When Lara was working her day shift, she would get home at around 7:30pm and have an hour where Neil was vaguely compos mentis. He would take his medication at around 8pm and by 8:30pm his eyelids were heavy and he would be slurring his words.
"Time for bed, Neil."
Uncomplaining and compliant Neil would be led to the bedroom where Lara would help him undress and get under the covers. It was as if he was blind drunk: barely able to comprehend where he was or navigate the short distance to the bedroom on his own. It was alarming to see how heavily medicated he was, but Lara trusted the judgement of the doctors and had confidence that his health would soon improve.
During her night shift, Lara became aware just how little of the day Neil was awake and active. Sleeping until nearly 11am, he pulled on some clothes and lolloped down the staircase where she heard him collapse on the sofa. The sound of daytime television could be softly heard from the bedroom, but she knew he was half-dozing with glazed eyes, not taking anything in. Before she left to go to work in the evening, his mind seemed a little less cloudy, but he had little more than an hour before he had to take his 8pm dose of medication.
The change from his depressed demeanour was unmistakable. When he was depressed he was present, but also cold, withdrawn and a little passive-aggressive. He was hostile towards the world, fatigued, but his mind was still sharp. Now, he was a shell of a man: he shuffled around, slept and ate, but there was no living spirit within him. He was dead behind his eyes, which seemed more sad than the expression he wore when he said he didn't want to live anymore.
It was pretty clear when Neil skipped his medication. He would be wired: wide awake with manic eyes and an electric energy, restless.
"Did you take your meds?" Lara asked.
"Whose prescription is it? Mine or yours?"
"OK. Good. You worry about your medications, I'll worry about mine."
He wore a fierce expression. He was upset, defensive, offended that she would question whether he was taking his drugs. It was obvious when he hadn't, but she couldn't press him further on the matter without an explosive argument.
At first, he only skipped doses sporadically. It was as if he wanted to occasionally remind himself what it was like to be unmedicated.
Returning home one day, Neil was not in the snug or in the bedroom. Looking in the box room and the spare bedroom, Neil didn't appear to be in either. As she walked through the hallway towards the kitchen, she heard a sound come from the cupboard under the stairs.
"What the hell, Neil? What's wrong?"
He was in the cupboard completely naked with a bright red mop bucket on his head.
"Get away from me! Shut the door!"
"What's wrong, Neil?"
"Don't let those bloodsucking bastards get in here. Keep the fucking bats away from me" he shouted, with his hands flailing in the air.
"What's wrong with your arms? They're covered in scratches."
This seemed to stir some memory in him that he had forgotten. He started attacking his skin.
"Insects. Ants. Under my skin. Look at them crawling under there!" he picked at something unseen on his arm. A little blood appeared where his fingernail dug in.
"Neil you're seeing things. There aren't any bats. There aren't any insects."
"Fuck off. Fuck off. Fuck off." he shouted, cowering in the corner of the cupboard and pulling the bucket down over his head as if it could protect his whole body.
"Please come out from there. You're covered in scratches. You're hurting yourself."
"Leave me alone. You're a liar. You're a fucking liar."
"What am I lying about, Neil?"
"You know what it is."
"What is it?"
"You know. You all know. Fuck off and leave me alone."
The crisis team convened an assessment with Neil's doctor, a psychiatrist, a social worker and a mental health nurse. Two police officers stood in the hallway. Lara hovered in the doorway of the snug looking extremely anxious. Neil was sat at one end of the sofa in his dressing gown.
"We know you've stopped taking your medication, Neil. You should have refilled your prescription a week ago."
"I told you. The side effects were intolerable."
"Yes, but the medication was controlling your illness. You need the medication to stay well."
"I wasn't unwell before I started taking it."
"That's not true. Your notes say you were very unwell. The crisis team have been in contact for quite a while now."
"I wasn't hearing things. I wasn't seeing things."
"That was because the medication was working."
"The problems started when I stopped taking the quetiapine."
