I gasped when I first saw her; seriously concerned by a woman walking across Albert Bridge in central Belfast just after 9am in only her bra and pants.
“What’s she doing?” I asked the taxi driver beside me as she reached the end of the bridge spanning the River Lagan.
“She’s taken her rings off and set them on the wall,” he said, “I think she’s going to jump.”
He suggested we turn back and I agreed. We made an awkward u-turn in the rush hour traffic, went back over the bridge, past the train station, under the railway bridge and round to Laganbank Road.
We couldn’t see her at first and both fell silent, but then she walked towards us again on the footpath from behind a tree which had blocked our view. We made a quick plan: I would talk to her and he’d ring the police if needed.
I got out of the taxi.
“Hey, are you okay?” She walked on quickly, shouting something back at me I couldn’t really make out. I ran to keep up with her as she strode on. “I just want to check you’re okay.”
She turned around.
“Why have you blood on your hands?” I asked, hoping my voice sounded calmer than I felt.
She stopped and looked into my face. Another woman walking by took off her coat and placed it gently over her shivering shoulders. We got her to sit down on a kerb and I draped my coat over her bare legs. There was a small gaping cut on one of her fingers and dry blood caked over both hands.
I got down to her level. She was speaking fast, crying, shaking. She talked about someone trying to poison her, she couldn’t trust anyone, and, no, there was no one we could call for her, “You think l’m mad but I’m not”, everyone controls her, someone was trying to give her fake drugs, she was worried about her son.
I called 999. They asked her name, her address, her age (she is in her 30s). I passed on what she said and I told her - let’s call her Josephine - that she was okay, she was going to be fine.
While I was still speaking to the operator, a police car pulled up and two male officers came over to us. I let the call handler know they had arrived and hung up. I later learned that others had called the police before me, including Josephine's mum.
One officer gave Josephine his heavier coat to put on. She nodded when I asked if she wanted me to stay with her and I thanked the girl with the kind face who had stood calmly beside me and now walked away. Josephine and I moved into the back seat of the police car.
The taxi driver was still there on the street, standing back, the hazard lights flashing on his hastily parked taxi. He was the person who immediately knew Josephine needed help and turned back. He came forward then and passed over her ring which he’d retrieved off the wall and I gave it to one of the policemen at Josephine’s direction. We didn't realise then its significance.
“Will you test it for poison?” she asked the officer.
He asked her how she’d got here; what happened that morning. Her answers were recorded on a small camera he held towards her from the front seat of the police car as she sat beside me squeezing blood from the cut on her finger. She wasn’t shaking as much as before.
She told us she’d taken off her clothes and shoes and thrown away her handbag as she walked along Short Strand. Her phone had gone too. I now know she wasn't intending to jump into the water - she was just getting rid of ‘poisoned’ items that were touching her body.
“They’ve bugged the house. I know they have.”
She really wanted us to believe her, her eyes were pleading with us to understand and to listen.
The police officers were calm and unemotional, as they probably needed to be. I was still worried about her son and if someone had hurt her and what was happening in her mind. Surely there was some truth in the middle of all of this?
A female police officer arrived and covered Josephine in a large foil blanket as she moved her into the back of a second police car. It felt then like it was time for me to go. It seemed like hours had passed but our encounter had maybe lasted half an hour.
I said goodbye and told Josephine, once again, that she was going to be okay.
The truth was, I didn’t know if she would be.
Personally, I was shaken and very worried about her. I was able to find out the next day that she had been admitted to hospital.
The journalist in me then had more questions. How do our public services in Northern Ireland deal generally with people in mental health crisis? How many people does this happen to?
And - the most important question of all - what happened to Josephine after she left me?
Josephine isn't alone. The rates of mental illness in Northern Ireland are higher than any other region in the UK; and at least 25% higher than in England. The legacy of violence and socio-economic factors are cited as major contributors and we also have the highest suicide rate in the UK.
The most recent Department of Health figures show that over the last five years the number of compulsory admissions to mental health hospitals under the Mental Health (NI) Order 1986 increased from 987 in 2014/15 to 1,106 in 2018/19 – that's an average of three people every day. Others are admitted voluntarily.
An annual mental health census is carried out in February each year. As of February 17, 2019, 615 patients were being treated as inpatients in mental health hospitals or were on home leave from hospitals across Northern Ireland. Almost 80% had been resident in the hospital for six months or less, whilst 10 (1.6%) had been resident for 10 years or more.
