Run with your client, not after

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:1176
  1. Jim Cromwell, clinical psychologist
  1. South West London and St George's Mental Health NHS Trust, London

    Chris was always climbing the fence, an eight feet high, chain link structure that surrounded the euphemistic “garden” on three sides. The fourth side faced the three storey, red brick ward that was home of sorts to a dozen people with learning disabilities and challenging behaviour, and half a dozen members of staff. Chris's most prominent behaviour was “absconding from the ward”—the reason for his admission and an activity he engaged in quite successfully on a daily basis.

    The escape itself was never witnessed. Chris would fade imperceptibly from the consciousness of the assembled staff and then suddenly reappear running full tilt away from the fence. The staff would then snap into action, our joint and single purpose to catch him and bring him back to within the confines of the fence. However, our prey stood more than six feet tall and, with daily practice, had developed the athleticism and speed of an ostrich. He could change direction in an instant with no evident loss of speed and could slow down and speed up with no suggestion of inertia.

    We would break into smaller units and, running at breakneck speed, try to limit the available directions he might take. We would gather volunteers to the chase as if in a stampede. But catching Chris, despite our greater numbers, invariably took upwards of an hour. Pursuers would retire from the chase exhausted; sometimes entire shifts would change during the hunt. Ultimately, however, Chris would be apprehended and, only partially subdued in a ruck of staff, guided back to the ward, where he would be carefully watched for the rest of the day while he returned our gaze as a scowl.

    I don't know how it happened, nobody does. Chris had breached the fence again, and somebody went to fetch him back. But this time the mood was completely different, completely at odds with the usual sense of crisis. Perhaps we no longer cared. Perhaps, somehow, we were inspired. Our solitary staff member didn't pursue Chris. He didn't barrel after him like a Pamplona bull. He just ran. Within a few minutes he was shoulder to shoulder with Chris and running alongside. And they kept running. They ran for a further 10 minutes or so and then returned to the ward. Nobody laid a finger on Chris. Nobody said a word. There was a 10 minute run and then home.

    There were no escapes after that. Just runs.

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