More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)
7 June
The word suicide itself defies us : if we know the word homicide, we are still stumped without a knowledge of Latin that sui means the particular, the self.
But the word gets heard - and used - often enough for us to know the meaning, without needing to know that it is an act of self-killing, and it even appeared, when Céline Deon took a career-break (for motherhood ?), in a French headline sa suicide incroyable (I quote from memory). The word, just now referring to 'career suicide', is with us in such manifestations as 'financial suicide' and 'intellectual suicide', and, if I am honest, it has become a little too cheap for my liking, a glib notion when what is embodied is that of choosing to end one's life.
And there we come against the taboos, the misconceptions, the prejudice.
We all know about 'suicides' (as, equally cheaply, those who carried through that choice are sometimes unfeelingly called) not being buried 'in consecrated ground', and so we have a lasting sense of the shame and crime that ecclesiastical law deemed this act to be. We will know also of the shame and penalty of bastardy, of 'being born out of wedlock', and the stigma is quite similar in origin, the shame of the state of affairs, but different in how the twentieth century came to view illegitimacy and suicide :
Legislation enacted by the UK Parliament in 1925 repealed the consequences of being born to parents who happened not to be married, and, in my view, the prevalence of people living together in the last thirty years suggests that little or no societal disapproval attaches to being unmarried parents (as against a young single mother, it must be said). The inability to inherit in certain situations had been swept away by the reforming legislation, and, with it, the negative and hampering limitations of being illegitimate, a notion also done away with. (All that survives are the feeble jokes about doubting my parenthood when the speaker has been called a bastard, etc.)
With suicide, we had to wait until only fifty-two years ago for Parliament to pass the Suicide Act 1961, and thereby decriminalize someone trying and failing to kill him- or herself : before then, because the act was a criminal offence, someone known to be a survivor of the attempt was open to prosecution.
I know only when the two changes that I refer to, not (for want of having researched the matter) what the policy and other considerations were that led to the disparity in timing : more than 35 years to correct the injustice of being open to prosecution for wanting to end one's life, as against remedying the things that a person born to an unmarried couple was prohibited from doing.
In both cases, the history of the law's disapproval of illegitimacy and of suicide lay in Christian theology, with a Biblical notion of birthright (and of the primacy of the legitimate first male child), and a belief that suicide was the unforgiveable sin of blasphemy against the Holy Spirit. Yet (as I have said), why decriminalizing suicide was less of a priority is not known to me : by analogy, I can say only that, under the law prior to the Mental Health Act 1983, being an unmarried mother made one liable to be detained under the predecessor Act, which is an almost incredible time for repealing such a policy.
Looking back to Greek mythology, whatever we think of Oedipus, it is clear enough in Sophocles' The Theban Plays that there is a taboo against suicide. There were also The Fates, whose Greek name (Moirai) means 'the apportioners', from which we partly get the idea of an allotted span on Earth, maybe three score years and ten : the strand representing each human life was spun by Clotho, measured out by Lachesis, and cut to length by Atropos.
You have your allotted span, and you don't seek to defy the Gods by prematurely shortening it, because there are penalties, if you do. Christian doctrine that this unforgiveable sin was that of suicide involved similar notions that God determines the length of one's life.
All of this history feeds in to the attitudes towards - the words used to describe - suicide now, and many object to the words 'commit[ted] suicide' on the basis that 'to commit' suggests a criminal offence. Whether that usage is a real hang-over from the days before the 1961 Act, I do not know, but it is not unlikely.
All in all, the public is so confused by the messages about suicide, assisted suicide, whether the former is a crime, or whether either is an act of courage or of cowardice (no neutral view here), that is no wonder that those who feel death to be the only way out are hurt and hindered sometimes by them : amongst which, they have the fear of being thrown into Dante's Inferno, of the stigma that will attach, and of being perceived as having acted selfishly.
To be continued
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Showing posts with label Mental Health Act 1983. Show all posts
Showing posts with label Mental Health Act 1983. Show all posts
Friday, 18 May 2018
Friday, 16 February 2018
A very strange choice of questions in the #MHAReview survey !
A very strange choice of questions in the #MHAReview survey
More views of - or before - Cambridge Film Festival 2017 (19 to 26 October)
(Click here to go directly to the Festival web-site)
15 February
A very strange choice of questions in the #MHAReview survey (and my attempts to answer them, without being sectioned) !
No, truly - I kid you not ! :(— THE AGENT APSLEY (@THEAGENTAPSLEY) February 16, 2018
Rather than 'Q2 What could have happened differently that could have prevented you from being sectioned ?', #MHAReview starts by presenting 'being sectioned' as if it's a gold standard...#WhatRealEncouragementToGetAsFarAsReadingQ2 ?
Isn't Q2 almost logically antecedent to Q1 (or even - if it were actually a classy, interactive survey - a Q that shouldn't be asked of someone who really did agree with the suggestion that 'being sectioned has been the best approach for your mental-health needs') ?#MHAReview https://t.co/nU1Vu5IxZV— THE AGENT APSLEY (@THEAGENTAPSLEY) February 16, 2018
Q1. Based on your experience, do you agree or disagree that being sectioned has been the best approach for your mental health needs ? Please explain your answer.
1. Being 'sectioned' is, in itself, a piece of jargon that we do not need - it is worse than when the language was 'committed', or 'certified', and has no objective justification : unless Regulations determine whether, for example, the police can detain a person against his or her will, such a detention will be under some section of an Act of Parliament, but we don't call that 'being sectioned', but (usually) 'arrested'.
2. Detention against one's will is often not an approach for that person's 'mental health needs', but, usually, to keep someone in an environment that is neither usefully stimulating, nor therapeutic, for the benefit of and away from others (e.g. family or neighbours), until that person 'is better', so I cannot agree that 'sectioning' was for my needs, or implies any approach (good or bad) to them - the existence, nowadays, of crisis resolution and home treatment, which are approaches, and the paucity of places on wards, mean that I would not have been sectioned now.
3. It was a dehumanizing and degrading experience, and it licenses the use, on patients and regardless of whether they have capacity to consent, with powerful medications whose exact effect is guesswork to those who prescribe them, as is the incidence of very unpleasant side-effects (of which no warning was given) : they may quieten them, but so would psychological interaction, and without badly altering their brain chemistry. It is legalized experimentation with dangerous substances.
Q2. What could have happened differently that could have prevented you from being sectioned ?
1. As mentioned at Q1, the existence of crisis resolution and home treatment services, or the lack of ready availability of psychiatric places, which allowed people to be detained who could clamour for one now, and not be admitted.
2. Psychiatric services for those who really do need and want them have, unfortunately, been deprived of such funding that the only benefit is that people can no longer be put under detention for so little reason.
3. In my case, proper psychological engagement with me, as I was, rather than the police-led escalation of my mood, thoughts and fears, would have assisted.
Q3. How would you describe the care you received while sectioned ? This could be either in hospital or a Community Treatment Order.
1. I am not sure that it is correct that one is, as such, sectioned when on a CTO : certain sections and / or certain triggering events may cause a Responsible Clinician to put someone on a CTO, but my understanding is that one cannot say 'while sectioned' to mean on one.
2. The care was not 'care', but containment. In comparison with even some other wards on the same site, it had a reasonable programme of activities, such as a cooking group, or a so-called 'breaking-out group' (going into the city under escort of 2-3 nursing staff). Other activities were more patronizing, such as being given time to make a piece of art, but then have to have someone supposedly analyse it / one through it, or the community meeting (which I avoided, after being at it once). Asking for an hour's ground leave and walking around the grounds was best.
3. None of this was 'care'. One was indoctrinated with some medicalized account of one's self, and obliged to take medication (haloperidol) - this felt more like punishment for what one was not meant to think / have thought, with constipation, stiff and awkward arms and legs, painful neck-cramps. All depersonalizing, humiliating and taking away any status that one had in the name of psychiatry.
Q4. In your experience, what are the most important things that can help people stay well following discharge, and reduce the need to be sectioned again in future ?
1. The 'need to be sectioned' proved to be tied to finances - when funding for mental-health services became curtailed, it became less likely that anyone with my experiences (20+ yrs ago) would be sectioned.
2. Nonetheless, the important less that being 'sectioned' teaches a former detainee is to behave in such a way that psychiatrists lose interest and discharge him or her. Then, despite a mind that has almost certainly been damaged in the way that the nonsense about 'chemical imbalance' claimed justified one's detention, take sufficient medication to control behaviour that attracts others' attention.
3. For those who were desperate to be discharged (and did not just outright refuse to agree to the terms of Supervised Community Treatment, because then a so-called Community Treatment Order would be impossible to make), it will not be the CTO - no evidence of that whatever.
4. The 'need to be sectioned' - there is no such need, because it is driven by societal and family pressure, but only as long as there is money for it.
Q5. Do you feel you were treated with dignity and respect ?
As a person who was twice detained against his will ? Absolutely not !
Put on section 2 on c. 21 April 1996, the consultant did not even have the decency to tell me that she had taken me off the section - for years, until I saw my records, I thought that she had just let it expire.
