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The new millennium mental health act probably will double the number of patients being detained under the new act?
- AK Al-Sheikhli (17 July 2004)
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Re: The new millennium mental health act probably will double the number of patients being detained under the new act?
- Rita Pal (17 July 2004)
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Compulsory "service users"
- Anthony Stadlen (19 July 2004)
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True!
- Dr.G.Chidambaran Chidambaran (26 July 2004)
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Compulsory treatment can be liberating
- Trevor H Turner (29 July 2004)
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The Tzar of mental health and the increasing abandonment of human liberties in UK
- susanne mccabe (9 September 2004)
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AK Al-Sheikhli, Psychiatrist Medical centre,Nuneaton,CV11 5HX,England.
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16th,July,2004 EDITOR-It was interesting to read the editorial of Thomas &Cahill,Compulsion and psychiatry-the role of advance treatments[BMJ(2004);329:122-123]. My comment, 1.It seems whether we agree with the proposal or disagree,as psychiatrists or general public,,and whether there are studies to support that on both directions,The Government is going to implement the new act(new millennium mental health act). 2.I think the new act will lead to have more patients being detained under the new mental health act. 3.By having other patients to be detained under the act by broadining the bounderies,for e.g to remove the severe from severe mental illness,to include patients with personality disorder whether they benefit from treatment or not?,and to have others,and not only psychiatrists to have the power of using the mental health act to detain the patient or block the discharge of patients will confirm my expectation of the doubling of the patients being on section. 4.Probably we were lucky that the new act did not extend to include patients who are not psychiatric and need medical or surgical treatments?, Thanking you, Yours sincerely, AK.Al-Sheikhli,MRCPsych,DPM Competing interests: None declared |
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Rita Pal, Editor NHS Exposed
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I often wonder whether the financial incentive to section patients is a prime motivator for some doctors? Each section done gains the doctor around £100 ( rates may be higher in some places). It is not unheard of to find people under a section for simply arguing with their wives! Perhaps all you psychiatrists out there would let me know whether money is a prime motivator in some instances. In my view, doctors who section should not be entitled to extra money. The forms are short although the assessment is long but it should all come within a days work. Dr Rita Pal Competing interests: Have worked in Nuneaton |
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Anthony Stadlen, Psychotherapist, lecturer in psychotherapy Regent's College of Psychotherapy and Counselling, London NW1 4NS
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The authors write: "Many service users do not consider themselves ill, yet find themselves forced to take medication. Another way of understanding the reluctance of service users to plan ahead is that they feel demoralised, disempowered, and oppressed by years of compulsion in the mental health system." The authors thus perpetuate the absurd and dishonest use of the term "service user" to refer to persons who may not wish to "use" the purported "service" of psychiatry at all. The term is dishonest because it implies, first, that the persons compulsorily incarcerated or "treated" by psychiatry nevertheless wish to "use", and indeed have already been "using", this "service" voluntarily; and, second, that, even when they are being compulsorily incarcerated or "treated", they are still "service users". But the notion of a compulsory service user is an oxymoron. The authors do not refer to the fundamental work of Thomas Szasz in this area. This is unfortunate, both because their failure to do so neglects elementary principles of decency and scholarship, and because Szasz's writings offer a paradigm of plain writing about these matters, purified of the mystificatory jargon of "service users" perpetuated by the authors. Competing interests: None declared |
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Dr.G.Chidambaran Chidambaran, Hon.Med.Officer, VHS,Chennai-600020,India
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Sir, It is a fact that Pschiatry is the only branch where the the specialist has to extend the treatment for a period which may go on from months to years to prevent exacerbation or relapse & again it was rightly said that the patient & more than the patient ,his or her spouse or parents feel that the patient is under compulsion for taking the treatment when he or she is free of symptoms. I as a GP always tell my patients' attendants that the patient may require pronged therapy after the treatment for acute symptoms for prevention of relapse. A problem is withdrawal of drugs when the patient is remitting. Reporting comes only when the patient is unmanagable in the house. Again ECT treament- not acceptable to the patient as well as attendants. Fear of this treament is also one reason to feel that there is no option for the patient/attendants but to agree to the doctor as he or she [the patient/attendant] is compelled to feel that it will improve her/his condition towards remission. Anyway to me, Chronicity is the rule . This article is an eye opener. Dr.G.Chidambaran Competing interests: None declared |
