DMH 216 Self-Injury Support in North Cumbria
Riverside House
Warwick Road
Carlisle
Cumbria
CA1 2BS
Tel: 01228 515500
email: jill@sis-cumbria.co.uk
www.sis-cumbria.co.uk
______________________________________________________________________________
The Joint Committee on the Draft Mental Health Bill
27th October 2004
Dear Sirs,
Memorandum of Evidence to the Joint Committee
on the Draft Mental Health Bill
from: SIS (Self-Injury Support in North
Cumbria)
1. Introduction:
1.1 SIS is a voluntary
and independent organisation that provides a free information
and support service to people who self-injure or self-harm and
to those people who support them in North Cumbria. As Manager
of this organisation, I wish to express our service's concerns
that the proposed Draft Mental Health Bill is both unnecessary,
wrong and fails to meet the needs of those people experiencing
emotional and mental distress. We wish this memorandum to be
treated as evidence.
1.2 I am writing about
the following:
1.2.1 Compulsory treatment
1.2.2 Advocates and
nominated persons
1.2.3 Advance Directives
1.2.4 ECT (Electroconvulsive
therapy)
2. Compulsory treatment
2.1 SIS feels that compulsory
treatment should only be used as a very last resort and when all
other possible voluntary treatments have been attempted. SIS
is concerned that the combined effect of the extended powers being
added in this Bill, will mean that more people fall within the
scope of provisions for necessary treatment for mental disorder.
In our view extended powers are neither necessary or desirable
and that alternative options should be considered and used.
2.2 SIS and its service
users believe that people who are emotionally and mentally distressed
should not be put under compulsion unless they are truly in crisis,
in danger and when they have lost the ability to make choices
for themselves. We feel that it is an offence against human rights
for a person to have treatment forced upon them when they do not
want it and are able to make that choice.
SIS is concerned that people who self-injure or self-harm
can be considered to be dangerous to either themselves or to others.
In our experience people use self-harm as a coping mechanism
and not, what is often assumed, as a suicide attempt. A person
usually self injures or self-harms, for example by cutting, drinking
to excess or taking large amounts of prescription or other drugs,
to get relief from or blot out unbearable feelings, emotions or
memories. It is an attempt to 'stop' what is going on in their
minds and the release or relief from self-harm can be enormous
and very necessary to that person at that moment. Self-harm can
be a very effective coping mechanism, makes people feel better
for a while, and certainly prevents a person from becoming more
distressed and suicidal.
People who self-harm use it to cope with how they
feel and it relieves emotional distress that might otherwise build
up and lead them to feel suicidal or be 'a danger to themselves'.
Self-harmers 'hurt' themselves - not other people and are therefore
not a danger to other people.
SIS is concerned that some mental health professionals
still consider that people who self harm may be a danger to themselves
or other people. SIS and our service users feel very strongly
that people should be allowed to have choices about their self-injury
and self-harm and be supported in understanding the meaning and
purpose of the self harm and in finding alternative coping mechanisms.
2.3 Case Study:
'S agreed to voluntary hospitalisation for medical
treatment for serious physiological imbalances arising from her
long-term eating disorder. Once her medical condition had been
stabilised, a re-feeding programme was prescribed for S. S expressed
severe anxiety about being able to manage the proposed re-feeding
regime alongside continued tube feeding. At this point she felt
she could not accept the proposed regime as she felt it was introducing
increases in her nutritional intake that felt too great for her
to contemplate psychologically and asked that a more gradual increase
in re-feeding be considered. At this point S was accused of
being manipulative and threats were made to S. by a psychiatrist,
that unless she agreed to the proposed treatment she would be
'sectioned' and 'forced' to accept the treatment.
SIS feels that 'threats' and 'compulsory treatment'
were completely unnecessary and worked against S being able to
achieve an improvement in her dietary intake. S was willing to
accept support to achieve a change in the delicate balance of
her physiological levels but was very aware that for herself this
could only be achieved by a slow and steady regime of re-feeding
with appropriate and understanding support. To support S in her
wishes to challenge the threat of compulsory treatment, S was
offered advocacy support through agencies supporting her wishes;
this was instrumental in helping S. to have a dialogue with her
medical and psychiatric team and her wishes respected and considered
in reaching a joint agreement for treatment.'
2.4 SIS feels that surely
a spirit of cooperation is far more effective and more conducive
to the complete recovery of an individual than if a person is
threatened or forced to do something against their wishes.
2.5 In our experience,
local mental health services, generally now appear to be respecting
the wishes of individuals with regard to hospital admission and
that admissions and compulsory treatment are very much used as
the last resort. We have seen evidence that this approach is
far more effective for those people who are able to express their
wishes and make choices. Usually our service users are able to
recognise when they need help and either ask for or accept help
when it is needed, so that the build up to a crisis can be averted.
There is though a huge lack of resources in place at present
to ensure that people in pre-crisis can access appropriate support
and treatment. SIS believes that to prevent crises developing,
more provision needs to be available at community level and that
the voluntary sector needs to be recognised as both alternative
and additional support networks for people in mental distress.
3. Advocates and nominated persons
3.1 SIS believes that
if a person feels they are heading for a crisis or in crisis,
then they need a friend or advocate of their choosing, who can
help explain what is happening to them, to negotiate with the
medical team and hopefully get agreement to the course of action
that is best for the individual patient. Such a person should
be someone trusted by the patient and who knows them well and
whom the patient chooses to be with them. It may be a carer,
paid or voluntary worker, member of the family, friend or professional
advocate. They need that person to be able to have a say in what
will happen, including a right to object to the patient being
put under compulsion.
4. Advance directives
4.1 SIS service users
tell us that they need to know that they are in control of what
happens to him or her in a crisis and that it is helpful to them
if they can decide in advance what should happen in a crisis.
This can be achieved with an advance directive, which is a statement
of wishes and instructions for what should and should not happen,
at a time when the person is not well enough to express their
wishes and make decisions for themselves.
4.2 SIS and our service
users are concerned that this right will taken away under the
Draft Mental Health Bill once a person is put under compulsion.
4.3 SIS believes that
advance directives should be used and that when they are, they
are beneficial and prevent compulsory admissions.
5. Electroconvulsive treatment
5.1 The proposed Bill
is an improvement on the current law on electroconvulsive therapy
(ECT). It will not be possible to give ECT to a person with the
capacity to consent unless they do consent.
5.2 However SIS is concerned
that the new law does allow ECT to be given against a person's
consent in an emergency.
5.3 SIS believes that
ECT must never be given to a person who has the capacity to make
his or her own decisions about this controversial treatment.
Yours sincerely,
Jill Eastham
Manager
SIS (Self-Injury Support in North Cumbria)
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