE that Anne Marie

took Liz’s artwork. Liz had feared that father would throw her work away. I feel Liz had more to offer with her artwork but perhaps she made her point by choosing not to use her talent to convey her illness, but to be apart from it. I asked to move into her flat as the noise from the upstairs flat was annoying, and so that Sonia could have a downstairs flat that she needed being unsteady on her feet. The staff agreed. Moving into Liz’s old flat I found the possessions that her executors had left behind. There were some plants on the windowsill, some very cheap jewellery in a little wooden box, a silver ring a silver cross, some cassettes, some glass decorations, and in a draw in the kitchen and on her bedside cabinet, some boiled sweets. I had rescued some odds and ends from the dustbin, I have always tidied up the bins after the residents who have not always been well enough to put their rubbish out properly. I found her anorexia videos, programmes about the illness that she had recorded from the television. I found a door key but would not enter the flat. I should have rescued her diaries but did not. However I did find a couple of photograph booth pictures of Liz and a notebook that had hardly been used. I made a note of the following table I saw in this notebook. Sunday 10th July 10266 steps 3.16km 116 kcal steps: kcal 88 Mon 11th approx. 4500 steps (only entry for this day).Tues 12th 12846 steps 3.98km 129 kcal steps: kcal 99Wed 13th 11483 steps: 3.56km 108 kcal steps: kcal 106 Thurs 14th 7680 steps: 2.38km 83 kcal steps: kcal 93 Fri 15th 4348 steps: 1.35km 51 kcal steps; kcal 86

The Footstep per Kilometre ratio is consistent where the Footstep per Kcal ratio, that I have added, is not. Though the record is only for five days, the date shows it to be one month before her death. It is possible that the calorie amount represents daily intake and that she continued a regime of minimal food intake and exercise to work off the little amounts he did eat until the end. It is possible and probable that there were days when she ate nothing at all. All around her flat were little tins, other containers, and packets of boiled sweets, each sweet having a calorific value of 19. Although none of the entries in the table are multiples of 19 perhaps the other calories were tea. Black tea is well known amongst anorexics to be 1 calorie. So perhaps after pigging out on a whole six boiled sweets she decided to cut back on the tea and just have two cups that day, making sure she burnt off the evil calories by walking a distance of 3.16 km a distance she arrived at by counting her 10266 footsteps that day. Whatever the calorie intake, the entry says little for those paid to care for her if she was able to carry out such a regime and the attendant passing back and forth of blame and responsibility says even less. Staff at the Red House regretted that compulsory admission was not the current policy, even though they were aware that Liz’s immune system was damaged by years of anorexia. Liz Brown had a body mass index of 17.5. Compared to the slightly lower Body Mass Indices flaunted by super models, some claiming as low as sixteen, and those under eighteen banned from fashion shows in Milan, Liz’s condition might not appear so extreme but this 17.5 is more than likely the weight she left the Red House with. She would regularly drop below this reading but would stay away from staff when she was not

eating. As she was less than five foot the 17.5 puts her well weight or target weight at under six stone to begin with. Staff at the Red House probably did not know that Liz had, before and up until the time of her death, had to share facilities with another resident who, after falling down the stairs, was treated for MRSA infection at St Mary’s Hospital Sidcup and had only just returned to the PSYCHE house. PSYCHE staff, any of whom could have carried the disease back to the house after visiting, gave no instruction regarding this matter and to this day there are no washing or toilet facilities for specifically for staff, visitors, or maintenance workers on the premises. For Liz this was a cause for concern for she had an immune system damaged by years of anorexia and taking medication on a very empty stomach. It is also likely that the staff at the Red House were unaware of a mark the size of a half crown on Liz’s forehead that looked like either a bruise or an infection.Liz Brown’s Post Mortem was inconclusive. A blood test was taken but appears to have not contained enough toxins to provide a definite verdict of suicide. Liz’s body was found, apparently appearing restful, on the floor. If this is true, and there is no reason to believe that it is not, then it indicates that Liz died as a result of her illness. Always in hindsight there are events that could have been taken as warning signs or cries for help but were at the time ignored or misread. Why did I not see and report her again deteriorating health. In the weeks before she died Liz actively avoided me. I noticed her creeping by my window; through the net curtains I saw her walk by she walked by with an apple, perhaps she was trying to convince me she was eating.

