I first met Luke, a young man in his twenties, in the spring of 2015. He wasn't homeless at this point. He was encouraged to visit our Suicide Crisis Centre by a member of his family who was desperately worried about him. She had been in contact with us because he had gone to the top of a high building recently with intent to end his own life.
At his first appointment Luke described how he felt that God was speaking to him through the television. Religion had previously been a source of comfort to him - now it was frightening. He feared God and found contact with the church terrifying, he said. He had a sense of being trapped and felt there was no escape from God or religion.
He had been prescribed anti-psychotics but had stopped taking them because he wanted to be like everyone else, he said. Despite this prescription, he wasn't having any ongoing mental health care. He was using substances and had been referred only to addiction services which in our county are totally separate.
I contacted our local mental health service to express my concerns about Luke and to request that they provide mental health care. He needed their input in addition to the care which we could provide. They didn't become involved, though. We see this frequently where a person has a mental health diagnosis and substance misuse (dual diagnosis). They are directed to addiction services only.
Luke's contact with us became intermittent as his drug use increased. He became more unwell and the next time I saw him he was in the general hospital, having contracted septicaemia, a serious and potentially life-threatening condition. This is always a risk when someone is regularly injecting substances and using unclean needles. He had lost a huge amount of weight, too. At that point we feared he may die as a result of a physical condition rather than by suicide.
Both his mum and I continued to push for mental health involvement. We were told that addiction services were appropriate. Luke has a mental health diagnosis which comes under the category of severe and enduring mental illness. In the eighteen months that we have had involvement with him he has had no input from mental health services.
Luke continued to use drugs and was eventually evicted from the supported housing where he lived. He became homeless at that point and for the past two months he has been living on the streets. His drug use has increased and he has become very mentally unwell. We have tried everything in our power to help him be admitted to psychiatric hospital. He is deemed not detainable and there has been no possibility of informal admission either. The message remains the same - addiction services only. His GP believes he needs input from mental health services. Still nothing happens.
We tried to at least ensure that Luke has accommodation and is not on the streets. His local council initially appeared to cast doubt on the severity of his mental health issues: "If he is so unwell, why haven't they admitted him to psychiatric hospital?" I explained that the majority of people who are mentally unwell and at risk of suicide (even at high risk) are supported in the community by the Crisis Resolution and Home Treatment Team. Except that in Luke's case, he doesn't even have this community support. On the basis of our discussion he was deemed a priority case and I was told he will be eligible for emergency accommodation.
It didn't happen, though. I was contacted the next day and told that none of their landlords offering emergency accommodation would consider him because of his drug use. One of their regular landlords also flagged up concerns about his previous behaviour when he had stayed there before. This now meant that the council wouldn't even send him for studio apartment accommodation. He has been assessed as being eligible for emergency accommodation, but is not being offered it.
This weekend he is still on the streets. In recent days he has been expressing thoughts which appear to be delusional. He has been having suicidal thoughts. All this information was passed to mental health services, addiction services and the council last week and yet he remains without even a place where he can sleep and be safe.
Our fear is what will happen to Luke now. There is a huge risk of further deterioration of his mental health. He is having suicidal thoughts but does not at this moment have a plan to end his life, and this is why he needs help now - before he reaches the point of suicide. My concern is that he will lose hope that he can get out of his current situation. His suicidal thoughts centre once again on a feeling of being trapped - trapped within the cycle of addiction. He has been trying this week to get the kind of help which he feels he needs to escape that trap: mental health care and housing. This week he asked for psychiatric help and it was refused. He asked for accommodation and it is currently being refused. It is so hard for him not to lose hope. At the moment, he knows that there are people who care and who are fighting hard to try to get him the help that he deserves. But the situation is very fragile.
I have already told Ellie's story. Ellie died of the physical effects of alcohol.
I do not want to see Luke's story end in a similar way, nor anyone's story. I don't want to have to witness the devastating impact on his family nor its impact on us as a team, because we care very much and will be profoundly affected, too. We care not only for Luke but for his family, too, since we have worked together with them and come to know them well. Are deaths such as Ellie's not a powerful enough message that we need to do more? What more does it take for change to occur?
Luke is not our client's real name.
For more information about the Suicide Crisis Centre: http://www.suicidecrisis.co.uk