Detention under section is one of the most humiliating and degrading experiences of my life - that is the true answer to Q5, that, apart from the GP's stupid 'experiment' of continuing me without medication after an abrupt week-long withdrawal (as I had no tablets, and he decided not to prescribe), which saw a re-admission in January 1997, I had no intention, after that, of going back to hospital again for more dehumanizing and status-less time there.
Q6. Where relevant, do you feel your carers (e.g. family or friends supporting you while you were sectioned) were treated with dignity and respect ?
More so than I was. I was only taken off haloperidol, during the first admission, when my somewhat hard-hearted wife, obsessed with how her life had changed, pleaded for me.
During the second admission (January 1997), she agreed to apply for me to be discharged from my section (section 3) - that, as I only established from the records, appeared to have been blocked within the period of 72h, but, again, there was zero transparency as to what had happened.
Besides, my wife was not a carer - she was a prime cause of the behaviour that was diagnosed as supposed mental illness.
Q7. What rights do you think a person sectioned under the Mental Health Act should have ?
1. They should have the rights that the Act already gives them - not available, in my experience.
2. A curiously open-ended question, but, certainly :
(a) the right to a full assessment of capacity to consent to treatment in compliance with the Mental Capacity Act ;
(b) based on being found to have capacity, the right to refuse treatment ;
(c) the right, again with capacity or based on a relevant advance directive, to refuse ECT, and not for there to be a deemed lack of capacity or an 'emergency' need for ECT ;
(d) not to be put on a CTO (and for all existing CTOs to be discharged), failing which explicit rights to an IHMA when a CTO falls to be considered and to be told of the right to refuse to agree the terms of a CTO and the consequences of so doing ;
(e) the right to much better than the tokenistic 'reading of rights' that patients are given, by staff who do not believe that someone detained against his or her will has any rights ;
(f) an easier way than displacing a nearest relative to have that a person of one's choice ;
(g) right to a second opinion ;
(h) better protection against ill-treatment than under s. 127 (has anyone ever been prosecuted successfully ?).
Q8. What rights do you think a carer (e.g. family and friend) sectioned under the Mental Health Act should have ?
They have too many rights as it is, e.g. to request a Mental Health Act assessment. Carers are often not the people whom those for whom they claim to care would choose, and the balance is too far in favour of abusers, who take away others' peace of mind, or even apparent sanity.
Q9. If you could change one aspect of the Mental Health Act, what would you change ?
It must be that, irrationally, it overrides people's capacity to refuse treatment (i.e. forced medication) for their alleged mental ill-health, but the very same people, with capacity to consent to treatment for a cancer or other such condition that will kill them (and a consultant in that field would be absolutely bound by their advance directive, if they lacked capacity, for such treatment, or to require them not to be resuscitated) - so much for parity of esteem !
(A close-run thing with the unnecessary involvement of the police, which makes people confuse their psychiatric detention with the criminal-justice system - e.g. returning 'absconding' patients, or under s. 136.)
Q10. Is there anything else you would like to tell us ?
The power of others to put people, either supposedly out of concern for them, or - as neighbours or as family members - by complaining about them or alleging being in fear of them, into a coercive environment that is unlikely to be therapeutic should be reduced / redressed in favour of those detained against their will.
How much has really been understood since, or changed because of, Placed Amongst Strangers [www.mentalhealthalliance.org.uk/pre2007/documents/placedamongststrangers.pdf] ?
[...]
Q16. Do you know which section(s) of the Mental Health Act you were sectioned under ?
Yes :
April 1996 - s. 2
January 1997 - initially informal, then a s. 4 holding power was used* when - peaceably - I decided that I wanted to go back to the ward where I had been admitted overnight, and six staff used face-down restraint on me, I was taken back in, sedated, and put onto s. 3
End-notes :
It looks as though that should have been s. 5, in fact :
My video on #restraint is being edited tomorrow, it’s great that my trust wants to hear my experience and use it in training #coproduction— C (@KnightonStar) February 20, 2018
True, too, of the casual word 'sedate' - i.e. we rendered you unconscious, against your will, because s. 2 (or s. 4) of the Mental Health Act 1983 just lets us, if we think that we should.— THE AGENT APSLEY (@THEAGENTAPSLEY) February 21, 2018
(a) that the patient is suffering from mental disorder to such a degree that it is necessary for his health or safety or for the protection of others for him to be immediately restrained from leaving the hospital ;— THE AGENT APSLEY (@THEAGENTAPSLEY) February 21, 2018
-> for a period of six hours from the time when that fact is so recorded or until the earlier arrival at the place where the patient is detained of a practitioner [or clinician] having power to furnish a report under that subsection.#Restrain #Sedate #Discredit— THE AGENT APSLEY (@THEAGENTAPSLEY) February 21, 2018
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Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
Wednesday, 4 October 2017
Let's* overhaul the Mental Health Act 1983 !
Let's* overhaul the Mental Health Act 1983 !
More views of - or before - Cambridge Film Festival 2017 (19 to 26 October)
(Click here to go directly to the Festival web-site)
4 October
Let's* overhaul the Mental Health Act 1983 !
Well, MHA 1983 was looked at - in much detail - between around 2004 and the enactment of the 2007 Act :— THE AGENT APSLEY (@THEAGENTAPSLEY) October 4, 2017
Who says *what's* wrong matters !
* Mental Health Act 1983, 'trumping' Mental Capacity Act 2005 - cannot refuse consent for #mh treatment— THE AGENT APSLEY (@THEAGENTAPSLEY) October 4, 2017
* How #ECT proponents avoid consent
And what of other supposed opportunities or achievements... And looked at now, after so many people have died - or even killed themselves - because of the #WCA and #ESA ? :
Where were we, with questioning 'Am I celebrating Royal Assent for the Mental Health (Discrimination) Act 2013 ?' :https://t.co/iR5pFbNqGo— THE AGENT APSLEY (@THEAGENTAPSLEY) October 4, 2017
Mental illness can drain away your self esteem and self-belief. Recharging can feel like an uphill battle. RT if you can relate. #StopStigma pic.twitter.com/m1TjbDIsSM
— SANE (@CharitySANE) October 6, 2017
But dominant words are #resilience / #recovery, so - even after admissions (under section) - our saying so's been made to sound an excuse ? https://t.co/aRkuvULkPE
— THE AGENT APSLEY (@THEAGENTAPSLEY) October 6, 2017
End-notes :
* Let's = Let us. So who are we - and what do we want, and Why ?
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Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
Saturday, 29 November 2014
Section 136 : What is it and why do we have it ?
More views of - or before - Cambridge Film Festival 2014 (28 August to 7 September)
(Click here to go directly to the Festival web-site)
29 November (now (5 December) with esteemed Tweets of appreciation from @MentalHealthCop)
One would have to read Hansard, the verbatim record of the business of the Houses of Parliament, to know what was on the mind of MPs and Peers when they enacted the Mental Health Act 1983 (since amended), and, within it as a sequence of numbered enactments, section 136, which begins (quoting sub-section 1) :
Mentally disordered persons found in public places
(1) If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.
Not exactly normal English ! However, if they can interpret it, our police are given a power by this sub-section (s. 136(1)), but only if the criteria apply for it to arise – one could infer a concomitant duty to act by using this power, though, if so, one should be able to justify one’s thoughts…
The test of whether someone is ‘suffering from mental disorder’ is a subjective one, i.e. what appears to the constable. Fair enough, but how has the constable been trained to recognize ‘mental disorder’*, and does the constable even know what happened last time that he or she exercised the power (please see below for how often officers are wrong) ? If not, how does he or she know whether that had been a case of ‘mental disorder’ and so learn from it ?
Or should we even be putting a responsibility on the police to construe mental-health legislation and to assess the appearance of a person on public property as to whether there is mental disorder ? One has to ask, because (under s. 136(2)), the person with the appearance of mental disorder can be detained (i.e. against his or her will) for as long as 72 hours. Sub-section 2 specifies what that period of time – longer, by far, than the period for which someone can be detained, on such authority, because of suspected criminality – is to be used for :
(2) A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling him to be examined by a registered medical practitioner and to be interviewed by an approved mental health professional and of making any necessary arrangements for his treatment or care.
The sub-section is therefore quite precise about what the purpose of the detention is, but the Act fails to make any link between sub-section 2, and exercising the power to take the person (against his or her will) to a place of safety under sub-section 1 : where is the link, except temporally, for up to 3 days in detention within which to arrange the specified matters ?
The Act is not explicit, but one is essentially looking at an assessment to see whether the person should be detained under ss. 2, 3 – but giving this period of 72 hours in a so-called place of safety to do it. As can be seen above, s. 136(1) refers to s. 135 in this connection for a definition, where s. 135(6) says :
(6) In this section “place of safety” means residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948..., a hospital as defined by this Act, a police station, an independent hospital or care home for mentally disordered persons or any other suitable place the occupier of which is willing temporarily to receive the patient.
