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Mental Health Act

  
 
gozer the destructor
10:21 / 28.06.02
I posted this in Ganesh's thread about anti-psychiatry and he told me to get my own thread, rightfully I should add, here's the post in full.

I wonder if I can bring the new mental health bill into this discussion if I may? The new bill going through parliment, of which there is a consultation being run (get in touch if you wanna know more), will be the biggest change in British Mental Health legislation for the last 50 years, no longer will you have to have a 'disorder' that is deemed 'treatable' for you to be 'sectioned' ( that's forced to comply to medical advice against your will for your own of others safety). Previously asomeone who was deemed anti-social but untreatable could refuse treatment on the grounds that is was a waste of time basically, this will change if the new legislation goes through (and for yuor information they reckon there's between 300-600 people in this category in England, so they are changing the law to effect this minority).

As regards the mistrust of Psychiatrist, I don't think that it is limeted there, I think there is just a general mistrust of the medical proffesion at the moment, especially in Britain. Y'see the last post-war generation appreciated the NHS a lot more as something to be grateful for, free health care led to a dramatic rise in the standards of living for the majority of people whose previous life expectancies had been extremely low. People got used to this and demanded more, it couldn't be provided and so the relationship between doctors and patients (or users as we are now being told to refer to them) changed, whereas the doctor was all knowing, we now distrust them.

I have always been intrested in Psychology and there is a history of mental illness in my family and my opinion has always been that support either from friends, lovers, family goes along way. I personally would like to see a more obvious move away from pharmaceutical treatments to disorders like schizophrenia and the users I work with generally feel the same, although it must be realised that the types of schizophrenia range dramatically but also that most grow out of it. Drugs have a place in the treatment of mental disorders but one of my main concerns is the fact that there is so little concern for the rehabilitation of the sufferer to leave the institutions and live a normal life, to misquote someone above, to make them think of themselves as autonomous entities rather than labeled and pigeon holed objects who have no control over their own future.

Another point I would like to raise is the ECT thing, last time I saw Ganesh we had a chat about it and i'm still not decided on the subject as I got an opposit point of view from another friend whose a psychiatric nurse. Discuss. To start off though, and go full circle I suppose, the new legislation being debated at the moment alows for 'emergency' ETC's to be performed without the pre-consideration of the Tribunal set up to deal out these new powers. Concerned?
 
 
Ganesh
12:52 / 29.06.02
You might be surprised to learn that the majority of psychiatrists are equally dubious where the new Mental Health Act is concerned. Contrary to the beliefs of some, psychiatrists (like most doctors) get their kicks from alleviating illness - improving people's lot in life - and have no great wish to be handed responsibility for those whose extreme behaviour is due not to illness but to personality, and therefore highly, highly resistant to change.

The Mental Health Act, as it stood, provided some degree of legal justification for those of us attempting to resist the societal drive to 'lock up' anyone who excites the public fear of Otherness. I can recall many a mutually-frustrating session in the police cells explaining that yes, so-and-so has a diagnosis of Antisocial Personality Disorder (psychopathy), yes, they're loud, obnoxious and a breach of the peace, but no, they don't have a treatable psychiatric illness and there are no grounds for detaining them in hospital.

Generally speaking, we have enough hassles with tabloid expectations of our 100% ability to predict future dangerousness within the psychiatrically ill, without assuming responsibility for the decisions and impulses of those who aren't...

As far as ECT goes, I'm broadly in favour, as you know, provided it's used for those situations in which it's been clinically shown to be useful ie. in the treatment of severe (often life-threatening) depression. Over the years, I've followed various people who've received courses of ECT - and sometimes administered it myself, as part of my training - and have concluded that it's generally a safe, effective treatment. We don't know how it works, but it works. If I or any of my family were severely depressed, I'd want it.
 
 
gozer the destructor
07:58 / 30.06.02
Whilst on the subject of ECT, how can the Bill morally legislate for 'emergency ECT', that ones got me baffled. And I was aware that there was a lot of clinicians very wary of the new proposals, i'm not a doctor basher, for me this is a civil liberties/patient consent issue.
 