Just weeks after my encounter with Josephine in June, a new Acute Mental Health Inpatient Centre opened at Belfast City Hospital. The purpose-built facility brings the acute mental health services for Belfast together in one location. There are 80 en-suite bedrooms - including six psychiatric intensive care beds - located within five interconnected buildings. In its first two months the centre treated 166 patients as inpatients – 91 men and 75 women.
I visited the centre and met with approved social worker Martin Mulherne and Kerry McVeigh, principal social worker with Belfast Trust and Mental Health Adult Safeguarding Team Manager. Security is still understandably tight within the centre but the design is less hospital-like with meeting spaces, a gym, family visiting rooms and a meditation room in a central courtyard. The staff couldn't speak to me about individual cases or tell me what happened to Josephine.
Approved social workers co-ordinate any referrals that come in from GPs, family members and others. To be admitted on a compulsory basis to the centre for assessment under the Mental Health Order, an individual has to be a substantial risk of serious physical harm to themselves or others. People can also be admitted on a voluntary basis.
Miss McVeigh told The Detail: “If a referral is received, the approved social worker collates information around the reason for the referral, their personal details, any background information and the risks presenting at the moment. There is also a medical assessment by a GP.
“If there is significant concern that the service user is placing themselves or others at risk and it seems like they are experiencing some serious mental health disorder then we would proceed with an assessment.
“This may result in a compulsory admission, but we must look at the least restrictive option. A person’s liberty must be interfered with only in those situations where it is absolutely necessary to act. We consult with their nearest relative and gather their thoughts and any concerns. We also look at what other support has helped in the past.
“Hospital admission can be very frightening but at times it is absolutely necessary. If we can help them recover and be at home to receive treatment in the community that is often the best option.
“The investment the Belfast Health Trust has made in this new facility demonstrates how they have prioritised the need for service users to be able to access acute treatment in a very recovery focused environment.”
Social work staff help with patients' accommodation needs, finances and relapse prevention. They can also liaise with children’s services if there are children involved, as was the case for Josephine.
Miss McVeigh said that she would like to see more community-based services to increase the accessibility to services at the point where people begin to feel they cannot cope before things become more difficult for them.
“We have a 24-hour service and would encourage the public that have concerns or feel that things are seriously deteriorating for them to seek help,” she said. “The first port of call would be GPs but if it is not possible to get the immediacy you require then that is what our urgent services are for.”
Approved social worker Martin Mulherne deals with many of the urgent cases. He said: “The compulsory route is the last thing we want to do. The best place for people to recover is with their family in the community.
“We are involved with people in crisis so it is important for us to remain calm and focused while we look at short term interventions to keep them safe and others safe. We need to take their emotion, stress and fear on board and remain objective.”
One in five people here will have a mental health issue at some point during their life, and each month, around 1,600 calls with a mental health component are made to the PSNI.
A report by the Northern Ireland Audit Office published in May revealed that a sample of 200 police arrests made during 2017/18 had shown nearly two thirds of those arrested were identified, or had previously been identified, as having a mental health issue.
On the summer day I met Josephine on the bridge, the PSNI dealt with 61 call outs with a mental health component. The PSNI would not speak about Josephine’s individual case, but we did talk about dealing generally with mental health cases.
Mental health practitioners and paramedics are working alongside police officers as part of a pilot project which aims to provide on-the-spot help to vulnerable adults with mental health difficulties, while at the same time reducing their reliance on hospital, ambulance and PSNI resources.
The Multi Agency Triage Team (MATT) operates in Ards, North Down, Lisburn and Belfast areas on Friday and Saturday nights. The team responds to calls made to the police or ambulance service via the 999 or 101 numbers. They responded to hundreds of calls in the first year – around half were face-to-face contacts and the rest were dealt with over the telephone.
I spoke to Inspector Mark Cavanagh, who is PSNI lead for the MATT project.
He said: “We are all about keeping people safe and being empathetic to people who are in crisis. We may need to take them to a designated place of safety or deal with any physical ailments. That all takes priority.
“A place of safety can be an accident and emergency department, a police station or the third category which we don’t utilise enough is ‘any other place’ the occupier of which is willing to temporarily take responsibility for that person. I think that’s quite important as that could be someone’s home.
“For someone in a mental health or emotional crisis to be sitting in a busy and manic environment such as an emergency department room, this may not be the best place for them and may actually exacerbate their condition. So, going forward for us as the police service, we are trying to re-educate ourselves that there may be other options. The paramount consideration has to be the individual in crisis.”
