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)
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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 ! :(

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 ?

— THE AGENT APSLEY (@THEAGENTAPSLEY) February 16, 2018

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)

Mental-health in-fighting

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22 October

There is a well-worn claim that a person with an experience of schizophrenia is called a schizophrenic, whereas a person who has cancer is not called a cancerist.

But we do call people diabetics, haemophiliacs, coeliacs, hypochondriacs, hysterics, alcoholics, etc., and half of those nouns relate to physical conditions.

Yes, it is nicer not 'to define someone' by reference to their health, but the cancer argument employed is a bogus one, not least since I believe that people do sometimes relate to hearing that someone has cancer on an irrational level, of its being karma / punishment, or as if the cancer is infectious, or the person can no longer be related to as a person, but as only a substrate for a deadly disease : dehumanizing the person, by only seeing him or her in terms of the spread - or remission - of the cancer(s). (In another posting, I suggested how mental ill-health is not different from, but exactly like, a broken leg.)

Some people object to the term service-user, saying that they did not choose to have mental-health services (they were cajoled, coerced, sectioned, medicated against their will, mistreated (when they were supposed, ironically, to be treated in the system's own terms)), others simply do not care, even if they have had the same experiences, and are not worried about a need to challenge use of the word.

In similar ways, some have a diagnosis thrust upon them, and struggle to feel content with someone else defining their experience in that way, whereas others, refused a service unless they have a diagnosis, embrace one, and feel that it validates.

Of course, that sense of validation, of finally being believed, could relate just as much to the situation of someone with what turns out to be a brain tumour, who succeeds in persuading someone to carry out a scan and whose findings account for their bizarre or troubling symptoms, previously discounted on supposed medical grounds.

Or there could be a person who is happy with his or her body-shape at 22 stone, and who rejects the notion of being obese - and, if it is not interpreted as a mental-health issue (with implications for a forced admission), but, say, as a lifestyle choice, he or she is free (subject to these irritating medical promptings) to do as he or she pleases with his or her body.

So, returning to the question of diagnosis, one person might be able to get help, because of a diagnosis, whereas a person, supported with a diagnosis of bi-polar disorder, might then be denied support, if it is claimed that it was a misdiagnosis and that he or she has borderline personality disorder (and vice versa, the latter likely to be a case where he or she is pleased with the new diagnosis, which he or she has probably been fighting to have recognized as 'a better fit').

And then there is so-called depression (because I believe that the word has outlived its usefulness - unless it can be 'reclaimed' - when too many people think that it just means being a bit sad, that the person described as being depressed is lazy, shamming, not trying as they would, and that they know what it means, when they do not). I took issue with @StephenFry likening depression to a meteorological cold front, which, like the wind, rain or snow, just is until it is over :

I honestly thought that having that debate might make people question whether low mood and negativity really just are, or whether some people might be helped - some of the time - by psychological intervention, as practitioners and writers such as Paul Gilbert want to say (e.g. Gilbert's self-help book, Overcoming Depression). Fry's message of waiting for the good days to come may work at one level, where crashing for two or three days may allow one to regroup and feel restored / revived, but what if that crashing could be avoided, or, at least, postponed to a less critical time ?

It is this polarity of the discussions in mental-health circles that frustrates me : Fry was no doubt wishing to be helpful, but seemed didactic in his statement, as if to the exclusion of the possibility that sessions with a psychologist might make an improvement such as described. Likewise, those 'saddled with' a diagnosis (and, maybe, poor or no treatment) seem to be at odds with those who, as suggested, might have had their beliefs about themselves confirmed by one.

When one person, wanting to feel safe from impulses to commit suicide (which I maintain is an acceptable expression), might benefit from feeling safe on an acute psychiatric ward, someone who is at a level of depression not just to be numbed to what is happening might equally experience it as too lively, too fuelled by the activity of those whose mood is at the opposite extreme to be a therapeutic environment - and they, too, might find each other's psychotic assertions frightening and disturbing, which is hardly likely to lead to peace and a lowering of anxiety.