"There you go then, see! The medication was working. Why won't you start taking it again?"
"I told you. I'm OK. I can't stand the side effects. I don't need the quetiapine."
"But you had a psychotic episode. You got very sick without the medication. You need the medication to control your illness, Neil."
"What illness? I was depressed. That was all."
"Neil. You're very sick. You're exhibiting all the symptoms of paranoid schizophrenia. We're all very worried about you. You're not safe if you're not taking your medication."
The social worker from the crisis team got up and took Lara into the dining room.
"Look, we're going to have to take him into hospital to look after him and to assess him."
"OK, when? How long for?"
"I think we're going to recommend that he stays for 28 days. He's really sick and we need to get to the bottom of this. He's clearly not coping at home. You've been doing a great job, but he needs to be looked after in hospital."
"So, you're sectioning him?"
"We need to make our final decision, but it's likely that he's going to go to hospital under section two. He's not well and it's the best thing for him right now."
"What happens next?"
"We'll find a bed for him at a local facility and then he'll be admitted. Once he's settled in you'll be able to visit. He might not have to stay for the full 28 days, but we need to make sure he's in a safe place where the doctors can properly assess him and help him get better."
"He's angry with me. He was furious that I called you guys."
"You did the best possible thing you could. He was a danger to himself. It's really great that you called us and we can start to get Neil the help he needs."
Lara wasn't able to get to the ward during visiting hours until the weekend. Neil didn't want to see her and refused to come out of his bedroom.
"I'm sorry Lara, he doesn't want to see you right now" a nurse explained.
After 3 weeks, Neil appeared back at the house.
"I didn't know you were coming home."
"They let me have some leave. Time off for good behaviour" Neil chuckled darkly. He avoided eye contact and he scowled.
"Are you OK?"
"Would you be OK if you'd been forcibly removed from your own home, bitch?"
Lara drew her breath sharply, as if she had been physically struck.
"Neil!" she sharply rebuked at the harshness of his language, but she was more hurt and shocked than anything.
"It wasn't like that" she said with a concillatory tone. "You were really sick. Do you remember what you were like? Do you remember? You were under the stairs with a bucket on your head. What was I supposed to do?" Lara asked, reaching out to touch his arm. Neil pulled away from her baring his teeth, his eyes flashing with rage.
"Stay the fuck away from me."
She knew she sounded patronising and he felt betrayed. He had been brooding in hospital and the situation was highly charged, but she wanted him to know that she hadn't meant to hurt him. It was painful to see so much anger and mistrust directed towards her.
"Look. I love you. I care about you. I just want to see you get better."
"You got all those people ganging up on me. You turned my own doctor against me. What right do you have to do that?"
"You were having a crisis, Neil."
"Stop using my fucking name. It's just me and you here. There's nobody else here. Fuck."
Neil stormed off. Lara heard the sound of shattering glass and then a yell of pain. She hesitated and then started to walk upstairs. Neil crossed the landing and went into the bathroom. Tentatively, she poked her head in the doorway.
"Fuck off. Fuck off and leave me alone."
Neil was wrapping tissue paper around his hand. There were blood spots on the grey tiles all over the floor around his feet.
"Why the fuck are you still stood there? Fuck off. FUCK OFF" he screamed.
Lara went into the bedroom where a full-length mirror was shattered. The glass was mostly clean but large dark red blood spots were soaked into the carpet, trailing through the hallway and into the bathroom. Neil emerged and walked into the spare bedroom.
"Are you OK?" she asked.
He slammed the door closed.
"FUCK OFF!" she heard him yell, muffled inside.
On Sunday evening Neil left the house without saying a word. Lara waited until about 9pm and phoned the hospital.
"Is Neil back?"
"Yeah he came back a couple of hours ago."
Lara was relieved. She had been torn, not knowing whether to phone the crisis team again or not, knowing that Neil would feel even more betrayed. She sunk into the sofa and convulsive sobs hit her before she'd even put the phone down.