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Fearing Joe


How I treasure my memories of the homeless people I worked with from the time in the 1980s when I was, in turn, a hostel, outreach and resettlement worker. Such warm recollections of a procession of individuals who invariably treated me with courtesy and kindness, dispensing practical advice to a raw kid who was, at times, out of his depth. Though in circumstances where people were frequently struggling with alcohol or drug dependency, debilitating mental health problems and extreme living conditions there was also an overlay of threat, sporadic violence and moments of stomach-churning fear.

At 22, working in a homeless young people’s hostel near Kings Cross station in London there was plenty of opportunity to taste fear on a regular basis. We were a young team, the hostel was expected to take the most chaotic young people from the West End and it was 1981, a time when, at least in my experience, risk assessments had still to be invented.  Hostel shifts felt like a form of Russian roulette. At some point you knew you would get the loaded chamber and eventually my time arrived.  Sparky, a familiar visitor with a serious heroin habit raging through the hostel in search of his girlfriend who he intended to batter, settled instead for the next best thing. The full force of his fist in my face left me for the only time in my life, at least so far, spitting teeth.

My fear of Joe Reddy was a slow burn that flared up sporadically.  By 1984 I was working for Thames Reach, a new organisation pioneering outreach work. This involved working with rough sleepers in central London predominantly at night, to help them find a way off the street and into accommodation. Our offices were in Craven Street which ran down from Trafalgar Square to the Embankment. It was not difficult to find rough sleepers. Under the Hungerford railway bridge outside the Embankment tube station, around 80 men and women slept rough every night.

It was here that I first met Joe Reddy. He was in his early 30s with a strong Liverpudlian accent and his slicked back dark hair gave him the look of a youthful, portly Dirk Bogarde. That first night he was agitated and desperate to get away from the Embankment. He was nonetheless quiet and courteous and his gentle helplessness led me to conclude that he would be a dead cert for acceptance by the Simon Community whose house in St Pancras Way, Camden was one of the main routes off the street for rough sleepers. This was the age of scribbled numbers in notebooks and phone calls from dilapidated phone boxes involving coins being pushed rapidly into slots. I duly rang the Simon Community who explained that they couldn’t take Joe because of his previous violence at the house. That night, as on later occasions, I left Joe on the street, an outcome he accepted with uncomplaining resignation.

This was the first of many surprising things that I was to learn about Joe. At the time it was not uncommon for hostels and shelters to evict people for minor misdemeanours. But to be required to leave the Simon Community was a different matter entirely. Then, as now, the Simon Community showed an impressive capacity and appetite for working with people who were volatile and chaotic. An eviction from St Pancras Way was rare and invariably an action of last resort.

Joe couldn’t be found the following day and it was over a month later that early one morning, visiting the Embankment at a time when people were waking up and the regular Simon Community tea run was in attendance, I came across him dispensing tea in the role of a Simon Community volunteer.  He was in good spirits having been accepted back into the St Pancras Way house and feeling settled. I thought I might not see him again. 

Shortly after this the Simon Community rang to ask me, at Joe’s request, if I would be involved in considering his next steps as his time at the house was approaching an end. I made the trip to the St Pancras Way house with its distinctive heavily patched front door. The house accommodated some of London’s most needy rough sleepers and the regime in every way exemplified the ethos of the Simon Community’s founder Anton Wallich-Clifford who apparently talked with fondness about ‘the chaos that is Simon’. It would be easy to be condescending about the radical ethos of the Simon Community, its dependence at the time on young, inexperienced volunteers and the basic nature of the accommodation.  But, in truth, very few organisations then were prepared to work with a group of challenging rough sleepers bizarrely referred to in generic terms as ‘the dirty dozen’, though as far as I could ascertain the number of this mythical clan actually ran to at least one hundred.

 At the meeting I learnt about Joe’s mental health issues which were clinically categorised as a personality disorder and an untreatable mental health condition.  He was required to take Modecate, an antipsychotic drug considered essential for controlling his moods.  At the meeting Joe was eager to tell me that he had declined his regular Modecate injection and was feeling much better without it. By this stage he had proved himself to be a well-behaved resident and a reliable volunteer and on this basis the Simon Community nominated him for one of the very few local authority tenancies made available to them in the London Borough of Hackney. I agreed to be part of Joe’s support network and to visit him once he had moved to his Hackney flat.    

