Showing posts with label sectioned. Show all posts
Showing posts with label sectioned. Show all posts

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) !





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 :









Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)
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Saturday, 10 October 2015

For World Mental Health Day 2015 : Where, in me, is Kafka’s Josef K. ?

More views of – or before – Cambridge Film Festival 2015 (3 to 13 September)
(Click here to go directly to the Festival web-site)

10 October, World Mental Health Day

A personal vision of trying to relate to the experience of breakdown / psychiatric challenge in the form of ongoing existential / spiritual self-examination

This is not [meant to be], on #WMHD2015, @THEAGENTAPSLEY talking about others as if about the self (or vice versa)*.

Rather, it is more in the nature of a confession, of trying to be honest and open about what breakdown, and admission under section (circa 21 April 1996), deep down meant and felt like, and still does, just now – when the feeling of how I act, and have acted, hypocritically can be keen, as here :






If needed, here is a paragraph from Wikipedia®'s summary of the plot of The Trial**, by way of partial context for those Tweets :

K. is visited by his uncle, who was K.'s guardian. The uncle seems distressed by K.'s predicament. At first sympathetic, he becomes concerned that K. is underestimating the seriousness of the case. The uncle introduces K. to a lawyer, who is attended by Leni, a nurse, who K.'s uncle suspects is the advocate's mistress. During the discussion it becomes clear how different this process is from regular legal proceedings: guilt is assumed, the bureaucracy running it is vast with many levels, and everything is secret, from the charge, to the rules of the court, to the authority behind the courts – even the identity of the judges at the higher levels. The attorney tells him that he can prepare a brief for K., but since the charge is unknown and the rules are unknown, it is difficult work. It also never may be read, but is still very important. The lawyer says that his most important task is to deal with powerful court officials behind the scenes. As they talk, the lawyer reveals that the Chief Clerk of the Court has been sitting hidden in the darkness of a corner. The Chief Clerk emerges to join the conversation, but K. is called away by Leni, who takes him to the next room, where she offers to help him and seduces him. They have a sexual encounter. Afterwards K. meets his uncle outside, who is angry, claiming that K.'s lack of respect has hurt K.'s case.


NB Looking back, in that way, to sectioning in 1996 (and again in January 1997), there is no intention to suggest that anyone else does feel, or ought to feel, twinges of conscience that are tied up with their experience of mental-health issues or services.

However, for me, conscience / awareness of feeling a fraud seem in the midst of what happened then, now, and everywhere in between.

If I see a spiritual or existential dimension in my own issues of mental health, it is for me to see – or, more likely, pretend to myself that I am aware of it, when largely I keep it well hidden (at least from myself) : it is all in relation to wanting to work out my paranoia, and why I can, so easily, find accusation in comments, words and texts (mainly from memory, though also in recollected things that people said or wrote, and what they meant / whether they really meant xyz)…


Coda :

And remembering may be, for some, to do with learning not to forget... ? :




End-notes

* As one of Beckettt’s authorial voices says somewhere (in The Unnamable, or is it Company ?), When I say ‘I’, and – having addressed the question whatever / whoever ‘I’ is (and he digresses, as I do, in the fashion of Laurence Sterne’s principal narrator, Tristram Shandy) – he goes on to say just that : when saying ‘I’, he does not intend to talk about someone else (as if it were he).

(Molloy, too, certainly mentions that he may lapse into talking of himself as if of another.)

** Kafka wrote the (incomplete) novel in German, entitled Der Prozeß.



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




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