Pretty broad, one would think – so why do commissioners of mental-health services not have standing arrangements with, say, independent hospitals for them to be places of safety in case of need ? Why, if NHS Trusts do not have the beds, is someone not paying for them to be provided in this way – somewhere that would also have staff trained to know mental disorder when they see it ?
And we are relying on officers on the street, etc., to determine what appears to be mental disorder, when – even if they could all be given training in Mental Health First Aid – it would probably be far better for them to call someone who is versed is mental disorder – except that we seem to jump straight to the ‘place of safety’, often enough a police-cell, and then no one stirs themselves, because the medical practitioner and / or AMHP (approved mental health professional) have three days in which to call by.
Would a police officer be trusted to move someone with a suspected broken neck in the back of a police-car ? No, of course not ! An ambulance would be called, and one would rely on those trained medical staff to deal with assessing the person’s injuries and moving him or her.
If there were a crowd or other situation, one would keep the person safe at the scene until the trained staff arrived, and then assist them in carrying out their duties or treatment on site and of taking the person to an appropriate hospital. Why – just because so many people view those who may have a mental disorder as nutters ? – should the status quo equally not be maintained until appropriately trained mental-health professionals can arrive, rather than ‘carting the person off’ ?
Allegedly, we have parity of esteem under the NHS (Health and Social Care Act 2012) for mental and physical health, so why is the person suspected of a breakdown not treated in the same way as for a broken neck ? So, X fell from a balcony in a shopping centre – we clear the area and keep him or her out of harm until the ambulance crew arrives – and the same should apply if X had been reported to be behaving bizarrely in that shopping centre, keeping X safe until the trained personnel come.
A Briefing Note by the Centre for Medical Health makes a point relevant to how s. 136 is being used, quoting this statistic given by a report from 2013 by Her Majesty’s Inspectorate of Constabulary, Care Quality Commission, Health Inspectorate of Wales, and Her Majesty’s Inspectorate of Prisons :
It also noted that 80% of those detained under section 136 are not admitted to hospital for treatment. This suggests an urgent need for better working relationships and knowledge between the police and mental health services.
Thus, in just 1 in 5 cases, the officer was right. Hardly a good enough percentage on the basis of which – even if it were not otherwise problematic – to continue as we are ?
But we must end as we began, with sage words - albeit of denial - from @MentalHealthCop... :
End-notes
* If one wants to know what that phrase means, the much-amended s. 1 tells one…
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
(Click here to go directly to the Festival web-site)
29 November (now (5 December) with esteemed Tweets of appreciation from @MentalHealthCop)
@THEAGENTAPSLEY A fairly weak BLOG, you must admit - it fails to consider history, law and practice in light of how services have evolved.
— InspMichael Brown (@MentalHealthCop) December 5, 2014One would have to read Hansard, the verbatim record of the business of the Houses of Parliament, to know what was on the mind of MPs and Peers when they enacted the Mental Health Act 1983 (since amended), and, within it as a sequence of numbered enactments, section 136, which begins (quoting sub-section 1) :
Mentally disordered persons found in public places
(1) If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.
Not exactly normal English ! However, if they can interpret it, our police are given a power by this sub-section (s. 136(1)), but only if the criteria apply for it to arise – one could infer a concomitant duty to act by using this power, though, if so, one should be able to justify one’s thoughts…
Usually, the police can hold you for <24 hours before they have to charge you with a crime or release you : not under Mental Health law ->
— THE AGENT APSLEY (@THEAGENTAPSLEY) December 25, 2014-> Is it right that, just because one was in a public place and an officer *thinks* one has a mental disorder, detention can be for <72h ?
— THE AGENT APSLEY (@THEAGENTAPSLEY) December 25, 2014The test of whether someone is ‘suffering from mental disorder’ is a subjective one, i.e. what appears to the constable. Fair enough, but how has the constable been trained to recognize ‘mental disorder’*, and does the constable even know what happened last time that he or she exercised the power (please see below for how often officers are wrong) ? If not, how does he or she know whether that had been a case of ‘mental disorder’ and so learn from it ?
Or should we even be putting a responsibility on the police to construe mental-health legislation and to assess the appearance of a person on public property as to whether there is mental disorder ? One has to ask, because (under s. 136(2)), the person with the appearance of mental disorder can be detained (i.e. against his or her will) for as long as 72 hours. Sub-section 2 specifies what that period of time – longer, by far, than the period for which someone can be detained, on such authority, because of suspected criminality – is to be used for :
(2) A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling him to be examined by a registered medical practitioner and to be interviewed by an approved mental health professional and of making any necessary arrangements for his treatment or care.
The sub-section is therefore quite precise about what the purpose of the detention is, but the Act fails to make any link between sub-section 2, and exercising the power to take the person (against his or her will) to a place of safety under sub-section 1 : where is the link, except temporally, for up to 3 days in detention within which to arrange the specified matters ?
The Act is not explicit, but one is essentially looking at an assessment to see whether the person should be detained under ss. 2, 3 – but giving this period of 72 hours in a so-called place of safety to do it. As can be seen above, s. 136(1) refers to s. 135 in this connection for a definition, where s. 135(6) says :
(6) In this section “place of safety” means residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948..., a hospital as defined by this Act, a police station, an independent hospital or care home for mentally disordered persons or any other suitable place the occupier of which is willing temporarily to receive the patient.
Pretty broad, one would think – so why do commissioners of mental-health services not have standing arrangements with, say, independent hospitals for them to be places of safety in case of need ? Why, if NHS Trusts do not have the beds, is someone not paying for them to be provided in this way – somewhere that would also have staff trained to know mental disorder when they see it ?
And we are relying on officers on the street, etc., to determine what appears to be mental disorder, when – even if they could all be given training in Mental Health First Aid – it would probably be far better for them to call someone who is versed is mental disorder – except that we seem to jump straight to the ‘place of safety’, often enough a police-cell, and then no one stirs themselves, because the medical practitioner and / or AMHP (approved mental health professional) have three days in which to call by.
Would a police officer be trusted to move someone with a suspected broken neck in the back of a police-car ? No, of course not ! An ambulance would be called, and one would rely on those trained medical staff to deal with assessing the person’s injuries and moving him or her.
If there were a crowd or other situation, one would keep the person safe at the scene until the trained staff arrived, and then assist them in carrying out their duties or treatment on site and of taking the person to an appropriate hospital. Why – just because so many people view those who may have a mental disorder as nutters ? – should the status quo equally not be maintained until appropriately trained mental-health professionals can arrive, rather than ‘carting the person off’ ?
Allegedly, we have parity of esteem under the NHS (Health and Social Care Act 2012) for mental and physical health, so why is the person suspected of a breakdown not treated in the same way as for a broken neck ? So, X fell from a balcony in a shopping centre – we clear the area and keep him or her out of harm until the ambulance crew arrives – and the same should apply if X had been reported to be behaving bizarrely in that shopping centre, keeping X safe until the trained personnel come.
A Briefing Note by the Centre for Medical Health makes a point relevant to how s. 136 is being used, quoting this statistic given by a report from 2013 by Her Majesty’s Inspectorate of Constabulary, Care Quality Commission, Health Inspectorate of Wales, and Her Majesty’s Inspectorate of Prisons :
It also noted that 80% of those detained under section 136 are not admitted to hospital for treatment. This suggests an urgent need for better working relationships and knowledge between the police and mental health services.
Thus, in just 1 in 5 cases, the officer was right. Hardly a good enough percentage on the basis of which – even if it were not otherwise problematic – to continue as we are ?
But we must end as we began, with sage words - albeit of denial - from @MentalHealthCop... :
.@THEAGENTAPSLEY Did I ever say that?!
— Insp Michael Brown (@MentalHealthCop) December 5, 2014End-notes
* If one wants to know what that phrase means, the much-amended s. 1 tells one…
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
Saturday, 11 October 2014
Answers to a quiz for World Mental Health Day : The British* Patient
More views of - or before - Cambridge Film Festival 2014 (28 August to 7 September)
(Click here to go directly to the Festival web-site)11 October
'Treating' The British* Patient
A quiz for World Mental Health Day (#WMHD2014 on 10 October), about patients’ rights, was inspired by re-watching The English Patient (1997) earlier in the week : here are the answers to the quiz. (That said, the answers are all The Agent Apsley’s and so - necessarily - is any responsibility for any mistakes or misunderstandings in writing them : unless, that is, you fail to offer a correction…)
A suggestion for reading : by all means read it all through, but why not focus on the answer to a question where you felt that a right had been outlined ?
Which of the following are rights of a patient in a psychiatric unit (in England & Wales*) when detained under section 2 of the Mental Health Act 1983 (as amended), headed ‘admission for assessment’ ? :
1. To be placed in a unit within 25 miles of home
Sadly, this is not a right, as recent news stories have highlighted, and even a patient being detained somewhere at that distance could effectively cut him or her off from most visits :
In rural Cambridgeshire, Huntingdon used to have its own units for adult and elderly mental health, whereas the provision for the town and its area is now located in Peterborough. A bed only being found initially at a distance (sometimes now hundreds of miles) is not a new phenomenon, but it is one that has been made more likely, and is so affecting more people, by reductions in both the numbers of units and the provision of accommodation (i.e. the capacity for which funding exists, irrespective of how many people the unit could hold (and even have been built for), if enough nursing and ancillary staff, supplies, etc., existed)
2. To see a psychiatrist within 3 hours if distressed
Since, as one might have been led to believe, psychiatric units are therapeutic, such a right might seem plausible.