Sadly again, Liz was able to hoard property that she did not want to be parted from and this increasing and unforeseen problem that has become part of care in the community may have been a factor in her illness. Liz was about to be readmitted to hospital under section but had been informed of this decision by a health worker, who probably thought that he or she was giving Liz a little time to pack a few things for her stay. There is no doubt in my PSYCHE that Liz was an accomplished artist. I have seen work by her dating back to 1989 and over the years Liz attended her classes and gained qualifications. Liz learnt skills in art that ranged from realistic life drawing, and this in itself is significant as it contradicts the popular conception of the artist who suffers from mental illness as being clumsy and childlike in their art. Liz was not. In fact it was not uncommon to see an artist who was exceptional talented at realistic depiction in the old hospital art rooms as opposed to the bizarre and neo-surreal artwork that the public are expected to accept as representative of the art of the mentally ill. Liz also showed a proficiency in a wide range of crafts that used to take place in the Occupational Therapy department, before it was phased out with the care in the community programme. The Occupational Therapy department was part of the Psychiatric Day Hospital and their closure has been particularly damaging to the patients living in the community. Here the day patient could pursue a wide range of crafts from the often ridiculed basket weaving to knitting and making stuffed toys to weaving cookery woodwork metal work printing and of course the art room was part of the occupational therapy department. Liz excelled at cake decoration and at

tapestry. She was a keen photographer and sketched from her photography. She kept an extensive image bank of magazine and newspaper cuttings. Today Liz’s work would be described as that of an Outsider artist, but sadly this term has yet to be accepted in this country like it has in America, France, Ireland or Russia. Though she would set up a stall at craft fairs she never made the money that her work deserved. Though there is provision for force feeding under section 63 of the Mental health Act, in practice this, along with the constant one to one nursing often required, seems to out of the realm of the Little brook staff. Though Liz’s doctor at the Red House eating disorders unit at Maidstone regrets the situation, the unit does not take compulsory patients as the expense and potential for disruption forbids it. It seems that the days of the nurse patiently sitting at her station outside the side room for weeks or months until the anorexic patient reaches a target weight is a thing of the past. In the old days when the old psychiatric hospitals took the burden of the chronically ill, the incurable, and the elderly from the psychiatric units the anorexic patient would rewarded by a walk to the day room, where they could start to socialise again. If the treatment continued to be successful this would be followed by shopping trips, occupational therapy and eventually a trip home followed by increasing leave. Liz was to have been readmitted to Little Brook Hospital. This psychiatric unit is situated next to the old Stone House Hospital gradually replacing the old asylum, but with a vastly diminished allocation of in-patient beds and day-patient facilities. At that time Little Brooke had recently found fame as

the hospital that was treating Andreas Grassl, better known as the 'Piano Man', who was found on the beach at the Isle of Sheppey, Kent, by police, on 7th April 2005. Andreas would not talk when questioned, and carried no identification. He was taken to Little Brook and, still mute, he was kept on the locked ward for a month before being transferred to an open ward. Though he steadfastly refused to talk, he did however draw a picture of a piano, an image he drew repeatedly. He was taken to a piano in the hospital chapel where, according to staff, he played ’meandering melancholy airs’, for two hours. This was no mere reverie. Soon his performances, now timed at up to 4 hours, were identified as a selection of excerpts from Swan Lake, the Lennon and McCartney songbook, and the work of the Italian composer Ludivico Einoudi. He was given the use of an upright piano which was kept on the ward. When not playing he was seen to draw more pianos and write music, keeping a folder of sheet music that he carried with him. The newspapers ran his story. Mental Health workers betrayed the rule of patient confidence by talking to the press about the 'Piano Man' who refused to speak. At first the papers were sympathetic, speculating as to his identity and inviting the public to submit information and theories. The August edition of the Fortean Times, a magazine devoted to the paranormal contained a two page article about Grassl. ’Who is the Piano Man?‘ the article’s headline asked. Ironically two days after social services workers found Liz's dead body at the PSYCHE house in Giddon Hill, the 'Piano Man' broke his silence and was almost immediately discharged freeing his bed for another patient. The irony is more profound because the previous year a patient suffering from the same

