DMH 291 CITIZENS COMMISSION ON HUMAN RIGHTS
Memorandum from THE CITIZENS COMMISSION
ON HUMAN RIGHTS ON THE DRAFT MENTAL HEALTH BILL
INTRODUCTION
CCHR shares the view of many of those
contributing evidence to the scrutiny Committee that in its present
form the draft Mental Health Bill, read together with the Mental
Capacity Bill, does not go far enough to protect the human rights
of patients.
We urge the Committee to make, in
particular, two recommendations which will significantly improve
the Bill in relation to human rights.
1. The right to decide whether to
undergo any medical treatment is a fundamental human right protected
by Article 8 of the European Convention on Human Rights. This
right is respected in connection with the treatment of non-mental
medical conditions. The Bill should incorporate the same standards
for mental treatment, whereby the person has the right to decide
whether to undergo mental treatment. Moreover, the right to make
a "living will" or advance decision, at a time when
a person has mental capacity, should be unequivocally extended
to all medical treatment, including all mental treatment.
2. The right to have access to proper
medical treatment and a correct diagnosis is also a human right
(see for example Article 35 of the Charter of Fundamental Rights
of the European Union). Many studies have shown that unless patients
are given a full medical examination, including tests for physical
diseases, toxic poisoning, allergies or dietary deficiencies,
a misdiagnosis that they have a mental disorder can result along
with unnecessary psychiatric treatment. Accordingly the Bill
should provide for all patients to be given a comprehensive physical
examination and medical tests to rule out underlying physical
conditions being misdiagnosed as psychiatric in nature.
THE RIGHT NOT TO CONSENT TO MENTAL
TREATMENT
Unlike other areas of medicine many
psychiatric treatments remain highly controversial. If a patient
has a physical medical condition or deficiency, it can and should
be treated medically or nutritionally. But the attempt to cure
a mental condition using physically invasive means (such as destroying
healthy brain tissue) can often cause long term harm.
The history of psychiatry over the
last two hundred years is one of many new treatments being discovered
and heralded as scientific advances, and being widely adopted.
Then subsequently being abandoned when objective studies concluded
that they actually caused more harm than good, and were not in
fact supported by any real science.
For example, in the nineteenth century,
"spinning therapy" was adopted. This involved strapping
a patient horizontally to a board that could be mechanically spun
at great speeds. Doctors theorised that madness was caused by
too little blood circulation in the head, and that by placing
the patient with his or her feet at the board's fixed point of
motion, blood would rush to the brain. Another treatment involved
immobilizing a patient in something called a "tranquilizer
chair". They were strapped into the chair so that they could
not move at all for long periods of time (sometimes days and weeks),
and frequently doused with ice cold water.
Treatments in the twentieth century
have largely concentrated on making patients more docile and manageable.
The origin of mental treatments which involve the deliberate destruction
of brain tissue, such as ECT and lobotomies, was the philosophy
that it is better to be a contented imbecile than a schizophrenic.
Ironically, the psychiatric treatments
which have consistently enjoyed the most success are those that
have not involved dramatic attempts to interfere physically with
patients' brains, but treatments involving a far simpler and gentler
approach.
According to a 1992 report by the
World Health Organisation, studies showed a far better success
rate in treating schizophrenia in developing countries, where
there was little use of antipsychotic medication, than in developed
countries where the use of antipsychotic medication was the norm.
Moreover many antipsychotic drugs
used to treat mental patients in the past are now considered too
harmful to use. And even the use of many current psychiatric drugs
is considered controversial, because of unwanted side effects.
Mental problems or difficulties are
often the result of exhaustion and stress. The best therapy is
frequently simply rest and good food, in a peaceful environment
removed from the source of stress.
Given the controversy surrounding
psychiatric treatments such as ECT, surgery designed to destroy
brain tissue, and neuroleptics and other psychiatric drugs, it
is not unreasonable that many people would prefer not to have
such treatments, and must be granted the right to refuse them.
Moreover, it is a fundamental human
right to be able to decline potentially harmful treatment.
Additionally, people must have the
right to decide on the nature of future mental health treatment
should they in any way become incapacitated, hospitalised or simply
make a predetermined decision about future mental treatment, in
the same way individuals are able to refuse certain medical treatments.