The police time spent on mental health cases varies greatly. Two officers could be involved for up to an hour or in some cases officers can be with someone in mental health crisis for more than 40 hours safeguarding them at hospital.
Inspector Cavanagh said: “In some extreme circumstances where mental health is concerned, we could be dealing with reports of someone as a high risk missing person or someone who has some sort of suicidal ideation or self-harm interest in which case we could have helicopters deployed, we could have tactical support group units employed or engaged to try to find and safeguard that person and we could have armed response officers involved.
“We could go from having two officers to possibly having 50 officers involved throughout one particular scenario that might run on for hours and hours or even days.
“Normally the individuals haven’t committed any crimes other than to be a danger to themselves. In light of reducing resources and reducing budgets, we still have to step up to the mark to safeguard those individuals even when it is not crime-related. The challenge for us is how do we address this demand in the best possible way with the resources and the budgets that we have.”
Inspector Cavanagh continued: “Our training is quite basic with regard to legislative powers and what we can and can’t do with regard to arrest, detention and removal. Quite recently for the first time in the PSNI I conducted a survey of frontline officers in relation to their perception of mental health demand on policing. And overwhelmingly frontline officers have an appetite for better, more enhanced mental health training going forward.”
What should a member of the public do if they see someone in mental health crisis?
“They should engage with that person if it’s safe to do so. Very often all someone needs is someone to talk to,” he said.
“I would never say don’t ring the police because at the end of the day we are there to help and to keep people safe. But in some regards maybe we really should be the last people to respond. Who in mental health crisis wants a uniformed armed police officer with a very distinguishable police car arriving at the door or arriving at the scene? Very often it just exacerbates the situation.”
Inspire is a local mental health charity which runs an independent advocacy service designed to listen to the options, concerns and problems people experience when using mental health services. The role is independent of the health trusts.
I wanted to know what support it could provide to people like Josephine at a time of mental health crisis.
Sam Welsh, an advocacy volunteer with Inspire for four years, said: “People who end up as an inpatient in mental health inpatient services often report that such an experience is the worst point in their lives.
“It is in this place of fear and vulnerability that the advocate comes alongside the patient to support, reassure and provide them with a space to share their fears and feelings. We identify what needs to be discussed with staff and we will, with the patient’s permission, take these matters forward keeping the service user informed at every stage of the advocacy process.”
Scott Peddie has worked as an advocate for six years and his own diagnosis of bipolar disorder means he has lived experience of mental ill health. Outside of his advocacy role he works as a psychotherapist.
He said: “We seek to represent the patients’ wishes and concerns to the relevant staff in the trust. This means taking the time to listen to the service users and to reassure them that we are there to support them throughout their journey to recovery.
“We provide instructional advocacy for patients who are deemed to have capacity to make decisions about their life. We carry out their instructions and we will speak to the relevant staff member on the multi-disciplinary team to make sure the patient’s voice is heard.
“Where a patient is deemed not to have capacity, we provide what is termed non-instructed advocacy. We act in the best interests of the patient to ensure that their rights are upheld and that they are in the least restrictive environment for their care and treatment.”
Graham Logan is service manager for Inspire Advocacy Service and has 20 years’ experience in the field.
He said: “We see people who are very unwell including people with serious and enduring mental illness who learn to live with their condition. Some people recover and move on with their lives while others learn to manage their illness. There is no magic bullet for full recovery. Advocacy is there for the service user to engage, empower and promote their individual recovery journey.”
I have thought often about Josephine since our encounter on the bridge a few months ago. Is she – as I told her she would be – doing okay?
I didn't want to disrupt her recovery or cause her any more pain but I also felt I couldn't let her story go. Our paths crossed for a reason.
Belfast Health Trust decided to contact her as they felt they had a duty of care to tell her about this article. I sent an email to be passed on to her and she agreed to meet with me.
So last week, we shared a table in a Belfast café. Both slightly hesitant at the start - our circumstances so different to before. But there was also a familiarity between us; a sense that we had already shared an important life experience.
Her hair is a different colour but her eyes are the same – wide and blue with long lashes. They weren’t full of fear this time. They were calm and kind and settled. She wore a polka dot dress and black leather jacket. She is petite and softly spoken, but I can also feel her strength.
“I lost my daughter four years ago. She was six months and one day old. She never made it out of hospital. That’s when my mental health problems started,” she told me, her voice gentle. We discussed her baby girl's beautiful name, her time in hospital and the impact of her death.