However, even if the movement that gave us Patients’ Charters promised such a standard of care, or an NHS Trust itself committed to provide it, nothing under the Act itself gives this entitlement : seeing a psychiatrist within a specified time would not derive from being on section 2, but have to be a matter of Trust, or ward, policy.
3. Not to take medication, if offered twice already and refused
Although section 2 of the Act is headed ‘admission for assessment’, and section 3 ‘admission for treatment’, there is nothing to choose between them in this respect :
There is no general right not to be treated, i.e. not to take prescribed medication - which, if the patient repeatedly refuses when offered, can be given against his or her will.
This will either be by single injection (if the original medication exists in injectable form, failing which something similar), or, for anti-psychotic medications (properly called 'neuroleptics'), a long-lasting (depot) injection (to avoid the need for multiple forced administrations).
4. To take a walk in the ground for up to an hour, if the staff are told first
When on section, even such a simple thing as this depends on it being granted by the person who, at the time, is the Responsible Clinician** (RC), who can authorize (or rescind) it - for the starting position is that one is not allowed to leave the unit at all without permission.
If the staff have not been told that a person is granted ground leave, but he or she still goes for a walk, he or she is considered to be absent without leave (is this the Army ?) and can be brought back by force – if it were a longer walk, it might be interpreted as trying to abscond (is this HM Prison ?), and the police could seek out him or her and oblige his or her return.
And - cynically speaking - the unit is easier to manage, and there is less work and documentation, if patients are not, as they should be, encouraged to exercise and be physically active : RCs do not need to grant permissions that have to be checked, and it is easier to carry out the regular head-count (is this Colditz ?)
5. To have family or friends visit outside visiting hours in the first two weeks of the admission
This, too, might sound reasonable, but it is not a right that is given by falling under the Act (although the Code of Practice may have something to say about what is good practice) :
If the NHS Trust, or the manager of the unit, makes such a facility available, all well and good. (Likewise, the visiting hours themselves are determined at that level.)
6. To drive, as long as one’s partner is present
The Mental Health Act is silent about this (and it could be just as relevant to someone not detained under it, an informal patient).
Unfortunately, all too often, consultant and other staff are also silent, failing to ask themselves – by enquiring of the patient and / or his or her family whether he or she drives – whether the patient’s family realizes that his or her diagnosed (or suspected) mental-health condition needs to be reported to the DVLA (Driver and Vehicle Licensing Authority), and that it is appropriate to recommend to them whether he or she should be allowed to drive.
The DVLA then contacts the consultant for medical evidence, and makes a decision about maintaining, limiting, or revoking the driving licence, based on the diagnosis and what the consultant reports.
7. To go home on overnight leave at least once per week
Leave is sometimes called section 17 leave, because that is the section of the Act under which the Responsible Clinician** (RC) can choose to grant it. That will be a clinical decision, and, since RCs are cautious beasts (as they are still largely consultant psychiatrists), granting leave is never going to be tied to how long the patient has been admitted :
Not least on the common assumption that, if in doubt, it is better for the patient to be on the unit, rather than on leave at home (even if that is 'the least restrictive' option - and a noisy ward, with other patients who are 'high', may not do someone much good who is very depressed).
However, in practice, there will be a correlation between the length of the admission and the length and frequency of leave granted, if the patient is considered to be ‘getting better’ : so, patients can be directed to the fact that leave is being given more often, and for longer, if questioning what the consultant thinks of his or her state of mind.
8. To vote in local and national elections
One can find a summary of the position, under the sub-heading ‘Patients in psychiatric hospitals’, on Citizens’ Advice’s Advice Guide web-site.
As to the law, Acts of Parliament other than the Mental Health Act 1983 have legislated on this topic. Most recently, section 73 of the Electoral Administration Act 2006 has taken the trouble to abolish the so-called common-law rules about ‘mental state’ and ‘incapacity’ (s. 73(1)).
Also, the Representation of the People Act 2000 amended the 1983 Act of that name, to specify that, if registered to vote, there is a right to vote. Practically, though, one would not only have to get to a polling-station in one’s registered constituency, but also not be ‘subject to any legal incapacity to vote’ (s. 1(1)(b) of the 1983 Act (as amended)) : practically, then, staff on the psychiatric unit will not let one’s family take one to vote, if one has been determined to lack capacity.
9. To choose to be treated, on the NHS, by another psychiatrist who is employed by the same NHS Trust
If one credited that provisions in the Health and Social Care Act 2012 signified anything, such as the duty (under section 4) on the Secretary of State for Health to ‘have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service’, one might believe in a right to a second opinion, or even a choice of practitioner.
Or one can read NHS England’s web-site for what it similarly has to say about the much-vaunted principle of parity of esteem (under the 2012 Act), but one will probably search more successfully for a chimæra than in the 1983 Act for the right to choose who has oversight of one’s psychiatric care…
10. To specify that one would never, whatever the consequence, wish to have ECT
Yes, one has the right to make an advanced directive to this effect (as section 58A, sub-section (5), of the Act acknowledges (s. 58A(5)).
That said (and, again, despite that so-called parity of esteem, as discussed in answering Q9), one has less comfort in this than one might think, for, as Stephen Weatherhead (@SteWeatherhead) and The Agent (@THEAGENTAPSLEY) have suggested, the Act also stipulates (in s. 62(1), in the cases specified by paragraphs (a) and (b)) that the directive sometimes does not even signify :
For section 62(1A) says ‘Section 58A above, in so far as it relates to electro-convulsive therapy by virtue of subsection (1)(a) of that section, shall not apply to any treatment which falls within paragraph (a) or (b) of subsection (1) above’ :
Which means, as those paragraphs tell us, treatment ‘which is immediately necessary to save the patient’s life’ (para. (a)), or ‘which (not being irreversible) is immediately necessary to prevent a serious deterioration of his condition' (para. (b))…
11. To see a mental health advocate about any matter of concern
Under section 130A of the Act, the role of Independent Mental Health Advocates (IHMAs) was established (as inserted by the Mental Health Act 2007), and there is national provision for IMHAs (and their establishment and regulation).
Prior to the 2007 Act, but not in name, IMHAs already operated in some places, because advocacy services were already funded : they had protocols and agreements with psychiatric units that allowed these proto-IMHAs to see patients on units, and, because it was not IMHA, they were not limited (as IMHA requires) to addressing rights and concerns arising under the 1983 Act.
To answer the question, then, whether one has a right to see an advocate about ‘any matter of concern’, e.g. whether one can be dismissed for having been sectioned, depends on whether IMHA and general advocacy have been funded in one's locality. Only if so, and then not wholly because of the Act, could a patient raise any concern with an advocate.
12. To spend at least two hours per week, as a total duration, in conversation with one’s primary nurse
By now, the overall pattern may have emerged, so one may not be surprised that the Act would not require this amount of contact-time.
Which is not to say, whether or not directed to do so by a Clinical Commissioning Group (CCG), an NHS Trust could not have made that promise, or a manager of a unit made that part of its operational rules…
Those are The Agent's Answers (as at 11 October (updated 15 October))
It may be open to question whether any rights that are talked about were actually given by the Mental Health Act, or exist despite someone's being detained under one of its sections - the most common mistake of which there was already evidence is to believe that section 2 differs from section 3 regarding treatment under compulsion.
Probably the closest that we come is, with Q8, the changes that finally allowed someone to vote when on section 2 (whereas those in hospital because of the Act's criminal provisions are treated along with this government's attitude towards the prison population, hated for seeking to invoke the right to vote as a Human Right), provided that the person is not determined to lack capacity, though (as in Q10) there is this rather empty victory of advanced directives being acknowledged, but not always being binding (which feels as though one hand gives, the other takes away again)...
However, it was generally intended to challenge with these questions : the fact that, almost certainly, none of them embodied what one could call an absolute, unequivocal right for a detained patient.
End-notes
* Scotland has its own Mental Health Act, so this is only applicable to the law of England & Wales.
** Prior to 2007, this person was the RMO, or Responsible Medical Officer : most RCs are still psychiatrists, however, although the intention of the Mental Health Act 2007 was to widen eligibility for the role.
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
(Click here to go directly to the Festival web-site)11 October
'Treating' The British* Patient
A quiz for World Mental Health Day (#WMHD2014 on 10 October), about patients’ rights, was inspired by re-watching The English Patient (1997) earlier in the week : here are the answers to the quiz. (That said, the answers are all The Agent Apsley’s and so - necessarily - is any responsibility for any mistakes or misunderstandings in writing them : unless, that is, you fail to offer a correction…)
A suggestion for reading : by all means read it all through, but why not focus on the answer to a question where you felt that a right had been outlined ?
