Method amid the madness: As the debate continues on whether community care for the mentally ill is viable, a sister tells how the net was made to hold her schizophrenic brother

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The Independent Online
My father had a heart attack at home in March 1991. As he lay on the floor gasping for breath, my elder brother calmly walked to the phone, called the doctor, then announced he had to go out to meet some friends. My father died soon afterwards.

To some, my brother's behaviour may seem callous; to us it was the sort of behaviour we had learnt to accept of a schizophrenic. Since the age of 16 he had been in and out of psychiatric hospitals. He became paranoid and thought everyone was talking about him. He joined the Jehovah's Witnesses - to my parent's dismay because they were devout Hindus. When he began to think he was Christ we knew something was seriously wrong.

In those early years what always secured his path to hospital was his violent behaviour. Once there, his mind was dulled by strong drugs. His stay usually lasted four to six months, and he would see a psychiatrist regularly. Then he would be discharged into the care of his family. We, of course, knew nothing about how best to look after him.

For a while things would be fine. But there was never any supervision or follow-up work. My brother would soon tire of the weekly visits to the hospital for his injection, and eventually would stop going altogether. Then the slow, painful cycle of despair and madness would creep back into our lives.

After my father died, I shouldered the responsibility of looking after my brother, and began to notice the tell-tale signs that he was off his medication. At times his face looked absolutely tortured. Occasionally the voices inside his head were too much for him and I would catch him screaming at himself in the mirror.

From past experience I had learnt that I had to allow him to get really bad before the doctor would do anything. One day I returned home to find him pinning my mother against the wall. He was shouting and wagging his finger in her face. Then he took a swipe at her, deliberately aiming to miss. He wanted to intimidate her and she looked utterly terrified. I went straight to our GP.

When I explained what was happening, she asked if he had hit anyone. When I said no, I knew she wouldn't help.

Over the next six months, family life was hell. In that time my mother went to our GP three times for help. None was forthcoming. The doctor said that by law she could not force my brother to take medication, and suggested that we speak to a social worker.

A new psychiatric social work team had been set up in our area. Two days after my initial call, a social worker, Julia, came to see us. My brother, who had his own council flat, usually came round to my mother's house about 11 in the morning. That's when I arranged for Julia to be there as well.

The plan worked. She was sitting in the front room sipping orange juice just as he arrived. When I tried to introduce her to him, he went beserk. He knew why she was there, and that the time had come for him to go back to hospital. While he had gone quietly in the past, this time he was going to put up a fight. We had left it so long to get help that he had degenerated very badly. That was partly my fault. I should have sat in our GP's surgery refusing to move until she did something.

Julia asked me how long he had been like that and was amazed when I said about one year. Thankfully, she was convinced that my brother needed help. The next stage was to convince everyone else.

She arranged for an approved social worker - one trained in mental health capable of recommending hospital admission - to visit our house to meet my brother. This social worker arrived, accompanied by our doctor and the consultant psychiatrist from our local hospital.

I tried to get my brother into the front room to talk to them. He became very agitated and when I tried to stop him leaving, he grabbed my arm, swung me round and slammed me against a wall. I could have kissed him: that is what it took to convince all of them, including our GP, that he had to go into hospital.

But he would not go voluntarily. He had to be 'caught'. The doctor had signed a compulsory section order, which meant that we could get the police to help us, but I knew my brother hated the police. Twice when he arrived at the house, I phoned Julia, who called the police. They turned up in time to see him escape over the wall.

We decided that the only thing to do was to break into his flat first thing in the morning. What followed will haunt me for the rest of my life.

Julia, the police and I met outside the tower block at eight o'clock one morning last July. We went to my brother's flat and I tried to coax him out, but he wouldn't reply. Two police officers then forced their way in. He was waiting for them swinging a large ceremonial sword. When he lunged, they quickly retreated. As I left, I saw six riot control officers equipped with batons and shields making their way up to his second-floor flat. I watched from the car park, terrified.

Every few seconds he kept going to his window and looking at the police cars in the car park. He looked like a frightened animal in a cage. A few minutes later I saw the curtains moving violently. Then the six officers led him out. One was dragging him by the hair. My brother's hands were handcuffed behind his back, and all he had on was a T-shirt and underpants; no trousers, socks or shoes.

He was taken to a secure psychiatric unit and sedated. When I saw him three days later, I cried. He had a black eye and was covered in cuts and bruises. Otherwise, back on medication, he was calm but sad.

This story does, however, have an upbeat ending. My brother now has a wonderful social worker helping him. And despite cutbacks in local authority finance, he was found a room in a St Mungo's hostel after he left hospital a few weeks ago.

I didn't want him to go back to his council flat; left alone with his thoughts, he would have entered the same cycle all over again. The hostel houses other ex-psychiatric patients and has a warden to supervise them. A community psychiatric nurse visits my brother every week to give him an injection.

The established support system will, I hope, ensure that he won't go off the rails as he did before.

The author is a television journalist who wishes to remain anonymous.

(Photograph omitted)