illness as Liz, Anorexia Nervosa was refused admittance to Little Brook despite the fact that doctors had given her only five days to live. Almost as soon as he spoke opinion turned against him. A ’member of staff’ claimed that far from being the virtuoso musician that both his social worker and ward manager had claimed he could barely play a note, and often tapped one key continuously. The Piano Man broke his silence on the 19th August, by the 23rd he was not only without talent but had ’confessed to being gay’. Though the same paper that outed Andreas Grassl printed an article the following day in which his father denied the allegation, adding that he if anyone would have noticed such a thing, another daily had reassessed and downgraded his talent. No longer a probable concert pianist or ballet company ‘repetiteur‘, the Piano Man’s lawyer, Jurgen Linhart, told the press that ‘Andreas ‘had learned to play a keyboard by himself.’ Though he denied that the Piano Man had any special talent, Mr Linhart added ’But it is simply wrong to suggest that he just tapped one key all the time. Josef Grassl, the Piano man’s father confirmed that Andreas Grassl was a talented musician who, besides playing a simple keyboard alongside his younger sister, also entertained relatives on an accordion. Perhaps it is simply wrong to call the Piano Man gay and perhaps it is wrong and a little insulting to call someone who has been mute for four and a half months a fraud but that is what Dr Stoat MP and government spokesman for health did in the national and local press. By September the first, according to a local paper, Dr Stoat was saying that the Piano Man should ’be placed under a European arrest warrant and brought back here to face charges. He’s guilty of wasting police and NHS time.’ Dr Stoat was apparently reacting to a

report in a national paper that claimed that Andreas Grassl was a fame hungry young man who wanted to appear on German television. The paper claimed that Mr Grassl was a fame hungry young man who wanted to appear on German television. His silence had been a publicity stunt. He had written to celebrities asking for advice on how to become famous. The Piano Man was an impostor patient who stood to make the estimated cost of his treatment by selling his story to the papers, more if he wrote a book about his experiences. The article went on to say that the Piano man was now back with his family in Prosdorf, Bavaria. The family home was surrounded by reporters who were tracking his every move. Two years later, the Piano Man has yet to sell his story or publish a book. It is likely that the press no longer surround the Grassl residence. Surprisingly Dr Stoat did not accuse the Piano Man of blocking the very bed that Liz Brown needed to stay alive though the fact that he started to speak just two days after she was found dead on the floor in her flatlet suggests that someone may have informed him of this fact in an attempt to make him talk. He certainly understood English well enough. The fact that he ‘knew what was going on all the time’, would have been enough to enrage the spiteful gossips that try to control the staff that work for the local mental health service. Certainly one member of staff saw fit to discredit Andrass Grassl in the daily papers of Tuesday 23rd August 2005. Whether this was an individual or collective act I do not know. Certainly Dr Stoat appeared to pick up on the suspicion cast on Andreas Grassl , whether he was egged on by the press or was directly in touch with Littlebrooke staff does not matter much.

It is hard to dislike Dr Stoat. When he has been asked to speak on the news he presents a reassuring character. Though Colin had left by early summer, the upstairs neighbours were still playing up. Then new resident who proved too ill for supported housing began taking up PSYCHE resources. She fell down the stairs contracted MRSA while in hospital and was moved to another house where PSYCHE staff doted on her despite the fact she had an able bodied and supportive family which Liz did not. She moved back shortly before Liz died, playing the same record over and over again until a ground floor flat became available, which it did when Liz died. Just because no-one noticed her illness entering another acute stage for what must have been at least some weeks may imply neglect but who could say that if that neglect was wilful? After Liz died the staff expressed a wish to destroy her diaries. I thought this was insensitive and suspicious. Perhaps Liz documented the abuse she had to endure. I was told that her friend Ann-Marie had taken her diaries, along with her artwork, by a social worker. The fact that the drain to the bath in Liz’s old flat has been blocked with what looks suspiciously like ashes may be just a coincidence. But Norma and Jenny’s comments on entering her Liz’s flat just added to my misgiving. Norma looked at the wall storage unit, full of Liz’s art and craft materials books diaries photographs image bank and art and craft work, and said ‘Call that work?’. The Jenny made some comment about Liz having ‘had her fun’, and said that she received a ‘fair whack of benefit’. Jenny later described my benefit payment as ‘owt for nowt‘, even though Dr Shan had advised me to take my benefit payment in lieu of compensation, and my social worker had endorsed this idea.