Which of the following are rights of a patient in a psychiatric unit (in England & Wales*) when detained under section 2 of the Mental Health Act 1983 (as amended), headed ‘admission for assessment’ ? :
1. To be placed in a unit within 25 miles of home
Sadly, this is not a right, as recent news stories have highlighted, and even a patient being detained somewhere at that distance could effectively cut him or her off from most visits :
In rural Cambridgeshire, Huntingdon used to have its own units for adult and elderly mental health, whereas the provision for the town and its area is now located in Peterborough. A bed only being found initially at a distance (sometimes now hundreds of miles) is not a new phenomenon, but it is one that has been made more likely, and is so affecting more people, by reductions in both the numbers of units and the provision of accommodation (i.e. the capacity for which funding exists, irrespective of how many people the unit could hold (and even have been built for), if enough nursing and ancillary staff, supplies, etc., existed)
2. To see a psychiatrist within 3 hours if distressed
Since, as one might have been led to believe, psychiatric units are therapeutic, such a right might seem plausible.
However, even if the movement that gave us Patients’ Charters promised such a standard of care, or an NHS Trust itself committed to provide it, nothing under the Act itself gives this entitlement : seeing a psychiatrist within a specified time would not derive from being on section 2, but have to be a matter of Trust, or ward, policy.
3. Not to take medication, if offered twice already and refused
Although section 2 of the Act is headed ‘admission for assessment’, and section 3 ‘admission for treatment’, there is nothing to choose between them in this respect :
There is no general right not to be treated, i.e. not to take prescribed medication - which, if the patient repeatedly refuses when offered, can be given against his or her will.
This will either be by single injection (if the original medication exists in injectable form, failing which something similar), or, for anti-psychotic medications (properly called 'neuroleptics'), a long-lasting (depot) injection (to avoid the need for multiple forced administrations).
4. To take a walk in the ground for up to an hour, if the staff are told first
When on section, even such a simple thing as this depends on it being granted by the person who, at the time, is the Responsible Clinician** (RC), who can authorize (or rescind) it - for the starting position is that one is not allowed to leave the unit at all without permission.
If the staff have not been told that a person is granted ground leave, but he or she still goes for a walk, he or she is considered to be absent without leave (is this the Army ?) and can be brought back by force – if it were a longer walk, it might be interpreted as trying to abscond (is this HM Prison ?), and the police could seek out him or her and oblige his or her return.
And - cynically speaking - the unit is easier to manage, and there is less work and documentation, if patients are not, as they should be, encouraged to exercise and be physically active : RCs do not need to grant permissions that have to be checked, and it is easier to carry out the regular head-count (is this Colditz ?)
5. To have family or friends visit outside visiting hours in the first two weeks of the admission
This, too, might sound reasonable, but it is not a right that is given by falling under the Act (although the Code of Practice may have something to say about what is good practice) :
If the NHS Trust, or the manager of the unit, makes such a facility available, all well and good. (Likewise, the visiting hours themselves are determined at that level.)
6. To drive, as long as one’s partner is present
The Mental Health Act is silent about this (and it could be just as relevant to someone not detained under it, an informal patient).
Unfortunately, all too often, consultant and other staff are also silent, failing to ask themselves – by enquiring of the patient and / or his or her family whether he or she drives – whether the patient’s family realizes that his or her diagnosed (or suspected) mental-health condition needs to be reported to the DVLA (Driver and Vehicle Licensing Authority), and that it is appropriate to recommend to them whether he or she should be allowed to drive.
The DVLA then contacts the consultant for medical evidence, and makes a decision about maintaining, limiting, or revoking the driving licence, based on the diagnosis and what the consultant reports.
7. To go home on overnight leave at least once per week
Leave is sometimes called section 17 leave, because that is the section of the Act under which the Responsible Clinician** (RC) can choose to grant it. That will be a clinical decision, and, since RCs are cautious beasts (as they are still largely consultant psychiatrists), granting leave is never going to be tied to how long the patient has been admitted :
Not least on the common assumption that, if in doubt, it is better for the patient to be on the unit, rather than on leave at home (even if that is 'the least restrictive' option - and a noisy ward, with other patients who are 'high', may not do someone much good who is very depressed).
However, in practice, there will be a correlation between the length of the admission and the length and frequency of leave granted, if the patient is considered to be ‘getting better’ : so, patients can be directed to the fact that leave is being given more often, and for longer, if questioning what the consultant thinks of his or her state of mind.
8. To vote in local and national elections
One can find a summary of the position, under the sub-heading ‘Patients in psychiatric hospitals’, on Citizens’ Advice’s Advice Guide web-site.
As to the law, Acts of Parliament other than the Mental Health Act 1983 have legislated on this topic. Most recently, section 73 of the Electoral Administration Act 2006 has taken the trouble to abolish the so-called common-law rules about ‘mental state’ and ‘incapacity’ (s. 73(1)).
Also, the Representation of the People Act 2000 amended the 1983 Act of that name, to specify that, if registered to vote, there is a right to vote. Practically, though, one would not only have to get to a polling-station in one’s registered constituency, but also not be ‘subject to any legal incapacity to vote’ (s. 1(1)(b) of the 1983 Act (as amended)) : practically, then, staff on the psychiatric unit will not let one’s family take one to vote, if one has been determined to lack capacity.
9. To choose to be treated, on the NHS, by another psychiatrist who is employed by the same NHS Trust
If one credited that provisions in the Health and Social Care Act 2012 signified anything, such as the duty (under section 4) on the Secretary of State for Health to ‘have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service’, one might believe in a right to a second opinion, or even a choice of practitioner.
Or one can read NHS England’s web-site for what it similarly has to say about the much-vaunted principle of parity of esteem (under the 2012 Act), but one will probably search more successfully for a chimæra than in the 1983 Act for the right to choose who has oversight of one’s psychiatric care…
10. To specify that one would never, whatever the consequence, wish to have ECT
Yes, one has the right to make an advanced directive to this effect (as section 58A, sub-section (5), of the Act acknowledges (s. 58A(5)).
That said (and, again, despite that so-called parity of esteem, as discussed in answering Q9), one has less comfort in this than one might think, for, as Stephen Weatherhead (@SteWeatherhead) and The Agent (@THEAGENTAPSLEY) have suggested, the Act also stipulates (in s. 62(1), in the cases specified by paragraphs (a) and (b)) that the directive sometimes does not even signify :
For section 62(1A) says ‘Section 58A above, in so far as it relates to electro-convulsive therapy by virtue of subsection (1)(a) of that section, shall not apply to any treatment which falls within paragraph (a) or (b) of subsection (1) above’ :
Which means, as those paragraphs tell us, treatment ‘which is immediately necessary to save the patient’s life’ (para. (a)), or ‘which (not being irreversible) is immediately necessary to prevent a serious deterioration of his condition' (para. (b))…
11. To see a mental health advocate about any matter of concern
Under section 130A of the Act, the role of Independent Mental Health Advocates (IHMAs) was established (as inserted by the Mental Health Act 2007), and there is national provision for IMHAs (and their establishment and regulation).
Prior to the 2007 Act, but not in name, IMHAs already operated in some places, because advocacy services were already funded : they had protocols and agreements with psychiatric units that allowed these proto-IMHAs to see patients on units, and, because it was not IMHA, they were not limited (as IMHA requires) to addressing rights and concerns arising under the 1983 Act.
To answer the question, then, whether one has a right to see an advocate about ‘any matter of concern’, e.g. whether one can be dismissed for having been sectioned, depends on whether IMHA and general advocacy have been funded in one's locality. Only if so, and then not wholly because of the Act, could a patient raise any concern with an advocate.
12. To spend at least two hours per week, as a total duration, in conversation with one’s primary nurse
By now, the overall pattern may have emerged, so one may not be surprised that the Act would not require this amount of contact-time.
Which is not to say, whether or not directed to do so by a Clinical Commissioning Group (CCG), an NHS Trust could not have made that promise, or a manager of a unit made that part of its operational rules…
Those are The Agent's Answers (as at 11 October (updated 15 October))
It may be open to question whether any rights that are talked about were actually given by the Mental Health Act, or exist despite someone's being detained under one of its sections - the most common mistake of which there was already evidence is to believe that section 2 differs from section 3 regarding treatment under compulsion.
Probably the closest that we come is, with Q8, the changes that finally allowed someone to vote when on section 2 (whereas those in hospital because of the Act's criminal provisions are treated along with this government's attitude towards the prison population, hated for seeking to invoke the right to vote as a Human Right), provided that the person is not determined to lack capacity, though (as in Q10) there is this rather empty victory of advanced directives being acknowledged, but not always being binding (which feels as though one hand gives, the other takes away again)...
However, it was generally intended to challenge with these questions : the fact that, almost certainly, none of them embodied what one could call an absolute, unequivocal right for a detained patient.
End-notes
* Scotland has its own Mental Health Act, so this is only applicable to the law of England & Wales.