Therefore , there should be a simple
means of registering a decision to opt out of certain mental treatments.
This could be achieved by allowing people to send a letter or
prescribed form to a national registry, where advance decisions
can be recorded against names and national insurance numbers.
Where an advance decision has been so registered a person could
carry a card to alert others to the fact.
THE RIGHT TO PROPER MEDICAL TREATMENT
AND DIAGNOSIS
Numerous studies by medical research
teams and psychiatrists have investigated the relationship of
underlying physical conditions being misdiagnosed as mental illness.
These studies have shown that unless patients are given a full
medical examination, including tests for physical diseases, toxic
poisoning, allergies or dietary deficiencies, a misdiagnosis that
they have a mental disorder can result.
Here are a few examples which demonstrate
the importance of this.
In one study, Dr Poldinger and colleagues
from Basel University in Switzerland gave depressed patients either
an antidepressant or a nutrient called 5-HTP (hydroxytryptophan).
5-HTP outperformed the drug on every measure, resulting in greater
improvements in their depression, anxiety and insomnia.
Psychiatrist William H. Philpott,
now a specialist in nutritional brain allergies, reported that
symptoms resulting from B12 deficiencies ranged from poor concentration
to stuporous depression, severe agitation, and hallucinations.
Evidence showed that certain nutrients could stop neurotic and
psychotic reactions and that the results could be immediate.
Dr. Giorgio Antonucci used physical
examinations and standard medical treatment to help schizophrenic
and "incurable" patients who had been restrained for
decades at Imola psychiatric asylum in Italy. He taught his patients
living skills, how to read and write, how to work and care for
themselves, and organised concerts and trips to Rome as part of
their therapy. Subsequently, many were discharged from Imola
to lead successful lives.
A study by Hall , Popkin , Devaul
, Faillace and Stickney of 658 consecutive psychiatric outpatients
receiving careful medical and biochemical evaluation, defined
an incidence of medical disorders productive of psychiatric symptoms
in 9.1% of cases. The most frequent presentations were of depression,
confusion, anxiety, and speech or memory disorders. The presence
of visual hallucinations was believed to indicate medical etiology
until proved otherwise. Major illnesses presenting with psychiatric
symptoms in order of frequency were infectious, pulmonary, thyroid,
diabetic, hematopoietic, hepatic and CNS diseases. Forty-six percent
of these patients suffered from medical illnesses previously unknown
to either them or their physician.
A study reported by Dr. Koranyi after
a careful screening of 2,090 psychiatric clinic patients showed
that 43% of this population suffered from one of several physical
illnesses. 46% of the physical illnesses remained undiagnosed
by the referring source. Among others, diabetes mellitus was a
frequently overlooked diagnosis and proved, particularly to produce
emotional disturbances. Physicians other than psychiatrists missed
one-third and psychiatrists one-half of the major medical illnesses
in patients they referred.
In another study of 100 mental patients,
who were intensively evaluated medically, 46% were thought to
have medical illnesses that directly caused or greatly exacerbated
their symptoms and were consequently responsible for their admission,
while an additional 34% of the patients were found to be suffering
from a medical illness requiring treatment. A diagnostic battery
of physical, psychiatric, and neurologic examinations, coupled
with a 34 panel automated blood analysis, complete blood cell
count, urinanalysis, ECG, and sleep deprived EEG established the
presence and nature of more than 90% of the illnesses detected.
Copies of these studies can be provided
to the Committee.
In simple terms, the studies show
that the more extensive the medical screening in a psychiatric
setting the higher the percentage of medically induced psychiatric
problems can be found. These conditions must be correctly diagnosed
and then medically treated, as they are medical abnormalities
or illnesses.
It is a basic human right to have
the correct diagnosis and treatment.
The Bill should therefore specify
that a full searching medical examination be given to any patient
to rule out physical causes of mental or emotional difficulties.
CONCLUSION
All human beings are entitled to
basic human rights. With these two simple and sensible recommendations
people who have the misfortune of suffering from mental problems,
do not suffer from the double misfortune of being deprived of
these basic human rights. We therefore urge the Committee to adopt
these recommendations.
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