Memorandum submitted by anonymous (MH 13)
My background is as a service user of the psychiatric system for the last 18 years, both as an inpatient and out-patient. I am also in regular contact with fellow service users through my work within the service user movement, both within Leicester and Leicestershire, and on a national level as an elected member (for the last four years) on the Mind Link National Advisory Panel (Mind Link is the service user network within Mind). I am also a member of the board of directors of LAMP, the Leicestershire Action for Mental Health Project, editor of a service user and carer produced magazine, and a member of one of the Guidance Development Groups at NICE.
Through discussing the proposed amendments to the Mental Health Bill both locally and nationally, whether in local service user organisations, on an individual level, at Mind network events in Newcastle, Manchester and London, and at Mind's recent annual conference in Bournemouth, I do feel in a position to voice a number of concerns regarding the amendments that do seem to be common amongst mental health service users.
I have to say to start with that I do feel the amendments proposed by the Lords do improve on the original proposals and these are to be welcomed. They do not, however, go far enough in addressing the legitimate concerns of people on the receiving end of psychiatric services.
One of the main concerns is that the Government is widely seen by service users as using the need to amend the Mental Health Act as a means for them to introduce by the backdoor the measures in the aborted Draft Mental Health Bill that faced such widespread opposition when originally proposed. This encourages an unhealthy cynicism towards the political process in this country, through failed legislation being brought in via other means, and politicians have to realise that this kind of political game-playing encourages cynicism in the wider electorate too.
A contempt for stakeholders in mental health also seems to emanate from those who have drafted these changes to the Mental Health Act by the fact that all the testaments and evidence provided to the Joint Committee on the Draft Mental Health Bill (as well as the Joint Committee's final report and its recommendations) have had no bearing on the amendments being proposed. This prompts many service users to feel that the Government has already decided what it wants to do and has little or no intention of taking their views into consideration when proposing mental health legislation, and this sets a dangerous precedent not just for future mental health legislation but the legislative process as a whole, since it makes people feel ultimately powerless and that their input is of no value.
There is also the concern that many people who need help from mental health services will either fail to engage with psychiatric services or drop out of them altogether through fear of being locked away for no good reason or of being forcibly treated in the community. This comes from the Government's focus in these proposed amendments on the danger posed by people with mental distress, which not only creates fear amongst those with mental health problems but also reinforces the stigma faced by them on a day-to-day level from other members of the community, which also focuses on them being dangerous and in need of being controlled, compulsorily treated and locked away for the good of the rest of society. This is a wasted opportunity to focus on favouring choice and autonomy for service users, on improving the quality and provision of mental health services, and on creating forward thinking and innovative mental health legislation.
There were positive aspects of the Draft Mental Health Bill, and it is incredibly disappointing to see that these have disappeared from the Government's proposals, and I would urge the Committee to seriously consider asking for these to be part of the amendments to the Mental Health Act. The right to advocacy for all those subjected to compulsory powers, for example, is a significant loss from the legislation and should be reinstated, as should the patient's right to be able to nominate a person who they feel could best represent their interests.
One issue that many service users have been worried about since the Draft Mental Health Bill proposals, and which is still unresolved in the proposed amendments, is the right to be able to make advance directives, because even though this right was enshrined in the Mental Capacity Act 2005, the amended Mental Health Act as currently proposed would allow these wishes to be ignored if the patient becomes subject to compulsory powers. This seems neither right nor fair - to give service users the right to advance directives on the one hand and then to effectively take it away with the other. There is mention in Chapter 4 (64J) of the Mental Health Bill of advanced wishes as a "factor to consider" "but only so far as it is still appropriate to consider them"! This isn't good enough, and there needs to be an explicit statutory recognition of advance directives within the Bill, or at least a clear statement that the right to an advance directive under the Mental Capacity Act 2005 will not be taken away from people by the amended Mental Health Act.