** Prior to 2007, this person was the RMO, or Responsible Medical Officer : most RCs are still psychiatrists, however, although the intention of the Mental Health Act 2007 was to widen eligibility for the role.
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
Thursday, 9 October 2014
A quiz for World Mental Health Day : The British* Patient
More views of - or before - Cambridge Film Festival 2014 (28 August to 7 September)
(Click here to go directly to the Festival web-site)
9 October
The British* Patient
Inspired by rewatching The English Patient (1997) earlier in the week, here is a quiz for World Mental Health Day (#WMHD2014 on 10 October) about patients’ rights...
Which of the following are rights of a patient in a psychiatric unit (in England & Wales*) when detained under section 2 of the Mental Health Act 1983 (as amended), headed ‘admission for assessment’ ? :
1. To be placed in a unit within 25 miles of home
2. To see a psychiatrist within 3 hours if distressed
3. Not to take medication, if offered twice already and refused
4. To take a walk in the ground for up to an hour, if the staff are told first
5. To have family or friends visit outside visiting hours in the first two weeks of the admission
6. To drive, as long as one’s partner is present
7. To go home on overnight leave at least once per week
8. To vote in local and national elections
9. To choose to be treated, on the NHS, by another psychiatrist who is employed by the same Trust
10. To specify that would never, whatever the consequence, wish to have ECT
11. To see a mental health advocate about any matter of concern
12. To spend at least two hours per week, in total, in conversation with one’s primary nurse
Answers, as at 11 October, are here...
End-notes
* Scotland has its own Mental Health Act, so this is only applicable to the law of England & Wales.
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
(Click here to go directly to the Festival web-site)
9 October
The British* Patient
Inspired by rewatching The English Patient (1997) earlier in the week, here is a quiz for World Mental Health Day (#WMHD2014 on 10 October) about patients’ rights...
Which of the following are rights of a patient in a psychiatric unit (in England & Wales*) when detained under section 2 of the Mental Health Act 1983 (as amended), headed ‘admission for assessment’ ? :
1. To be placed in a unit within 25 miles of home
2. To see a psychiatrist within 3 hours if distressed
3. Not to take medication, if offered twice already and refused
4. To take a walk in the ground for up to an hour, if the staff are told first
5. To have family or friends visit outside visiting hours in the first two weeks of the admission
6. To drive, as long as one’s partner is present
7. To go home on overnight leave at least once per week
8. To vote in local and national elections
9. To choose to be treated, on the NHS, by another psychiatrist who is employed by the same Trust
10. To specify that would never, whatever the consequence, wish to have ECT
11. To see a mental health advocate about any matter of concern
12. To spend at least two hours per week, in total, in conversation with one’s primary nurse
Answers, as at 11 October, are here...
End-notes
* Scotland has its own Mental Health Act, so this is only applicable to the law of England & Wales.
If you want to Tweet, Tweet away here
Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
Tuesday, 9 July 2013
Is mental health advocacy better than nothing ?
More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)
10 July
I worked as an advocate for eight years.
When I started, there was no such thing in name as IMHA (Independent Mental Health Advocacy) for people detained under the Mental Health Act 2003 as it then stood (commonly known, for no good reason, as ‘being sectioned’), but our contract, and our arrangement with the mental-health trust, meant that we went onto the wards and could give people just the same help with the Act, but without the powers given to IMHAs, for example, to look at hospital records (I never needed to).
IMHA is a very specific thing. The training to become one, I have to say, is rubbish and factually incorrect or misleading in several places, when, that is, it is not box-ticking and jumping through hoops. That apart, one could and should be very competent in being able to explain a person’s rights to him and her.
Yet that is not because of the training, but because of the limited compass of what one typically needs to know from day to day, whereas the vast numbers who are on supervised community treatment (usually thought of as a Community Treatment Order, or CTO, though it is not an Order as such) indicate either that few people take the chance to have their rights explained, or that (which has to be laid at the IMHA’s door) they do not understand their rights.
Considering supervised community treatment is a triggering event for a person to be advised of his or her rights to see an IMHA, so I should be interested to see figures for how many exercise it. Just a guess, but I imagine few, because it is typically hard, as a patient, to believe that there is a just and fair system and that one has any right that is not compromised.
After all, the person may already have poured his or her heart out to an advocate that he or she should not have been detained under (the civil sections of) the Act, and have been told that, all impressions and intents to the contrary, the psychiatric unit is not a prison or part of the criminal-justice system. Under IMHA, one would be able to know more about the detention, and, safeguarding not telling the person something that would injure his or her health, to pass that reason on.
So that is IMHA, and the typical scope of enquiries that one might have under the Act. Contrast that with, say, a matter of contract or of family law for the same person, whether or not still in hospital. For good or ill, advocates largely ignore the question of capacity, and so will support clients (including seeking to find them, without charge, increasingly unavailable legal representation) to do what they seek. This never happened to me, but he or she may want to give up a tenancy, and, if he or she refuses to have advice on doing so, may be guided through an irreversible process that will later be regretted.
That is one point where I say that advocacy is not better than nothing : with nothing, the person might not get there on his or her own, whereas what, of lasting good, has been achieved in the name of empowering the client ? I had colleagues who had had to help with such folly in the name of empowerment, and who gained some reassurance, by relying on the generalized and self-perpetuating ‘advocacy principles’, that they had, by doing their job, done the right thing. I cannot say or think so – that is the mindset of advocacy, but it is wrong.
Advocacy puffs itself up with the notion that it is a profession. It even uses terms from ‘taking instructions’ to ‘attendance notes’ that are (did one’s colleagues but know it) properly those of solicitors, but with this important difference : The Law Society will not allow a solicitor to proceed, without some independent verification of capacity, if her or she doubts that the client lacks it (in relation to the legal task in hand and the decisions that have, or may have, to be taken). There is no equivalent of The Law Society for so-called generic advocates, but just guidance from bodies such as Action for Advocacy.
Advocacy is not a real profession, although caught by the requirement to provide a service with reasonable care and skill (but advocacy services have scant notion of liability, risk and the scope of a duty of care), and it will sidestep the protection that, as just seen, a solicitor will have to employ to achieve outcomes that can be as damaging, if not more so.
Damaging, if not pointless, for my manager once required me to fly in the face of a direction from a judge in the belief that going to a full hearing would give the client closure* (I had no such belief, and it did not, because he wanted to appeal, and then, when told that he had no grounds for an appeal, wanted a second opinion) : to my mind, if a judge, prior to trial, expresses the view that, without x, a case cannot succeed, one either gets x, or tells the client that one cannot support him to go to trial unless he agrees to get it.
What we did was to go to trial without x, and it was a futile exercise, built on unrealistic ideas that the client would see that the process had been gone through and exhausted, in giving the client the right to ignore a very big judicial piece of advice for no very good reason. Did the client have capacity in relation to these matters ? I rather doubt so, and his ‘instructions’ were of a repetitive, yet not always consistent, kind that was unlikely to find judicial favour in any case. I say all this as a former solicitor (though none of my colleagues had any legal training whatever.)
So on lack of proper safeguards for imprudent decision-making there are concerns, but advocacy is also founded on the shaky basis, touched upon already without calling it such, of giving the person the right to have his or her say. If it’s having a say that rights were infringed, and that hospital staff should not have done what they did, how crushing is it to put all that into a complaint, and then have back from the complaints department that there is ‘no evidence’ that what the client claims happened.
Does one, in hindsight, guard the client’s expectations of the process so that he or she will not be crushed by the outcome, or has the client made his or her own bed ? To make the complaint with the client, it was necessary to come alongside and to empathize with what he or she said, and one is forbidden (despite being permitted to say what is likely to happen from past experience) to express one’s own opinion, because that is a big advocacy no-no except by taking the client, with his or her consent, to someone else such as a solicitor who can express one, and give advice.
If, faced with a client who is upset by what happened and wants to make a complaint, one cannot really say that most complaints procedures are a whitewash and that the client will just be upset more, because that would stray from what is likely to seeking to persuade or advise : the client alone must decide, and one has no opinion to express.
The blind leading the blind ? Sadly, yes, I think so, however well-meaningly grounded in peer support, and little better than kindly do-gooders, unanswerable to anyone much when it all comes unstuck. Add to that people who know things that they do not, such as how one cannot (one cannot ?) be dismissed for being off sick or that, even if the time-limit for bringing an employment claim may turn to be passed, one can simply argue that one could not bring a claim before (and so simply), and the cacophony becomes unbearable.
Either non-IMHA advocates such know more, and be qualified as legal executives, or they should do less. They are not professionals in any meaningful sense, and they should not be allowed to help people without capacity to do objectively undesirable things on some woolly basis of empowering them.
As to IMHA, I reserve judgement, but a five-day training on the Act before IMHA came in was a much better grounding in how it works than the dedicated IMHA module. The advocacy world went soft when the statutory training was announced : there should have been exemptions for existing advocates, more intensive training for new advocates, and none of this vague competency-based accreditation, which does not substitute for solidly understanding the Act and how it applies to different situations.
