The legality of psychiatric medicine and why our mental health system is so inadequate

A service user reflects on her experience

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In 2016, can it really be said we have an adequate mental health system for the one in four of the 60 million people living in the United Kingdom who has, or will develop, a mental illness?

The experiences of many patients and their families — as well as the opinions of carers and mental health professionals — suggest that we do not.

Only recently, a report found that mentally ill patients in the north of England were being admitted to hospitals in London due to budget cuts, wards closing and beds being lost more so in psychiatric medicine than general medicine.

When comparing psychiatric medicine to physical ailments, why is it that psychiatric medicine is considered less worthy than general medicine?

Drawing on my experiences of psychiatric medicine as a mental health service user who suffers from depression, I feel that a mentally ill person’s treatment is comparable to a person with a broken arm going to A&E and being told “here are some painkillers to numb the pain, but we’re not going to treat the underlying condition of your broken arm.”

Shockingly, once a person has been sectioned under the Mental Health Act for the first time, they usually never leave the psychiatric care system (which includes NHS trusts, the police, Social Services, social housing landlords and many more.)


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This is not the fault of psychiatrists and psychiatric nurses, but the fault of the national government reducing NHS funding for psychiatric medicine.

The legality of being sectioned

When a professional talks about the Mental Health Act they are usually referring to the Mental Health Act 1983, however a modern Mental Health Act was implemented in 2007 by the Labour government.

The 1983 act — brought onto the statute books by the Thatcher-led Conservative government — was a money saving idea that has proven a legal minefield over the 30 years since it was implemented.

Ss2 and 3 are the most commonly used in the Mental Health Act 1983 and a Community Treatment Order (CTO) is the most commonly used ‘section’ of the Mental Health Act 2007. Although ss 2 and 3 are for hospital-based settings only, its 2007 equivalent — the CTO — can be enforced in a patient’s own home. A s3 and a CTO can be enforced for a maximum of six months but can be renewed at the request of the consultant psychiatrist also known as a responsible clinician.

Other sections can be used to make sure dangerous criminals with diagnosed psychiatric conditions are detained for long periods of time (many months, sometimes many years). The most notable of these is the criminal partner of Myra Hindley, Ian Brady.

The appeals process

Once sectioned and admitted to hospital a patient can request that they be discharged via two options:

1) An Independent Mental Health Tribunal, where the patient will usually be represented by a lawyer or advocate specialising in mental health, or
2) The Hospital Managers Appeal Board, though a potential conflict of interest arises here: how can the managers of the hospital who employ the providers of care (doctors and nurses) also decide on the legal rights of the patient (notably whether to discharge the patient)?

Legal ethics of psychiatric medicine

A mental health patient can, if necessary, be made to take medication against their will with force being used if necessary. It’s worth noting a doctor could not and would not be legally allowed to force a diabetic to take Metformin against their will if necessary to maintain their optimum health. Does this distinction stem from the old lunatic asylums (before community mental health treatment became available) or is it a recently modern medico-legal issue?

Non-medical professionals and the mentally ill

Is it right for non-medically trained professionals like the police to be dealing with the mentally ill on a regular basis without proper training or resources put in place?

At this moment in time, Cheshire police are making use of psychiatric nurses when attending an incident involving a person suspected of having a mental illness. I think that this is a forward-thinking initiative, but it simply doesn’t go far enough.

An idea of mine is for all police forces to have psychiatrists and psychiatric nurses working directly for the police rather than a medical trust, with mental health professionals at the police force HQ, each divisional HQ and then each individual station. If the police can have a medically trained mental health professional to go to, then the police may deal with the mentally ill better — the police deal with the mentally ill on evenings and weekends when the NHS effectively shuts down.

The media and its perceptions of the mentally ill

When someone is killed by a mentally ill person, they are always depicted as mad, someone to be avoided at all costs.

Statistics have shown that the likelihood of being murdered by a mentally ill person — even someone with paranoid schizophrenia — is lower than the likelihood of being murdered by a relative. So why the perception of crazed maniacs? It sells papers but in reality it is not the truth.

There is a minority of mentally ill individuals who are dangerous to the point of needing detaining for life to prevent a crime from happening, and there is a minority of mentally ill people who do not have the mental capacity to know what they are doing or to accept responsibility for their actions. However, most mentally ill people — including myself — are highly intelligent and are safe to be around. Life goes on whether you have a mental illness, a physical illness or are blessed with no ill health.

Samantha Fogg is a law student at the University of Manchester. She wishes to put her personal experiences of the mental health system to good use by becoming a lawyer specialising in mental health.

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20 Comments

Anonymous

Really good and insightful article/report and totally agree. Its a shame that mentally ill people are treated (socially and medically) differently to those with physical problems. But with continuous funding cuts from the government to all areas of the NHS and health, it’ll be difficult to see what the future holds for the system and service users.
More pressure and advocates like yourself are needed to resolve such issues.

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Screaming Lord Lyle

Now that’s not very constructive Anon of 1025.
If LC wanted something constructive it might want to get a “responsible clinician” to write such an article rather than a vulnerablerable “service user” law student.

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Not Amused

This is full of hyperbole and unsubstantiated statements of fact. I think that detracts from its message. As does the obvious political bent and shoe horning in Thatcher and the Victorians.

The article fails to engage with these difficult and complex issues.

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Anonymous

Not amused – what is wrong with the author providing the policy context (ie a cost cutting conservative government) of the time when the legislation is passed? – the author is factually correct.