There were undermining comments, and a drop in Norma and Jenny’s voices if I mentioned an achievement. If they were able to make such callous remarks, they were probably capable of starting rumours.I have had to suffer verbal abuse since I moved to Giddon Hill ten years ago. Soon after I moved in one of the residents, Linda, shouted in the hall, ‘I don’t want that poof living here’. At local hypermarket the women at the cigarette counter would point me out as a ‘poof’ to each other and to customers. Soon the men who collect the trolleys were in on the act as were some of the women at the tills. For years I have had to suffer the taunts from not only from some of the hypermarket staff but from the customers they told. Once I saw a red faced trolley collector tell the woman at the till in Holland and Barrett’s that I was a ‘poof’.And so the rumour spread. Soon I could not go shopping without someone pointing the finger. I am not gay but the more you deny it the more they will insist that you are, and if you ignore them they insist just the same. I went shopping in Orpington, Bromley, and occasionally in the West End when I made the journey to buy art materials and books for research. I had to take the bus to Orpington because the female ticket seller and the station master were verbally abusive.I decided the only way out of the situation was to work and make enough money to move away, so I applied myself to the only things I know how to do, writing and artwork. Under the illusion that honest work would be rewarded I collected research material for a book, part memoir part biography, and enrolled with an art group and a gallery. But the art’s world was more competitive than I imagined. By the time I had work that

was saleable the bullying, which by this time had spread to the supported housing itself, in the form of the same verbal abuse occasionally accompanied by threats. The next door neighbours the street sweeper the dustmen were all verbally abusive. I could not step outside the door for fear of verbal abuse from neighbours or residents visitors. When Sonia was moving into flat 6 I heard her sister and some other people one of whom I now to be her sister talking outside the kitchen window of flat 2 where I was then living; ‘Shall we ask him to help us’ said one, ‘No he’s a poof, the woman said’ said Sonia’s sister. Some of Sonia’s visitors were rowdy. One of them said as they left the house outside the same window,’ The best thing he can do is move out of here’; a remark that I felt was aimed at me. One visitor was shouting up at Sonia’s window one morning at six o clock in the morning;’ I can visit here any time I want’.I believe it was the same fellow who later called me a poof in the car park by the doctor’s surgeries in Giddon Hill. We exchanged words but I walked away. I ran into him outside the doctor’s surgery, he was with two women; one who I think may be his partner outside the surgery. I took refuge in the surgery and when he followed me in I threatened him with the police. ‘If you call the police I’ll kill you he said. I asked the receptionist to call the police and the fellow walked away. I don’t think that was the start of the verbal abuse at the surgery, I think the typist at the back of the receptionists work place was already mouthing the word poof at me. After this incident I was met by more hostility by not only the typist but also by an office worker who is quite short and has quite long dark hair. Here are some of the homophobic taunts I have had to endure over the years.

‘What’s he doing here?’‘He won’t get another appointment’.On one occasion a receptionist asked me point blank' Why do you sleep with men’ On another a patient asked’ What’s wrong with him?’ ‘He’s a poof’ replied the short receptionist. On another occasion the same receptionist said that I looked like I had AIDS. You can imagine how terrifying it is to be singled out as gay in a surgery that serves a parish that recently voted a British Movement candidate onto the council, in a town with a strong equally homophobic catholic and gypsy presence. Not all are homophobic but some are. It may be that the staff manager will not take any complaint from me seriously as I have a history of mental illness but will be more willing to listen to a health worker. The staff involved are unlikely to admit verbal abuse and it is likely that they will cover in any case as if there is a question of harm as a result, the practise will not want to be held responsible. I had heard two of the PSYCHE staff tell visitors I was a ‘poof’. First Julia told a visitor. Then just before it was decided that Colin was to install decking in the garden, Jenny had said the same thing to a landscape gardener who was giving an estimate for the work. If one of the PSYCHE housing staff told Sonia’s sister I was gay perhaps their malicious gossip and incompetence was inspired by the fact that they the PSYCHE staff have admitted to claiming for a service that they are not providing leaving patients at risk. This may account for the verbal bullying I have also had to endure.A fellow with an ulcer on his leg and another fellow who carried a clear polythene carrier bag full of scraps of paper