As if this were not enough, you can now read The Ten Glib Compromises of Advocacy (in retort to The Advocacy Charter)...
End-notes
* It may be explicit enough in what I wrote last night, but I still remember so much of the blinkered vision of advocacy's so-called principles that I was accustomed not to portray that as appalling cynicism - support the client to go to trial, not because we believe that he now, with the stance that he has taken, stands any chance, but just so that we have reason to shut him up !
In the same way, one insulated oneself, in the way that I mentioned earlier on, from questioning whether the principles that had one facilitate someone doing / not doing something just because, at that moment, he or she felt like doing / not doing it were sound or right.
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10 July
I worked as an advocate for eight years.
When I started, there was no such thing in name as IMHA (Independent Mental Health Advocacy) for people detained under the Mental Health Act 2003 as it then stood (commonly known, for no good reason, as ‘being sectioned’), but our contract, and our arrangement with the mental-health trust, meant that we went onto the wards and could give people just the same help with the Act, but without the powers given to IMHAs, for example, to look at hospital records (I never needed to).
IMHA is a very specific thing. The training to become one, I have to say, is rubbish and factually incorrect or misleading in several places, when, that is, it is not box-ticking and jumping through hoops. That apart, one could and should be very competent in being able to explain a person’s rights to him and her.
Yet that is not because of the training, but because of the limited compass of what one typically needs to know from day to day, whereas the vast numbers who are on supervised community treatment (usually thought of as a Community Treatment Order, or CTO, though it is not an Order as such) indicate either that few people take the chance to have their rights explained, or that (which has to be laid at the IMHA’s door) they do not understand their rights.
Considering supervised community treatment is a triggering event for a person to be advised of his or her rights to see an IMHA, so I should be interested to see figures for how many exercise it. Just a guess, but I imagine few, because it is typically hard, as a patient, to believe that there is a just and fair system and that one has any right that is not compromised.
After all, the person may already have poured his or her heart out to an advocate that he or she should not have been detained under (the civil sections of) the Act, and have been told that, all impressions and intents to the contrary, the psychiatric unit is not a prison or part of the criminal-justice system. Under IMHA, one would be able to know more about the detention, and, safeguarding not telling the person something that would injure his or her health, to pass that reason on.
So that is IMHA, and the typical scope of enquiries that one might have under the Act. Contrast that with, say, a matter of contract or of family law for the same person, whether or not still in hospital. For good or ill, advocates largely ignore the question of capacity, and so will support clients (including seeking to find them, without charge, increasingly unavailable legal representation) to do what they seek. This never happened to me, but he or she may want to give up a tenancy, and, if he or she refuses to have advice on doing so, may be guided through an irreversible process that will later be regretted.
That is one point where I say that advocacy is not better than nothing : with nothing, the person might not get there on his or her own, whereas what, of lasting good, has been achieved in the name of empowering the client ? I had colleagues who had had to help with such folly in the name of empowerment, and who gained some reassurance, by relying on the generalized and self-perpetuating ‘advocacy principles’, that they had, by doing their job, done the right thing. I cannot say or think so – that is the mindset of advocacy, but it is wrong.
Advocacy puffs itself up with the notion that it is a profession. It even uses terms from ‘taking instructions’ to ‘attendance notes’ that are (did one’s colleagues but know it) properly those of solicitors, but with this important difference : The Law Society will not allow a solicitor to proceed, without some independent verification of capacity, if her or she doubts that the client lacks it (in relation to the legal task in hand and the decisions that have, or may have, to be taken). There is no equivalent of The Law Society for so-called generic advocates, but just guidance from bodies such as Action for Advocacy.
Advocacy is not a real profession, although caught by the requirement to provide a service with reasonable care and skill (but advocacy services have scant notion of liability, risk and the scope of a duty of care), and it will sidestep the protection that, as just seen, a solicitor will have to employ to achieve outcomes that can be as damaging, if not more so.
Damaging, if not pointless, for my manager once required me to fly in the face of a direction from a judge in the belief that going to a full hearing would give the client closure* (I had no such belief, and it did not, because he wanted to appeal, and then, when told that he had no grounds for an appeal, wanted a second opinion) : to my mind, if a judge, prior to trial, expresses the view that, without x, a case cannot succeed, one either gets x, or tells the client that one cannot support him to go to trial unless he agrees to get it.
What we did was to go to trial without x, and it was a futile exercise, built on unrealistic ideas that the client would see that the process had been gone through and exhausted, in giving the client the right to ignore a very big judicial piece of advice for no very good reason. Did the client have capacity in relation to these matters ? I rather doubt so, and his ‘instructions’ were of a repetitive, yet not always consistent, kind that was unlikely to find judicial favour in any case. I say all this as a former solicitor (though none of my colleagues had any legal training whatever.)
So on lack of proper safeguards for imprudent decision-making there are concerns, but advocacy is also founded on the shaky basis, touched upon already without calling it such, of giving the person the right to have his or her say. If it’s having a say that rights were infringed, and that hospital staff should not have done what they did, how crushing is it to put all that into a complaint, and then have back from the complaints department that there is ‘no evidence’ that what the client claims happened.
Does one, in hindsight, guard the client’s expectations of the process so that he or she will not be crushed by the outcome, or has the client made his or her own bed ? To make the complaint with the client, it was necessary to come alongside and to empathize with what he or she said, and one is forbidden (despite being permitted to say what is likely to happen from past experience) to express one’s own opinion, because that is a big advocacy no-no except by taking the client, with his or her consent, to someone else such as a solicitor who can express one, and give advice.
If, faced with a client who is upset by what happened and wants to make a complaint, one cannot really say that most complaints procedures are a whitewash and that the client will just be upset more, because that would stray from what is likely to seeking to persuade or advise : the client alone must decide, and one has no opinion to express.
The blind leading the blind ? Sadly, yes, I think so, however well-meaningly grounded in peer support, and little better than kindly do-gooders, unanswerable to anyone much when it all comes unstuck. Add to that people who know things that they do not, such as how one cannot (one cannot ?) be dismissed for being off sick or that, even if the time-limit for bringing an employment claim may turn to be passed, one can simply argue that one could not bring a claim before (and so simply), and the cacophony becomes unbearable.
Either non-IMHA advocates such know more, and be qualified as legal executives, or they should do less. They are not professionals in any meaningful sense, and they should not be allowed to help people without capacity to do objectively undesirable things on some woolly basis of empowering them.
As to IMHA, I reserve judgement, but a five-day training on the Act before IMHA came in was a much better grounding in how it works than the dedicated IMHA module. The advocacy world went soft when the statutory training was announced : there should have been exemptions for existing advocates, more intensive training for new advocates, and none of this vague competency-based accreditation, which does not substitute for solidly understanding the Act and how it applies to different situations.
As if this were not enough, you can now read The Ten Glib Compromises of Advocacy (in retort to The Advocacy Charter)...
End-notes
* It may be explicit enough in what I wrote last night, but I still remember so much of the blinkered vision of advocacy's so-called principles that I was accustomed not to portray that as appalling cynicism - support the client to go to trial, not because we believe that he now, with the stance that he has taken, stands any chance, but just so that we have reason to shut him up !
In the same way, one insulated oneself, in the way that I mentioned earlier on, from questioning whether the principles that had one facilitate someone doing / not doing something just because, at that moment, he or she felt like doing / not doing it were sound or right.
If you want to Tweet, Tweet away here
Wednesday, 15 May 2013
Me and Theresa May
More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)
15 May
Here is a response to part of what Theresa May is reported as having said (in @guardian) :
THEAGENTAPSLEY
15 May 2013 3:51pm
Recommend
0
I believe all these proposals will make a real difference to police officers on the ground. But ultimately police officers need the assurance that vulnerable people with mental health problems will be dealt with by health and social care services, not the police.
Not for the first time, a Secretary of State not knowing what he or she is talking about :
If a person is 'liable to be detained' (i.e. before formally taken to a psychiatric unit, or having 'absconded'), or someone enters premises under s. 135 Mental Health Act 1983, the police have the specific job of, in some cases, of 'conveying' the person liable to be detained to the unit, but anyway of bringing back absconders and breaking into premises.
In fact, the police are all over the 1983 Act - talking about s. 136 is just the usual knee-jerk, ill-thought-out rash promise of change in the hope of not doing anything (much) before the General Election, and just because of having to in the light of the Adebowale report.
An average of 11 deaths per year just for The Met is shocking. However, does anyone care about the routine level of deaths on in-patient units ? :
It would be helpful to have some figures cited for this rate of mortality, if collated figures exist (Care Quality Commission ?), before assuming that (a) this is simply a problem of the police (with s. 136) having to do what they shouldn't do, or (b) is less mismanaged by 'health and social services', or that those services' practices are any better than those of The Met...