As readers, I think we should still have a healthy criticism of the political parties and governments we support. So for example, a tory voter should not blindly and tribally defend all tory party actions without looking at them rationally first. Neither should they be unfair to the author of this article. Clearly touched a nerve when thatcher was correctly referenced.

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Anonymous

I think Not Amused is over bidding her criticism of the article. I think it is well written and given the hurdles that the writer has overcome, she deserves a lot of credit and LC have done themselves proud in publishing her work.

My issue with it is that I do not think the science, therapy and medicine practiced by Psychiatrists and Psychiatric Nurses is fit for purpose, whereas the writer seems to think it is. She also seems to think that these professionals should be given more influence eg in the Police. That would be a matter of debate between the writer and I which we would probably find interesting.

I like the idea of ” I feel that a mentally ill person’s treatment is comparable to a person with a broken arm going to A&E and being told “here are some painkillers to numb the pain, but we’re not going to treat the underlying condition of your broken arm.” ”

I agree with that point.

I would say though, to emphasise my criticism of Psychiatrists etc above, that I never heard of a Psychiatrist or Psychiatric Nurse who could say “I have the experience of healing people – you know – taking someone who is sick with bi polar disorder and applying my skills and experience such that in a given amount of time, I can make them feel better and behave in a manner which they and I and society at large can be happy with, without a multinational drugs company or its attendant banks and pension fund investors being necessary to my relationship with the person.”

One example would be the quite common notion of someone with a personality complex who thinks they are Napoleon, Jesus Christ or the Pope. This complex is something, so far as I am aware, that the Psychiatric profession cannot cure. They can diagnose it as something and create a process whereby the cheap raw materials of drugs they prescribe (like Lithium) can be turned into investment products on the one hand, and an inducer of an acceptable state of mind to most of the takers of the drug, on the other, but cure a personality complex without an attendant stock market bonanza – Psychiatrists ? No . Not for me.

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A mentalist

There is a much clearer explanation on the Mind website. Whilst I will be gentle as it’s a first year law student, it seems like an ill informed rant at times. Yes those detained can under exceptional circumstances be forced to have medication but only if the alternative is that would remain psychotic. There is an overlap of the MHA and the HRA, which at all times applies. Oh and as btw, Hyndley was never under section and Brady was under a hospital order. There has to be some legislation that deals with people who through becoming unwell are unable to make their own rational decisions, I’d be happy to hear any alternative views on what legislation should be available?

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Anonymous

I take issue with you here Lyle,

1. This is indistinguishable – to me – from a self serving statement by someone making money from the mental health field. We have a society that is physically and mentally unhealthy – Minds are broken and industries like advertising, Big Pharma and many different kinds of lawyers, I have to say, thrive on them. At the top of that society, in the middle class, are quite a comfortable group of people – among whom are the higher paid mental health professionals. These people will not concede that “nothing short of everything needs changing” and they will not go about it, because they are so comfortable. To use IT parlance, they will patch a programme or software system, colloquially known as the Matrix, with labels and drugs which fall short of changing the system to one that is better suited to humanity.
2. (a)Psychiatry is fatally flawed as a subject. There isn’t a Psychiatrist that I know of, who, when presented with a Pope complex in his surgery will have kindly rung the Vatican to ask where the Pope was that day, and where they have been this week, and then base their treatment of the patient from there. In the worse case scenario, they will reach for a label and some Lithium instead and they may well campaign for Lithium to be prescribed to younger and younger people and further across the mental health spectrum.
(b)Someone specialised in healing people would be able to cure the well known boxer that has recently entered the mental health field, but a Psychiatrist will just label him and prescribe him cheap to make drugs at a high price to the tax payer via the NHS or BUPA.
3. Tards – by which you mean people who post anonymously on this website who you regard as being so less intelligent than you are that they warrant a nasty label which escapes software detection – are sometimes people with a different belief system to yours. They are not difficult, as you say, they are deprived of the opportunity to grow and to develop the world as it should be. They have retained their humanity where others often have not – Think of the well known 1960s hippy song “The Games People Play”. “You turn your back on Humanity, and you don’t give a damn” is one of the catchy lines in the tune.

The NHS is trying to reduce a £20 billion budget, which, if society was more egalitarian, greener, just, and focused on happiness rather than an economy, would not be necessary. It is a shame that barristers cannot imagine they have clients who wish to achieve that, such that they start to amass their skill and confidence in achieving it.

I think the writer of the article has written a piece which is fair comment. She is trying to think of ideas to make the Police less harmful to society and she is trying to lobby the reader’s better nature to say that people with mental health problems are intelligent, decent people.

I think that she needs to regard it as a touchstone that Manchester University have enrolled her and that Legal Cheek’s team have published her article. I would guess that if she can work well for her degree that there are lots of clients out there who would breath a sigh of relief dealing with a lawyer like her who can understand their problems in a flash and then push and pull on the law and the Tribunal Panel members to do her best for them. She does not need a pseudonym. Good luck to her, that’s what I say. It would be nice if someone will offer her a pupillage or a TC.
And to keep consistent with my earlier post, I would say to the writer (and to you) I’ll meet you at this point if you wish – let’s make the Police more pleasant and give the Police force a greater remit so that those who are currently permitted by their regulators to thrive economically on people’s weak mental health are meaningfully prevented from doing so.

I hope you come back to the colloquy.

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