 
Fist of Fun
09:04 / 30.06.02
FYI: The DoH consultation on the draft bill is at:

http://www.doh.gov.uk/mentalhealth/draftbill2002/index.htm

Please note - this is a draft bill at present, so it is still in the public consultation stage. Admittedly this has progressed beyond the usual green or white paper stages (pure consultation and setting out government policy in principle, respectively) but there is usually a great deal that can be done to amend government policy at this stage. It is also where a lot of policies get quietly dropped.
 
 
Fist of Fun
09:05 / 30.06.02
I should qualify that last post - I have no idea whether this bill is a good or bad idea. I was just posting information. My personal interest is because I deal with 'patients' under the present Mental Health Act 1983 in the Court of Protection.
 
 
Ganesh
10:15 / 30.06.02
In some ways, ECT given in an emergency setting (for example, severely depressed person hasn't eaten or drunk anything for several days, becoming dangerously dehydrated, etc.) is its most morally 'correct' application. I do think it's important that an examining body exist, though, and have power to rule on appropriate use of ECT.
 
 
gozer the destructor
12:23 / 30.06.02
But that's my point really, the tribunal that would be set up could be over ruled in the case of an 'emergency'. Also, would ECT treatment be the best course of action for someone who hasn't eaten? This does seem to me a little barbaric at best. Surely there are more humane ways to get someone to eat or to protect them from starving other than forcing an electric shock therapy?
 
 
gozer the destructor
12:24 / 30.06.02
Anyone in the Lambeth area who wishes to comment on the proposed legislation, please get in touch with me, i'm taking the lead on this for my office and so would appreciate any intrest in the matter. I work for an NHS dept. that covers community involvement.
 
 
Cloudhands
12:51 / 30.06.02
Given that ECT may cause permanent changes in the brain then shouldn't it be used only after everything else has failed? Giving ECT as an emergency means you haven't had the time to try out all the other options.
Ganesh- are there fast working anti-depressents that could be used instead?
 
 
Ganesh
12:53 / 30.06.02
When you say "barbaric", what do you actually mean? With a general anaesthetic and muscle relaxant, the most painful aspect is the momentary sting of the intravenous cannula. No-one's sure how it works - I can see why that might concern people - but it's been around long enough and been researched throughly enough for the relevant risks to be pretty well documented. I can see why the notion of ECT - suffering, as it does, from association in the public consciousness, with images of punishment, prison, Nazi 'experiments', the electric chair and 'One Flew Over The Cuckoo's Nest' - can seem frightening. Bottom line, for me, is that it works, works quickly and, in terms of side-effects, compares favourably with, say, antidepressant medication.

If someone is severely depressed to the point where they cannot or will not eat or drink and their physical health's an immediate concern are you really suggesting that, rather than attacking the illness process which is causing such behaviour, they should be restrained and force-fed or intravenously hydrated against their will for the weeks, months or years it might take for their depression to improve on its own? I don't see that as "humane" at all...
 
 
Ganesh
12:56 / 30.06.02
Cloudhands: no, even if it were possible to make someone stuporose with depression accept antipressant medication, no "fast-acting" ones exist. ECT is not undertaken lightly or without consideration of possible alternatives.
 
 
gozer the destructor
12:59 / 30.06.02
Fair comment, bad use of an emotive word, criticism accepted. How do you feel about the new approach to defining mental health disorders in the new act? Isn't there a bit of an ethical contradiction in forcing treatment on the untreatable? stamping out crime before it happens? i'm reading through the bill at the moment and this attitude seems contradictory, almost as though the state wants control a little too much. Isn't this whole idea against the aleged foundation of the justice system? innocent until proven guilty?
 
 
Ganesh
13:12 / 30.06.02
Basically, I'm in complete agreement that it's a civil rights nightmare. Like the vast majority of Governmental legislation on mental health, it's policy- rather than evidence-based and knee-jerk reactive to a tiny but well-publicised number of 'media outcry' cases.

On a more selfish note, I have absolutely no wish to become gaoler/custodian of a pool of individuals whose extreme behaviour (or worse, potential extreme behaviour) can barely - if at all - be labelled 'illness', cannot be modified by my interventions but, if it does result in harm or injury, will be my responsibility. It's not what I became a doctor for...
 
  
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