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Trevor H Turner, Consultant Psychiatrist & Clinical Director Homerton University Hospital E9 6SR
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The differences in outcome of the studies reported on advanced statements are not surprising, given that in both studies (as reported by Thomas & Cahill) over two-thirds of eligible patients failed to make it to randomisation. The reluctance of patients to become involved in such processes may relate to the nature of randomised control trials, or may relate to the power that professionals have over their patients anyway (as suggested by the authors). More likely it is due to the very nature of psychotic illness, which by definition puts one out of touch with reality. Rather than reaching for sociological notions of power relationships, the authors might wish to consider how patients react to compulsory treatment. It is exceptional, in my 18 years experience as a consultant psychiatrist, for patients to object to or subsequently reject a psychiatrist because he or she has used compulsory treatment towards them, and a number of my patients have actively thanked me for the intervention. In fact, an ongoing study (the Eunomia Project, Europe-wide) taking place at this unit is coming up with similar material. In a sense all medical practitioners, via their social status and enhanced knowledge, probably impose treatments on patients in much more subtle ways than psychiatrists do via the Mental Health Act, because who really and truly wants to have a surgical operation? Beliefs in the supernatural continue to be highly prevalent even in Western industrialised society, and it may not be fanciful to suggest that the medical profession has imposed its healing agenda, particularly in the last 100 years, on a semi-reluctant population that would prefer prayer or a magical formula (à la Harry Potter) to make bad things go away. The notion of psychiatrists as “oppressors” seems also to be inappropriate, since engaging with “our patients’ painful social realities” demands in fact the qualities of a freedom fighter. Not only are we fighting against stigma, Cinderella-esque resources and the hidden ‘social control’ agendas of ‘risk management’, but we are also fighting to free patients from the burden of their illness. In this sense compulsory treatment should be seen as a form of liberation, the insistence on the right to treatment of everyone regardless of their illness-induced disabilities. Looked at in this perspective, knee-jerk criticisms of compulsion can be seen as subtle forms of oppression, by the lazy and self -satisfied, who are content to see impoverished vagrants muttering to themselves as they scrabble around dustbins in city centres. Competing interests: None declared |
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susanne mccabe, retired cf24 3pf
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Unfortuate title and an even more unfortunate defence of the potential new mental health bill was made by Lois Appleby last night on Newsnight. The college of psychiatrists' press release today states that they collectively are 'anxious about civil liberties, ethics, practicality and effectiveness. That it will be unfair, stgmatising and dangerous. The Maudsley put up a very honourable case aganst it, providing interviews with a mental health nurse, service users, (suitably anonymised and by the way, not just from 'lower economic groups', which is too often the case, giving skewed impression of the rnge of mental health problems),and a psychiatrist. The Tzar's anxiety about their opposition was obvious from his response, warning that such health workers are being heard by people in the community who need treatment. What did he expect? - that it owuld be slipped in quietly after a certain amount of appeasing the psychiatric profession? That most potetial/users will not know about it until they become caught up in a system which could enforce unwanted powerful drugs and other treatments on them, or incarcerate people who have committed no crime? On the last point he would be correct. The majority of people do not follow these debates and any advance statement will obviously be useless.This is how liberty is eroded. Again how will users know which mental health area is safe to live in without fear, many already move around to keep out of the system and are aware of which areas of the country are more punitive. Are those health workers who have the decency to defend the honour of their profession and value the relationships they make with people during vulnerable and often relatively powerless phases of their lives, also in danger of being labelled with a 'personality disorder' and locked up? Competing interests: human rights activist |
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