“I was very up and down and went through long periods of depression and being manic. I wasn’t sleeping or eating. I kept getting palmed off by my GP that it was complex grief and postnatal depression. Even though my mum and my granny are bipolar and my dad and brother have schizophrenia.”
What does she remember about the day we last met?
“I do recognise you. I remember thinking you were some kind of social worker. I guess you sort of were. I remember being in a police car and I remember a foil blanket. But I don’t remember how I got there.
“I know I’d shown up at my mum’s door earlier that day and screamed in my dad’s face and said something awful to my mum. She rang the police after I left because she was scared I was going to hurt myself or someone else.”
She remembers thinking everyone was against her and out to get her. We worked out she'd walked about two miles from her mum's house and she tells me that the ring she put on the wall contained her daughter's ashes.
“I thought I was being poisoned. I was terrified. I was taken to the police station where I had to give a statement. Then they took me to the Mater Hospital and asked me would I be happy to sign myself in to Rathlin Ward at Knockbracken and I said I would do that. I knew I needed help.”
Josephine spent three weeks in Rathlin Ward and then moved to the new Acute Mental Health Unit where she stayed another three weeks.
“It wasn’t home but it was a much nicer setting and less like a hospital. My daughter was in hospital her entire life so hospitals don’t really agree with me.
“It was really busy in the acute unit when I was there. As soon as someone was well enough to leave, there was another person in the bed. I still keep in contact with some of the people I met there. It felt like a bit of a family and we all got on.
"There were two girls in their twenties who had tried to kill themselves. It just felt so wrong that they were having to go through that. They were very good with me and we are still in touch on Facebook."
During her time in hospital, Josephine was finally diagnosed with bipolar disorder and psychosis. She now takes lithium and other medication.
She said: “I was glad to get the diagnosis. It was justification for me that it was not just grief.
"But even when I was first in hospital I was anxious about what they were giving me. I rang my mum and she told me to take it and that I would get better. I needed that reassurance and once the medication kicked in, it became a lot easier. I will probably be on medication for the rest of my life."
She and her ex-partner share custody of their 11-year-old son.
“It was hard for my son to get his head around it all. After everything we have been through as a family, I have to be very honest with him.
“I am feeling great and I am hopeful that if I stay on my medication, what happened that day won’t happen again. There is a home treatment team if I need them or feel I am starting to slip back. It's nice to know that I have support. They want me to wait a while before I start counselling for my daughter.
“My family understand that I was ill. My mum reminds me to take my medication and can spot the signs. If I start to get manic or depressed, I clean the house, or take the dog out or spend time with my son. I channel it into something positive.
"It is time to get on with my life."
Josephine was keen to speak out about mental ill health and to contribute her voice to this article. She didn't whisper in the crowded café or apologise for her illness. It just is what it is. She choose the pseudonym Josephine. I told her that this is her story and I wanted her to feel in control of it.
“I don’t hide my mental illness. I don’t see the point in doing that," she said. "There is still stigma but it is an illness. My brother was in Knockbracken as a teenager and when he came out I remember people looking at him like he had two heads. The stigma was much worse then.
"People can see a broken leg but they can’t see a broken brain. Mental health needs to be taken more seriously.
“I am glad that I got the help I needed in the end – but it should not have escalated to the point that it did.
“If anyone ever comes across a situation like what happened to me, just try your best to help and get them the right help. Even just having a chat with someone can make them feel better. And if anyone feels like I did, try to go back to your doctor or maybe go to a charity like Inspire or contact the Samaritans.
“I am feeling positive. I would like to say that me being bipolar does not define me. I can go on and have a good life. I am in the early stages but I'm back doing normal mundane things like the school run and walking the dog. Things you take for granted. It’s those little things that I missed.”
- If you or someone you know is in distress or despair, call Lifeline on 0808 808 8000. This is a confidential service where trained counsellors will listen and help immediately on the phone and follow up with other support if necessary. The helpline is available 24 hours a day, seven days a week. You can also access the Lifeline website at: www.lifelinehelpline.info.
- Call the Samaritans on 116 123 or email [email protected] (email response time: 24 hours).
- More information on looking after mental health and the support which is available across Northern Ireland can be found at: www.mindingyourhead.info. You can also ask your GP for advice.
- For more information on Inspire’s advocacy service contact Graham Logan on mobile 07801254926, email: [email protected] or click here.