When I did visit Joe in his new flat it was clear that all was not well. Despite the flat being well furnished and maintained he was restless and suspicious and had a meandering tale to tell about an unfriendly neighbour he had reported to the police but who the police were not prepared to confront. For the first time he became angry towards me when I tried to unpick what exactly it was that the neighbour had done. My next contact with Joe, an early morning visit, was far more disturbing.  As he opened the door a person behind him pushed past and ran off down the street. I recognised him as his Simon Community support worker.  That morning Joe was fretful and uncommunicative, spending most of the time in his kitchen. So I returned early to the office where two Simon Community Leaders were anxiously waiting in order to personally pass on the information that when visiting Joe the evening before, their Simon Community colleague had been held by him at knife-point and released the next morning on the condition that he would say nothing to me as he left. I’m certain that if this event occurred today that both the Simon Community and Thames Reach wouldn’t have waited for me to return from Joe’s flat but instead immediately called the police.   

Over the next few days we made numerous attempts to get Joe to accept a Modecate injection. Soon he was unwilling even to open his door either to us or the Community Psychiatric Nurse assigned to him. There was a pervading feeling that we were sliding helplessly towards some dreadful, unfathomable calamity. Yet is was still a numbing shock when the police made contact to pass on the news that Joe had set fire to a room in his flat and been taken under a mental health section[1] to the Homerton hospital nearby.

Within three months Joe had been discharged from a secure ward and into a bedsit a few streets away from his former flat. I had not been notified of this move and would have opposed it. I was disappointed, indeed felt humiliated, as I believed I had developed a good relationship with the ward staff, having visited him at the hospital. If community support was provided, and Joe claimed he received none, then it wasn’t effective and, predictably, the next time I saw him was at the Embankment where it was already obvious that his mental state had deteriorated. Though this time Joe was different. He was clearly frightened by his collapsing mental health and seemingly aware that he was slipping into paranoid. When I proposed that we attend University College Hospital where he had links from a previous stay, to be assessed by the duty psychiatrist in the hope of getting a voluntary admission to hospital he was eager to comply.

We had a long wait for the Duty Psychiatrist who, when he appeared wearing a good quality suit and carrying an expensive briefcase, seemed more like a bank manager than a psychiatrist. In contrast, I wore boots, jeans and checked shirt with a small canvas bag slung over my shoulder, the de rigueur homelessness worker bohemian chic of the era, not yet realising that there are times when it pays to put on the suit in order to give yourself more authority, especially if you are 25, though actually look 21. 

Yet it seemed to go well. In a tiny room Joe explained that he was hearing voices. Disconcertingly, he spoke of the voices calling him ‘a fat bastard’ and telling him to ‘smash up Jeremy’s office’.  After some brief reflection the psychiatrist gave his assessment. This was that Joe was essentially manipulative, the voices story was manufactured in order to get a bed and that the hospital was unable to assist. Though it wasn’t stated, I realised he had also concluded that I had coached Joe in advance.  We returned to my office where I avoided calling Joe a fat bastard and he, in turn, left the office undamaged to meekly return to sleeping rough again. I felt demoralised and, seeing him stumble off towards the Embankment, an utter failure.    

This wasn’t the last I would see of Joe. The Simon Community, impressively tenacious, continued to work with him and decided to give him an opportunity to live in a Simon Community house in Oxford where Joe managed to cope for a few months before another relapse led him to be admitted to the Littlemore Hospital in the city. By now he was out of sight and out of mind and I was therefore taken aback when, one afternoon, he announced himself at our Craven Street offices. 

We sat together in one of our cramped meeting rooms and he told me that he had fled the Littlemore and had no intention of returning. However, he did want to get into a hospital in London. I was painstakingly explaining to him why this was not possible and that he would need to return to the Littlemore when Joe, with equal care, informed me that if I didn’t refer him into a London hospital then he would do me some serious damage. To emphasise his point, he took a small fire extinguisher off the wall and threw it on the floor. Sadly, the noise this made was not enough to alert my colleagues in the adjacent room.  

