So, my day today...

We -- the treatment team, which consists of me (the social worker), the attending psychiatrist and the nursing staff -- have really been in a quandary about this one patient of ours, I'll call him Arnie. Back in the day, Arnie apparently was a Real Bad Dude -- lots of jail time, long history of IV drug use, dishonorable dicharge from the Army for going AWOL a few times, family has all but disowned him. He has a dementia, an underlying bipolar disorder, and is still given to getting into fights. He's perfectly amiable now, but it takes a little bit of doing to really connect. He shuffles from foot to foot and is constantly gesturing with his hands. He mumbles badly, often just to himself, and has a quick laugh. But if you get in his face, he'll get back in yours. Given his history, only having gotten in a couple of fistfights on our unit is pretty good. He's what we call easily redirectable and every few days I coach him through putting his hands in his pockets and walking away if he's annoyed.

He was in a state hospital for a long time, sent there via the criminal justice system, because he had deteriorated enough to not be safe with a general prison population. He was court-committed, and so petitioned the court to let him go, as he had done several times before. Last fall they did. He told the judge that he'd be going to his sister's and everyone but the judge understood that that wasn't going to happen, so he's been on the streets.

Or really in psych hospitals mostly, because he doesn't have the wherewithall to keep himself together out there -- gets into fights in shelters, uses cocaine or heroin, doesn't take his meds -- and ends up getting picked up by the cops, who bring him to a hospital rather than the station. Now, I work in a private, acute hospital. What that means is that, among other things, our job is to stabilize patients and discharge them. We don't provide longterm care (if we can help it), so the almost three months that Arnie has been with us is a long time. But Arnie doesn't have anywhere to go, and has no one to look out for him, and his current strategy of trying to commit some petty crime so that he will be arrested and sent back to jail where everything is predictable just really isn't working out. As evidenced by the stitched up lip he came here with.

None of the various state agencies that might be called upon want anything to do with him. Remember that he used to be a Really Bad Dude? Well, he's managed to get himself kicked out of practically every group home, agency, rest home, program in the state. Nevermind that he can't get himself out of a paper bag right at the moment, they remember the time he set fire to the living room and he's persona non grata. Too young for a nursing him, too physically well for a department of public health bed, has an organic brain condition so the department of mental health won't take him. So he's mine. You'd think, given his history, that I'd have a hard time mustering up much sympathy for a sociopath like him, who is reaping what he has sown. But sociopaths are often quite charming, and dammit, there's something about this guy I really like.

Here's the kicker: Arnie wants to leave our hospital. Badly. Keeps putting in papers to make us decide whether to just unlock the front door or ask a judge to commit him to our care. Then just when we're about to go to court, he withdraws the papers. He's done this four or five times now. We don't want to go to court because he can pull it together for brief periods of time when there's something in it for him, and we're afraid the judge would find him competent to take care of himself and order us to release him. Which would let us off the hook for trying to find someone to take care of him. You'd think it would be a no-brainer. But as much as he keeps saying he wants to go to court, he can't seem to bring himself to do it, either. In the meantime, I've still got three or four rest homes I haven't called, and someone just gave me the number of some big state mucky-muck who might be able to pull some strings somewhere.

Madeline