Memorandum from the Citizens Commission
on Human Rights (DMH 291)
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.
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.
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
Basle 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
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.
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