Incredibly, or so it now seems, I came up with a plan. I knew some young police officers at the nearby Charing Cross police station as I had just undertaken training for them on homelessness. I liked them a lot. They were young and enthusiastic with ambitious intentions to improve the Metropolitan Police’s approach to working with homeless people. I requested Joe’s permission to ring them and ask that they get him into hospital. He agreed and within minutes they were at the office and taking Joe off, noting that if the hospital wouldn’t accept a voluntary admission then they would  ‘give him a 136’,  a reference to a mental health section that the police can undertake to remove a mentally disordered person from a public area to a place of safety for up to 72 hours. Joe was admitted to the Gordon Hospital in Westminster and when I visited him there, he was calm.  He explained, grinning sheepishly, that the police had initially sought to refer him to the Littlemore but that ‘once I had flipped a table over’ they decided on a local hospital instead. 

Joe spend some months at the Gordon where he had a very good, compassionate social worker.  And it was he who rang me with the news that Joe had been found dead in the street after absconding from the hospital and going on a massive bender, consuming a vast quantity of alcohol before eventually choking on his vomit. My feelings were a confusing mix of immense sadness and, I am ashamed to say, relief.

I won’t offer any profound thoughts about the life of Joe Reddy. Memory is unreliable and, besides, it is hard to be dispassionate about these events when my feelings remain so visceral. Though I cannot avoid the conclusion that the psychiatric services which regularly took him in and then arbitrarily discharged him seemed chillingly unconcerned as he journeyed towards some unfathomable oblivion and that his personality disorder, routinely described as an untreatable mental health condition, was a convenient trump card used to justify inaction. Or so it felt.  

Today mental health services are incomparably more accessible to people who are homeless and responsive to their needs and I feel blessed to have worked with some inspiring mental health professionals. One person in particular who restored my faith in the profession is Phil Timms, formerly Consultant Psychiatrist with the START team in south London who over many years of working with rough sleepers demonstrated an enduring mix of compassion, flexibility and expertise, enabling hundreds of people to improve their mental health and in the process saving lives.  

I wish I had done better by Joe, not been shackled by the feeling that he was heading towards an inevitable early death, been less cowed by imperious people in authority and got him the community mental health support that may have been the solution. He spoke rarely, and with reticence, about his early years, just once talking tersely and imprecisely of things his father had done to him. On another occasion he described the time he had been given a flat in Liverpool where his three brothers, all of whom seemed to be involved in some form of petty crime, paid him a visit and pulled the pipes off the wall ‘for a laugh’. 

I will remember with fondness our long conversations about what he intended to do once his mental health had improved and his struggles with his sexuality as a gay man finding his way in the macho world of the 1980s. And I still experience as if I am once again beside him, the chill of his fear as he sensed, yet again, his mental health crumbling.          

               

 



[1] Under the Mental Health Act, a person can be admitted, detained and treated in hospital against their wishes. For this to happen, certain people, for example an approved mental health professional and doctors, must agree that the person has a mental disorder that is putting themselves or others at risk. The process is often called ‘being sectioned’.

Comments

Unknown said…
Very moving, sad, doing the best one can. Kindness.
Jeremy Swain said…
Thanks for your comment. Glad it made an impact.
Becr said…
I have your blog bookmarked because you write (think) with such compassion and humility and I check once in a while to see if there is a new post. Thank you for taking the time to write again, I worked in Mental Health Care for many years in the 90s and some of what you experienced resonates with me particularly the sometimes conflicting emotions towards a service user. I feel very fortunate to have worked in Mental Health Care in my youth because I believe it enabled me to better tackle my own difficulties later in life and taught me that life is hard but simple human kindness is priceless.
Jeremy Swain said…
Thanks Becr. I've been struggling to find the time to write and I appreciate your kind words in response to the blog on Joe who I think about often, mostly with sadness though occasionally with amusement as we got into some tricky situations together and he had a good sense of humour, despite the bleakness of his life when his mental health collapsed.

I share you view that working with people with challenging mental health issues does provide insight into ones own struggles which can be invaluable. I thinks it has given me a bit of humility and an ability to be reflective which I might not have otherwise had. And, yes, simple human kindness is priceless and I see a lot of it from unexpected quarters.

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