If you want to Tweet, Tweet away here
(Click here to go directly to the Festival web-site)
15 May
Here is a response to part of what Theresa May is reported as having said (in @guardian) :
THEAGENTAPSLEY
15 May 2013 3:51pm
Recommend
0
I believe all these proposals will make a real difference to police officers on the ground. But ultimately police officers need the assurance that vulnerable people with mental health problems will be dealt with by health and social care services, not the police.
Not for the first time, a Secretary of State not knowing what he or she is talking about :
If a person is 'liable to be detained' (i.e. before formally taken to a psychiatric unit, or having 'absconded'), or someone enters premises under s. 135 Mental Health Act 1983, the police have the specific job of, in some cases, of 'conveying' the person liable to be detained to the unit, but anyway of bringing back absconders and breaking into premises.
In fact, the police are all over the 1983 Act - talking about s. 136 is just the usual knee-jerk, ill-thought-out rash promise of change in the hope of not doing anything (much) before the General Election, and just because of having to in the light of the Adebowale report.
An average of 11 deaths per year just for The Met is shocking. However, does anyone care about the routine level of deaths on in-patient units ? :
It would be helpful to have some figures cited for this rate of mortality, if collated figures exist (Care Quality Commission ?), before assuming that (a) this is simply a problem of the police (with s. 136) having to do what they shouldn't do, or (b) is less mismanaged by 'health and social services', or that those services' practices are any better than those of The Met...
If you want to Tweet, Tweet away here
Saturday, 13 April 2013
Soft targets for scorn : Who gives a stuff about homoeopathy* ?
More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)
13 April
Honestly, I'd really far rather that people such as Simon Singh, who campaign about homoeopathy, would consider the rights and wrongs of electro-convulsive therapy* (ECT), or even psychosurgery : that's keeping it within the so-called sphere of medicine (borderline butchery ?), but one could migrate to hammering many an alternative therapy, whereas homoeopathy seems to have an abiding fascination, which is what this posting concerns itself with.
To keep with ECT : it's odd that human-rights campaigners, journalists and the like want to stress the inhumanity of measures used against, say, Iraqi detainees to break them (whether or not to get information from them), but those - equally detained - under the Mental Health Act 1983 (as amended) seem to be have some different sort of emotional or moral status as victim, compared with military prisoners or officials of deposed regimes. Maybe I'm just weird in finding that curious...
Actually, I don't think so, because it actually seems easier (possibly as a result of documentary : but, then, who makes the documentaries, and why about that ?) for people to contemplate the ethics of the waterboarding or mock execution of a captive in (or brought from) a foreign country than what might happen, say, to an Afghani in a UK psychiatric unit, deemed to be in an unshakeable depression and (irrespective of consent) to need ECT to save his life or for some other reason under the 1983 Act.
And where are we with our headline issue, homoeopathy ? Well, isn't much criticism - dressing-up of the criticism aside - just saying either You're gullible pricks to believe in this crap (various royals included, I believe***), or You are exploiting gullible pricks who believe in this crap - and it matters because it is done 'on the NHS' ?
So what irritates me is the arbitrarily focused smugness of those who say that this is all crap and we're not such mugs as to believe in it, or to want it to continue :
Nothing better to get angry about (such as the mental-health or other humanitarian issues already mentioned) ?
Or just making a fuss because it's an easy battle to win, when most people grasp that the practice is one of repeated dilution, and don't need much stoking to concur that it should not happen at public expense.
Frankly, with the waste that is everywhere in this world, from unnecessarily upgrading phones or laptops (or PCs) just because people can, or have to****, is stopping homoeopathic treatment going to save anything sigificant in terms of money or lives ? Is is really such a huge topic that Pratter needs to be full of condemnation of it, whether in ridicule or rhetoric ?
Unless homoeopathy is banned by law (and might go underground ?), it will continue privately, so the people who were involved in the NHS have an incentive - called losing their job - to work for a private institution, or set up on their own. Net result what ? What savings, and what change ?
Maybe worthwhile in itself, but why not highlight the horrible and cruel isolation and poverty in which many with mental-health conditions have to live ? The lack of befriending or other support schemes, the lack of concern that poor diet, lifestyle and even the long-term effects of medication have on, and reciprocally so, physical health, the battles to be awarded and survive on wlefare benefits, etc., etc., ?
Honestly, Splatter, I really can't think that it matters any great amount, when such degraded lives are all around us, that a few people are being prescribed overdiluted extracts - don't mock or barrack this practice of low significance when people are living and dying in obscurity. If you choose to, you prove that your own mental and personal satisfaction in what you do outweighs the demands of your humanity, your integrity, and your intellect.
End-notes
* How can something as damaging, as brutal and little understood as to its mechanism of effectiveness (when effective), be called 'a therapy' ?
** Most people who Tweet so much about it can't even spell it - they write homeopathy, when they'd probably pounce on someone not putting homoeothermy...
*** And some might know, far better than I, how there came to be a Bristol Homoeopathic Hospital.
**** Because applications and web-coding becomes ever more (gratuitously ?) complicated, and not (or no longer) supported by the only operating that will run on a computer because of its specification, whose functionality is otherwise perfectly good.
If you want to Tweet, Tweet away here
(Click here to go directly to the Festival web-site)
13 April
Honestly, I'd really far rather that people such as Simon Singh, who campaign about homoeopathy, would consider the rights and wrongs of electro-convulsive therapy* (ECT), or even psychosurgery : that's keeping it within the so-called sphere of medicine (borderline butchery ?), but one could migrate to hammering many an alternative therapy, whereas homoeopathy seems to have an abiding fascination, which is what this posting concerns itself with.
To keep with ECT : it's odd that human-rights campaigners, journalists and the like want to stress the inhumanity of measures used against, say, Iraqi detainees to break them (whether or not to get information from them), but those - equally detained - under the Mental Health Act 1983 (as amended) seem to be have some different sort of emotional or moral status as victim, compared with military prisoners or officials of deposed regimes. Maybe I'm just weird in finding that curious...
Actually, I don't think so, because it actually seems easier (possibly as a result of documentary : but, then, who makes the documentaries, and why about that ?) for people to contemplate the ethics of the waterboarding or mock execution of a captive in (or brought from) a foreign country than what might happen, say, to an Afghani in a UK psychiatric unit, deemed to be in an unshakeable depression and (irrespective of consent) to need ECT to save his life or for some other reason under the 1983 Act.
RT @mrxeis From an adviser who says #Homeopathy is Mad to one who says it is Nonsense. Just about covers the spectrum of scientific opinion.
— Simon Singh (@SLSingh) April 18, 2013
And where are we with our headline issue, homoeopathy ? Well, isn't much criticism - dressing-up of the criticism aside - just saying either You're gullible pricks to believe in this crap (various royals included, I believe***), or You are exploiting gullible pricks who believe in this crap - and it matters because it is done 'on the NHS' ?
So what irritates me is the arbitrarily focused smugness of those who say that this is all crap and we're not such mugs as to believe in it, or to want it to continue :
Nothing better to get angry about (such as the mental-health or other humanitarian issues already mentioned) ?
Or just making a fuss because it's an easy battle to win, when most people grasp that the practice is one of repeated dilution, and don't need much stoking to concur that it should not happen at public expense.
Frankly, with the waste that is everywhere in this world, from unnecessarily upgrading phones or laptops (or PCs) just because people can, or have to****, is stopping homoeopathic treatment going to save anything sigificant in terms of money or lives ? Is is really such a huge topic that Pratter needs to be full of condemnation of it, whether in ridicule or rhetoric ?
Who cares, @slsingh ? All these Tweets about homoeopathy are plain boring !
— THE AGENT APSLEY (@THEAGENTAPSLEY) April 18, 2013
Unless homoeopathy is banned by law (and might go underground ?), it will continue privately, so the people who were involved in the NHS have an incentive - called losing their job - to work for a private institution, or set up on their own. Net result what ? What savings, and what change ?
Maybe worthwhile in itself, but why not highlight the horrible and cruel isolation and poverty in which many with mental-health conditions have to live ? The lack of befriending or other support schemes, the lack of concern that poor diet, lifestyle and even the long-term effects of medication have on, and reciprocally so, physical health, the battles to be awarded and survive on wlefare benefits, etc., etc., ?
Honestly, Splatter, I really can't think that it matters any great amount, when such degraded lives are all around us, that a few people are being prescribed overdiluted extracts - don't mock or barrack this practice of low significance when people are living and dying in obscurity. If you choose to, you prove that your own mental and personal satisfaction in what you do outweighs the demands of your humanity, your integrity, and your intellect.
@theagentapsley i think you want the unfollow button
— Simon Singh (@SLSingh) April 18, 2013
End-notes
* How can something as damaging, as brutal and little understood as to its mechanism of effectiveness (when effective), be called 'a therapy' ?
** Most people who Tweet so much about it can't even spell it - they write homeopathy, when they'd probably pounce on someone not putting homoeothermy...
*** And some might know, far better than I, how there came to be a Bristol Homoeopathic Hospital.
**** Because applications and web-coding becomes ever more (gratuitously ?) complicated, and not (or no longer) supported by the only operating that will run on a computer because of its specification, whose functionality is otherwise perfectly good.
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