The need to improve mental health provision is of the utmost importance if people are to be helped before they get to the point of being so unwell as to end up on psychiatric wards. But even then, it isn't good enough. The bottom line regarding the majority of psychiatric hospitals is that they offer little if anything of therapeutic value, have poorly trained (and poorly paid) staff, and are unsafe environments for vulnerable people. I would direct Committee members to the National Patient Safety Agency report, 'With Safety in Mind', which was published towards the end of last year. From talking to many patients and ex-patients of psychiatric wards, I would say that the report - shocking though it is - is merely the tip of the iceberg regarding the level of abuse (particularly the sexual abuse of female patients) in psychiatric inpatient settings. Surely, there should be in the proposed Mental Health Bill something to address these appalling inadequacies in inpatient conditions, some mention of a quality of care that should be expected by patients, especially if the powers to compulsorily treat people are being widened. Surely there is a need too for safeguards to be legally in place within the Mental Health Act to stop the abuse that is being inflicted on vulnerable people day after day on psychiatric wards, not just by patients but also by members of staff. If patients were being routinely sexually abused on a cancer-care ward, there would be an absolute outcry, but because this is about people with mental health problems, it doesn't seem to matter. And the lack of safeguards for patients on psychiatric wards being mentioned in the proposed Bill, and the emphasis being on protecting the public from people who are 'mad', seems to reinforce the view among many mental health service users that the Government isn't really bothered about doing anything about this incredibly important issue and much more interested in pandering to the stereotypes of people with mental distress as peddled by the tabloid press. I would point out that the argument for improvements to mental health provision being a part of the Mental Health Act are underlined by a number of inquiry reports, such as the Independent Inquiry into the Care and Treatment of Michael Stone (published by the South East Strategic Health Authority, Kent County Council and Kent Probation Area in 2006), which mentions specifically the lack of appropriate inpatient services as a significant contributing factor in the commission of homicides.
The use and limits of compulsion and coercion need to be tighter than those proposed in the amendments made by the Lords. Restrictions on the use of compulsory powers are vital to protect vulnerable people, with practitioners still having the power to essentially abuse their position and compulsorily treat people who will gain little or no benefit from treatment despite being of no threat to themselves or members of the wider community. People diagnosed with personality disorders are particularly concerned that they could still be locked away on a psychiatric ward for things they may do at some point in the future, just on the basis of their diagnosis, and the worry is that the amended Mental Health Act could be used to indefinitely detain people who have committed no criminal acts and have broken no laws, but are somehow perceived as a bit 'odd' or 'different'. The idea that legislation is even considered in this day and age that could allow this to happen is not just appalling but deeply disturbing. The Lords' proposal to reinstate the 'treatability test' is a welcome one, although the test should be more of a therapeutic benefit test similar to that used in the Scottish Mental Health Act, and I would welcome additional safeguards to be proposed to ensure that the situation feared by so many service users (and non-service users), and outlined earlier in this paragraph, cannot be allowed to happen.
Following on from this, the proposals regarding Supervised Community Treatment seem to have been represented (inaccurately) by the Government as an alternative to inpatient care, and yet the Bill would seem to imply (Chapter 4; 17 (A) part 5) that someone fitting the criteria for SCT would be considered as well enough not to require hospital treatment. The Lords amendment, that SCT should be limited to patients with a history of relapsing after discharge from hospital, points to SCTs being given to patients who have already received inadequate inpatient care and would then be forced to be on the receiving end of equally poor services in the community! This underlines again the need for quality standards of care as opposed to seeming to victimise patients who have not received the help they've needed when they've been unwell.
The issue of medication is an important one for service users, particularly regarding the risks of taking psychiatric medications (even at the normal prescribed dose), which can cause severe and permanent long-term health problems such as tardive dyskenesia and Parkinsonism, and when people are put on psychiatric wards they are routinely medicated at higher than the recommended dose. At the moment, the period of time before a second opinion is required regarding drug treatment is three months. This should be drastically reduced, preferably so that no one can be put on doses of medication than the recommended dose at all without a second opinion being required.
I welcome the amendments to the proposals regarding ECT not being involuntarily administered to people with capacity to make their own decision on this, but question the proviso that their wishes can be overruled in cases of an emergency. It is highly dubious to be suggest that there is any situation in which ECT would help someone in a highly distressed state - especially when considering its side effects, which include patients losing memories of whole years of their lives - but easy to see how this power to force people to have ECT could be abused. There should be no circumstances in which people are compulsorily given ECT.
Finally, it would help to have a tighter definition of a place of safety, as it is quite common for people with mental distress to be picked up under section 136 of the Mental Health Act and then put in a prison cell. This is an abuse of the Act, as a prison cell certainly isn't what most people would think of as a place of safety. There needs to be a definition that either prevents this kind of thing from happening, perhaps by specifying "a therapeutic environment", or at the very least limits the time period in which someone placed in a cell under section 136 can be detained, say to twelve or twenty-four hours.