were harassing people in the high street. They were seen drinking on the bench by the railway bridge, and outside the citizen’s advice. One day they turned up on my doorstep demanding ‘help’ with the same menacing attitude they used to accost passers-by in the high street. At first I wanted to help them and I agreed that they could wait in the house while I phoned the office to see if they would send someone to see these two street drinkers. When they started to make their way to the house I realised that I had fallen for their intimidation and I told them if they did not leave I would call the police, they left angrily. When I saw the fellow with the leg ulcer again he shouted at me calling me names in a threatening way.After Tom retired a new gardener/handyman turned up. After filling our wheely bins with Westbridge PSYCHE office waste Gary turned up making homophobic remarks to a female resident. Before he had met or seen me. He then went on to call me a poof in front of an elderly stranger when clearing the snow. On another occasion he turned up at the weekend and told his 12 year old daughter that I was ‘gay’. More recently he said to another resident that he can’t wait until that poof dies’. I suspect that his PSYCHE has been poisoned by the same staff who wanted to destroy Liz’s diaries, and want to divert attention away from that fact. Someone did.I caught the bus to the Bluewater shopping centre the other side of Westbridge from Giddon Hill. A fellow who used to work for PSYCHE and left to become a member of the local council was talking to a companion. He pointed me out saying that I was quite a worker in my day, but now they say I have got AIDS. Then he said something that I thought might point to the source of the rumour. ‘You were nothing if you did not work in

those days’. It seemed that he was saying that in case I had heard him gossip. But it was also a phrase I had told to one of the PSYCHE housing officers when I was describing what it was like in parts of America with a strong work ethic. Perhaps it was nothing but the rumour was being circulated by the local gossips. This talk worried me enough to have an HIV test more than once because, even though I had not practiced risk taking behaviour, I worried that someone had somehow contaminated me. Liz’s anorexia was not just a media fuelled obsession, centred on achieving the ‘perfect look’, in relation to her weight. Her illness was also triggered by and a reaction to bullying by people who thought they have a right to interfere in her life by using her as an emotional punch bag when they could not get their own way. Colin would leave sharp objects about, Linda’s boyfriend would turn up the television knowing that he was tormenting Liz. Over the years the government and local authorities have undermined PSYCHE’S independence by demanding they take on work previously carried out by the health authorities. PSYCHE staff are expected to do an impossible job, by a health authority that has a limited mental health budget, as do the social services, housing association and local authorities. By expecting untrained staff to do the work these agencies have opened the door for incompetence and abusive behaviour towards patients.

But there is no excuse for bullying. I think Jenny wanted to assert herself and prove she is in charge, because that way she can hide her incompetence. There are other possible motives.

Colin was afraid of losing custody of his children. Linda’s boyfriend may have been ill, reports vary.Recently a resident was terrorised by an ex-boyfriend who entered her flat by breaking in by breaking a large double glazed downstairs window. It was left to another female resident to call the police and handle the situation. To claim even a small amount of funding PSYCHE have had to agree to take younger residents on short term leases. PSYCHE cannot provide rehabilitation for these residents and in any case the residents sent here now are more likely to have issues with drink or drugs, whereas in the past this problem was kept out of the housing project by previous staff who were able to stand up to both the social services who knowingly send patients with drink or drug problems. They also send patients with dysfunctional families without warning PSYCHE of this potential cause of disruption in the housing project. But there is no excuse for spreading malicious rumours. Perhaps ‘the lady’ who Sonia’s sister referred to was trying to distract attention from the events that occurred during the summer of 2005.

