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Joint Committee on the Draft Mental Health Bill Written Evidence


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

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 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 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.

October 2004





 
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Prepared 23 March 2005