Memorandum submitted by Penny Stafford (MH 57)
I am submitting evidence as someone who has been a user of mental health services since the early seventies, and has been subject to detention under the Mental Health Act on a number of occasions, as well as having worked for many years within mental health sector and has previously served as a member of the Mental Health Act Commission.
A. TREATMENT OF MINORS (under 18) ON ADULT WARDS AND PLACE OF SAFETY UNDER S136 MHA 1983
First of all I am very pleased that the Committee has been discussing issues relating to minors (i.e. young people under 18), and in particular the detention of minors within adult mental health settings. Although now a very long time ago, I was treated as a child (between the age of 14 and 18) several times, in a number of different adult psychiatric wards. I was often treated with a cocktail of powerful psychotropic drugs designed for adults, leading to deterioration in my mental state, but even more unacceptably, I was subjected on a number of occasions to physical and sexual abuse both by mental health professionals and other patients during that period. On one occasion (when aged just 15) I absconded from an acute adult mental health unit, after having tried to talk to my consultant psychiatrist about one of the charge nurses, who was regularly entering my room late at night to sexual abuse me, and was also over- medicating me to try to ensure my compliance and silence (and even threatened to administer an overdose to me if I told anyone what he was doing). However the consultant's response was to tell me I was probably suffering from paranoid schizophrenia, (although I can assure you this was not the case), and that he was going to transfer me to the long-stay hospital, as I needed to accept I would probably need to spend several years or may well need to spend the rest of my life in a mental hospital. After several days on the run I was eventually picked up by the police, and spent five nights in police custody, as a place of safety, during which time the said consultant refused to re-admit me to his unit, and so was eventually remanded by the local magistrate's court to HMP Holloway for psychiatric assessment, although I had not been charged with any offence. There were also three other occasions when due to my mental distress I was inappropriately kept in police cells as a Place of Safety whilst I was still a minor.
When serving as a member of the Mental Health Act Commission I was very pleased to be asked by their Policy Unit to undertake a review of their special Visiting Programme to children and adolescents detained on adult wards, and the report I wrote for them was subsequently published by TSO "Safeguarding children and adolescents detained under the Mental Health Act 1983 on adult psychiatric wards" MHAC 2004. Among the key findings reported was that a fifth of the children and young people visited under this programme had been subjected to s.136 prior to their admission to the adult ward. Further as local CAMHS services do not usually provide any facilities for a "Place of Safety" for children subject to s.136 of the MHA, and even in those areas where there is appropriate "Place of Safety" provision in the local adult mental health services, these hospital based S136 Suites do not accept children of young people under 18, so instead these vulnerable distressed youngsters are held in police custody suites, an even more inappropriate setting for them. A key recommendation of the report was protocol should be put in place to allow for children and adolescents subject to s.136 to be taken to an appropriate place of safety within a hospital setting and to be assessed by a specialist in child and adolescent psychiatry. I believe this bill amending the 1983 Act should include a clause, safeguarding the rights of young people subject to s.136 to be taken to an appropriate health setting as a place of safety and to be assessment by an appropriately qualified and experienced doctor.
Other key findings and recommendations, regarding the detention of minors on adult wards, included; lack of access to specialists in child and adolescent psychiatry; lack of awareness and training in child protection procedures on adult wards admitting minors, including failure to CRB check all staff working with minors; the over representation of young people from BME communities among those detained; and lack of access to appropriately trained specialist independent advocacy for minor detained on adult wards.
I would also ask the committee to ensure the proposed Bill addresses all these very serious concerns regarding the care of children and adolescents under the MHA and to ensure there are appropriate safeguards put in place in the Amended Act.