If PSYCHE staff has to sink to this level then it is indicative of incompetence. If PSYCHE staff continue to be expected to look after the patients that need a higher level of support than they can provide there will be more disruption at the expense of the well behaved residents. If PSYCHE resort to bullying then they should not be surprised when residents become resentful. The fact that PSYCHE staff wanted to destroy Liz’s diaries is suspicious but also suggests she may have documented the bullying she had to endure from not only residents but possibly

the staff and local bigots. Because of her slight build and frailty Liz usually went out accompanied by one of her friends or a social worker. I still wonder how much of my account of Liz’s final days found its way into her diaries and if Ann Marie, Liz’s friend was really given these diaries to look after. I have phoned the hypermarket and complained more than once but though they have been sympathetic, the situation did not change. So I phoned the head office, and spoke to a woman called Chantelle who again was sympathetic. She asked me to name the abusive staff and asked if they did not wear name badges, and I replied they did not. Chantelle told me she would get in touch with Giddon Hill ASDA and ask the supervisor to have a word with the staff and to make sure that in future they wore their badges. Within a couple of days the staff were wearing name badges, and some walked away from me so I could not read their names. Some also wrote their names in small letters so it was more difficult to read them. They only wrote their first names, which is understandable. However I did go up to some of the staff that had been abusive over the years. I now know the big bully woman who usually works on the automatic tills near the tobacco counter is called Chris. A little supervisor who once was actually in crocodile tears at the prospect of having to deal with ‘that poof’ as a customer, is called Sue. Another woman with butterscotch coloured hair who also works on the automatic tills is called Norma. Another thing the staff do is give the limp wrist sign behind my back and Norma has done this more than once besides calling me a poof. The main offenders among the male staff are a tall skinhead who works collecting the trolleys and hand baskets.

He is called Dave and has said ‘look there’s that poof’ a few times as had the tall fellow who is always working in the bread aisle in the mornings, he also called me a ‘nutter‘. A woman who works on customer services with longish dark hair has been abusive. I have had the same trouble with the night workers who stack the shelves near the tills and from a security guard. I have taken their names as advised by the hypermarket head office but have yet to send them my report.A tall slim woman with long dark hair was re-stocking an isle near the automatic tills and said ‘there’s that poof’ to a shorter blonde hair woman who wears gold jewelry. The blonde woman started to shout and a paternal looking older man emerged from aisles further down the shop. I paid for my shopping and walked out. Then a few days another older man said the same insult to a shorter stocky man who collects the trolleys in the car park. The shorter fellow made a dart throwing gesture as if to say ‘bullseye’.

It’s nearly ten years since Liz died and I can’t help thinking that if I did not have to cope with the harassment the rumours brought, I could have saved Liz at least for a while. I told the head of PSYCHE staff that I do not want to work with them, too many undermining comments. I remember a patient in an NHS psychiatric unit in 1976. She was so badly affected by her anorexia that she was walking on crutches. She was given a side room and twenty four hour one to one nursing. The nurse would sit outside the patient's room to monitor her eating and so she was not alone. Slowly she reached target weights. She was rewarded with a visit to the day room, then occupational therapy then a trip to the shops. When she had reached her last

target weight she was allowed to go home hopefully rehabilitated. Psychiatric Nursing, a nurse’s study book written in 1957, tells us that anorexia psychologically is often accompanied by a denial of illness, hyperactivity, sleep disturbance and aggressive negativism against all treatment efforts. It is not merely an anomaly of food intake or weight regulation but a disorder involving extensive disturbance in personality development. Anorexics are liable to be labelled as 'demanding' patients, but at least some of their demands for attention should be satisfied by deliberately increased nursing care and attention, preferably by one nurse. The writers the go on to explain how the nurse can psychologically help the patient become aware of their feelings and impulses and learn how to use them effectively. So anorexics require trained nurses and not to be left in the community at the mercy of manipulative residents and staff who try to hide their own inadequacies by bullying. Ignorance breeds ignorance and the government and health authorities have done nothing to raise awareness leaving those who think anorexia and probably every other illness except those that they suffer from is 'self-inflicted' free to spread their misinformation. If Liz Brown had been able to access treatment before the old hospitals, including Stone House hospital near Westbridge, were closed she might have survived. As it was she was left to starve, her illness triggered by bullies and staff neglect. Staff who failed to prioritise her needs in favour of those of another resident. Then it appears, perhaps to cover the tracks, perhaps out of spite, they spread rumours which

prevented me from helping Liz more than I did, and reporting the situation to the local social services. No one spread rumours about me in St Mary Cray when I was with my ex-partner Barbara on the Mountfield estate, bringing up my son and babysitting for the Gypsy and Traveller community.

Elizabeth Brown 1975- 2005