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The local social services reported that an unkempt, dirty and bedraggled woman had taken to sleeping in a local park. She appeared to be physically unwell, with a bad cough and severe sunburn, and was scavenging food from bins. She appeared frightened when approached and was refusing assistance. Several complaints about her presence had been made by a child care centre next to the park.

Background information

A variety of health services were contacted and it appeared that the woman had been diagnosed five years previously with paranoid schizophrenia, came from interstate and had taken to travelling around the country as an itinerant person. She had a background history of severe trauma and abuse, was non-compliant with treatment and consistently absconded from hospitals if admitted involuntarily.

Engagement

A female community nurse and I did a brief initial assessment of the woman in the park. She was interviewed from about 10 metres away, which was as close as she would allow, and food, soap and towels, a small amount of money and a warm blanket were left with her. She appeared frightened and thought disordered, seemed to have a chronic chest infection and was underweight. She agreed to the nurse visiting her on a regular basis to provide food. The social services were informed of this arrangement, and over the next fortnight she was seen on most days. A general practitioner who knew her from the past visited her in the park with the nurse and she allowed him to examine her chest in the park toilets with the nurse assisting. She was prescribed antibiotics and eventually agreed to a one week hospital admission on a voluntary basis.

Further assessment

In hospital she was washed, and attended by a podiatrist and a hairdresser. With nursing care and regular food her health improved, and this (plus her voluntary status) increased her trust in the various clinicians. Back pay of her pension was organised and she agreed to take low doses of antipsychotics orally. Great care was taken not to repeat the dynamics of abuse and external control by allowing her to make her own choices and by concentrating on the areas of need that she saw as important initially.

Follow-up

Temporary accommodation was arranged after her brief hospitalisation and she was visited at her new home by her case manager (a nurse), either alone or with me or her general practitioner. She continued taking oral antipsychotics and when she decided, after three months, to return to her home State she allowed us to help with her travel arrangements and to arrange appropriate psychiatric follow-up.

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