B. STATUTORY RIGHT TO INDEPENDENT ADVOCACY
I understand from the Minister's comments during the second reading of the Bill in the Commons that the Government are willing to look again at the provision of IMHAA (Independent Mental Health Act Advocates), as proposed in the earlier versions of the Bill. This is most pleasing, as I believe this is an essential safeguard of the rights of vulnerable people, being subject detention and compulsory treatment often against their will, and from my own experiences know just how difficult it can be to speak up for yourself, often from a position of complete powerlessness. I have been involved with independent advocacy for people with learning disabilities and mental health needs since the early 1980s when I trained as a citizen advocate with the first pilot advocacy scheme in the UK (Advocacy Alliance established in 1982), and whilst I believe advocacy has been a great force for change with the mental health and learning disabilities sectors, provision is still very patchy, with local projects often struggling to attract and retrain adequate funding. I would also refer the committee to the recent Pleming Inquiry Report (2005) published by the Government, regarding the appalling mis-management of allegations and reports of serious sexual assaults by psychiatrists by the relevant health authorities and the very strong recommendation that independent advocacy should be available within all inpatient mental health settings, although the government as so far failed to provide a response to this report - I feel the Mental Health Bill is an ideal opportunity for them to ensure the provision of advocacy to thos who are most vulnerable within the mental health system.
I believe the only way to ensure that those people who are subject to the MHA or at risk of being sectioned, who need advocacy, have access to an appropriately skilled and trained advocate, is for this made a statutory right (with appropriate funding earmarked). Advocacy by other means just won't work, or at least won't work for everyone who needs it. I therefore trust the committee ensure that advocacy is reinstating in the current Bill.
I strongly believe a clause regarding the access to appropriate treatment for their "mental disorder" for anyone to be detained under the MHA is an essential safeguard, and this should apply equal to all persons, not just those with personality disorder or moderate/mild learning disabilities (or classified as having Psychopathic Disorder or Mental Impairment under the 1983 MHA). During the second reading of the Bill in the House of Commons the Minister referred on a couple of occasions to her concern about the number of very vulnerable and needy women, (often surviving long histories of violence and abuse) diagnosed with personality disorder (this is usually borderline Personality Disorder), who find it so difficult to access appropriate care and treatment due to mental health services and professionals viewing personality disorder as untreatable. As someone who has been diagnosed with borderline personality disorder for the past thirty years, I would put it to the Minister and the Committee, that the way forward to ensure appropriate access to care for people diagnosed with personality disorder (including women with BPD), is through appropriate training and education of clinicians, and the Government's own strategy document "Personality Disorder - no longer a diagnosis for exclusion" identified an evidence base for such treatment. Giving clinician's the right to detain people (even if they don't believe they can treat them) is not necessarily going to improve their access to appropriate care - I can assure you it simply won't!
I therefore urge the committee to ensure that an appropriate clause is inserted in the Bill to ensure that no one is made subject to a compulsory order under the Act unless they are to access appropriate treatment which is likely to alleviate their mental distress or prevent the further deterioration of their mental health.
D. COMMUNITY TREATMENT ORDERS
There is of course already some provision within the 1983 MHA for people subject to certain sections being discharged from hospital to be under the supervision either a community RMO (section 25) or under a Guardianship Order (s.7) with the local authority, and I do not believe it is in the interests of good mental health provision to extend these powers further. I believe strongly that the effectiveness of any mental health treatment, be it drug or psychological therapy, is strongly dependent on a positive and trusting relationship being developed between mental health practitioners and their service users. For instance anti-psychotic drugs, (and I spent over twenty years on this type of medication so I do have some understanding of how they work), are most effective at helping to control psychotic symptoms, when the person prescribed them believes they can help and wants to take them, and is supported to do so appropriately and also helped to manage any side-effects. It is usually the case that such drugs just help with the management of symptoms and does not make them magically disappear, and therefore the development of a strong positive relationship between the patient and mental health practitioners it vital to ensure any chance of recovery from or the appropriate management of psychotic symptoms. My worry is that with the increasing stress put on community mental health teams, often very under- resourced and with each practitioner managing an impossibly large caseload, if CTOs are introduced by the Bill, the focus with be on compulsion and not on developing the type of positive relationships with their service users that are so essential to the success of the treatments they are prescribing.
I would urge the committee to look again at the powers already in place to supervise people in the community (i.e. under s.25 and s.7) as I believe they are adequate - and not to introduce yet further compulsory powers which will do far more to damage the work of CMHTs rather than support it.