Is a ward such as that, then, a microcosm of the flare-ups that the mental-health element of Twitter seems to accommodate, perhaps even invite or spark ? Or is it no different from any topic where feelings are running high on both sides ?


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Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

What things do I point to in Laing and Szasz's thought?

More views of - or before - Cambridge Film Festival 2012
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13 October

Following on from Ronnie, gae hame!, I have some thoughts to share about Drs Laing and Szasz and their place in the order of things...

1. Dignity and respect - talked about in recent days, as if just invented with applicability to being an in-patient, but the story tells us that Ronnie was alongside, literally, someone who, naked, just rocked and would not engage, so he did the same. But, for all these schemes such as Star Wards, because it's not in the culture of mental-health nursing, nothing much is different, not least at the level of patients feeling that they're in an underclass because of being 'ill': on a crude scale, a sort of pecking order, anything that the relatives have to say (and so they can support, and speak up for, the patient about troubling side-effects, because, unlike the patient him- / herself, those people count) carries far more weight, and the status of anything said by the patient is less important than the family pet's views of his or her care.

2. Coercion - if I compel you to do or suffer something, even for your own good, how is it likely that you will feel about the thing that you did (or suffered), about me for forcing you, and about myself for having been a person who is legally allowed to be treated in that way? Whatever a breakdown is, if it leads to an admission, being dehumanized by hospitalization and institutionalization makes for far more trauma for the in-patient (whereas his or her aberrant behaviour hacked off friends, neighbours, relatives and /or the police, and so, for their sake, he or she gets detained) than the breakdown itself. I think that Thomas questioned why, if someone has to be coerced, there can be therapy, rather than distrust, resentment, fear, pain, on the part of the patient towards the detaining authorities - my analogy, but a bit like trying to carry out dentistry on someone who is not willingly opening his or her mouth.

3. Compassion - much more than those basic things at 1, above, - partly involved in doing what Ronnie did in rocking with that patient, and which feeling for and honouring the respect and dignity of patients would not, in itself, lead to. Compassion wholeheartedly and without reservation puts your lot in with the other person's*, often thought of as unconditional love, and is almost at an opposite pole to psychiatric practice of Ronnie's time - you wouldn't have found many endorsing the rocking anecdote as concordant with their views of patients.

4. Criminality - if I lock you up, whether you're drunk and have smashed some things, or in psychosis and have done the same, and you don't appreciate the situation (in the latter case, thought of as lack of insight), you will nonetheless - at some level - know that you are being treated as if you have done something wrong. As I look at what Thomas might have meant at 2, above, and think of mental health in England and Wales, the police can (forcibly) take you to a place of safety, they may be involved in any sectioning process or in taking you to hospital (if you do get sectoned), and they are the people who take you back, if you escape (or try to). In our own system, then, the coercion and the criminal taint are linked, even though, under the Minstry of Justice's control, there is quite separate legal provisions for the foricble detention of people on remand for or convicted of criminal offences: the in-patient not only feels imprisoned, mistreated, misunderstood, misrepresented, but has a perception that some criminal wrong is the reason for all this punishment. And, amidst all this, he or she is supposed to recover, respond to treatment, and - which is itself ambiguous as to health and character - get better.


For what it is worth, those are my thoughts on what Thomas and Ronnie still have to say to us, decades on...


End-notes

* In Ronnie's case, I suggest that he probably took compassion too far, rather than the approach of being empathic, which, for anyone with mental-health issues, is a less costly and, literally, less soul-destroying way of relating to patients. Whatever happened to him in later life, with booze - but he was a Glaswegian - and the effect of efame or whatever, I guess that he may have given too much of himself, and in a way that Adrian, one of his sons, likes to report (he has written a biography) that Ronnie did not do at home, by usually describing home life as a crock of shit.


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