20 November, 2007

Mental health

Mental Health

(Courtesy of the contributors to the MDU online casefile)

Most mental health patients are voluntary. Mental health legislation concerns patients refusing to enter hospital or take medication as their doctor requires. It allows the doctor to override a patient’s refusal and force medication upon him.

A patient cannot be detained under this legislation and forced to take medicine, however irrational the decision is, if the *only* reason for detention is to force treatment. Eg: a woman who is 39 weeks pregnant who has been advised that she must have a caesarian or she and the baby will die can legally refuse all treatment. If a doctor does treat, he may be charged with assault, battery and trespass to the person.

Exemptions under 1983 legislation

It is essential that people should not be detained under the legislation solely on account of their misuse of drugs or alcohol, committing disorderly acts, sexual behaviour, sexual identity, or for cultural, religious or political beliefs. These exclusions are important protections. Examples abound of discrimination, prejudice and ignorance by clinicians; with 44 per cent more black people sectioned than white there are clearly problems.

What options does the state have for mentally ill people who may pose a threat to themselves or others?

Sectioning (Compulsory detention for the purpose of treatment)

Under 1983 legislation a person can only be confined for medication against their will if their condition satisfies the criterion of medical 'treatability' it is alleged that this is often interpreted to mean 'cure' leading to dangerous people being released into the community. the government wishes to change this to if ‘appropriate treatment’ is available to them the lords believes that this is a dangerous catch-all

Although the average compulsory stay in hospital is three-and-a-half months, some patients have been detained for decades, and there are mistakes and abuses;

Released Under Supervision (Community Treatment Orders, CTOs)

Under the 1983 Act, patients are only discharged under supervision if there is ‘substantial risk of serious harm to the health or safety of the patient or the safety of other persons, or of the patient being seriously exploited’.

Negative Consequences of Sectioning (PB)

Detention for any patient often has significant ill-effects. Once detained, patients can lose their job and their accommodation, and employers prefer to take on staff who have served time for criminal acts than to employ people who have been sectioned. The insecurity that this brings is not conducive to recovery — added reason for detention to be used only when really necessary

Fear of sectioning is also a massive disincentive to seek treatment: Fear of compulsory treatment is so severe that it keeps many patients away from mental health services; by the time they do access them they are often more seriously ill and potentially more dangerous to themselves and to others. Early intervention works, and is demonstrated unambiguously by the evidence base; the Joint Parliamentary Scrutiny Committee Report Vol. 3 confirms this.

Compulsion also alters the theraputic relationship between clinition and patient - the evidence shows that it is the effectiveness of this relationship, not compulsion, that is the key to improving recovery for patients with mental health problems.

No comments: