Hello
I gave a version
of this talk to the Milan Committee that is looking into the Mental
Health Act at the moment and will give you a report on the views of
HUG on the Mental Health Act and how it might change for the better.
Before I start
I should say that I think that the use of sectioning is part of the
mythology of our society we don't exactly scare our children with
the threat of its use but it is a worry - the idea of "them"
coming to take you away!
The very first
time I was admitted to hospital I assumed that because there were
no bars on the windows and no strait jackets and no screaming people
that the use of compulsion must be a bit of folklore too. I was just
there being assessed I think, but I can clearly remember one night
saying that I thought I would like to leave, and being told that if
that was the case that I would have to wait to see a doctor and that
it was possible that I would be sectioned. I remember the pit of my
stomach becoming hollow at the thought. Until then I had felt looked
after and safe and this haven had suddenly turned into a place of
fear, a place to be threatened in and a place that I wanted to leave
and which I did by mutual agreement soon after.
There was a time
some years ago that I look on as when I did my big 'crack up'. From
the moment in the G.P's surgery when after my confession of spirits
and lights and the need to die accompanied by strange gestures of
my arms, I found that my life was taken over. I was told that I would
stay in the consulting room and that I would go to the hospital in
my wife's car as soon as an emergency appointment had been made and
at no point was there any room for disagreement.
When I was finally
being interviewed for admission by the psychiatrist at the hospital
he was called to the phone and I ended up escaping from the interview
because I believed that I was poisoning the person on the other end
of the phone line who the doctor was speaking to. I hid in a corner
of the courtyard of the hospital and was finally found by a nurse
who made me come back to see the doctor before I was admitted to the
ward.
In the ward a
group of staff surrounded my bed under which I was hidden and spent
a long time telling me to take some medicine because it would be good
for me. I did not know whether it would be good for me or not I was
frightened about where I was, about my experiences, about the staff
and the other people around. It felt like I was being exposed to a
process of attrition and that when I was finally worn out I would
have to take the medication anyway.
I did take it and it turned out to be Haloperidol - a liquid which
I grew to hate as I slowed down and my thoughts felt like they were
going through cotton wool and yet I grew to expect it whenever I was
doing something odd.
When I got wise
to the fact that I couldn't leave the ward to go to the trees where
I would spill the blood that I thought was full of the evil spirits
that were damaging me and those around me, I exercised choice and
worked out how to leave with no one seeing. Shortly after one lunch
time I ended up perched in the branches of a tree in the hospital
grounds with a razor blade in my hands looking at the ugly cut in
my wrist and debating "Can I not please cut through that horrid
vein".
I exercised choice
again and threw the blade away and jumped out of the tree and walked
back to the ward thinking to myself if only I could cut myself properly,
if only I could finish all this mess and misery and do the bidding
of the evil spirits and the next moment I was wishing that I wasn't
bleeding at all and that I could be safe and peaceful somewhere.
In the ward I
was stitched up and had the burns that I had made on my hands all
that morning treated, and in that place on the ward where I was shouting
and telling people to stop touching me because I might kill them,
I lost my choice again.
My possessions
were taken from me. I was searched and anything with which I might
hurt myself with was taken from me and a nurse was positioned besides
me who stayed there in shifts for the next couple of weeks. At first
when I asked for a cigarette and then a light I was easily able to
turn around and after a couple of puffs stub it out on my hands.
Whenever I tried
to leave the ward by the door nurses would gather around me and tell
me that I couldn't and eventually I would end up wandering up and
down the corridors again. I had to be accompanied to my bath, leave
the door ajar in the toilet, get permission to shave, be accompanied
anywhere that I went off of the ward, and at no time was I under a
section and for all of this time and most of time in the hospital,
I believed that I had to do as I was told and did so.
Eventually I stopped
trying to harm myself and both my various nurses and myself grew bored
and annoyed at being escorted everywhere. I was then free to be on
the ward but not to leave it. The doors became a symbol of liberation
to me. I yearned for the day when I could walk up to the door and
walk through it to somewhere pointless and aimless but my place where
no one would look at me, no one check on me where I could do what
I wanted.
Being compulsorily
treated as I was or feeling forced to do things against your will
when there is no legal sanction for it is not that rare. In fact most
people would agree that the concept of choice is always a little limited
when in hospital even if there is no overt "you will do this",
there is a very familiar feeling of expectation to conform to the
rules of treatment and a hospital environment.
This is not to
say that it is automatically wrong. When I was being treated against
my will I did not feel wronged, but I do distinctly remember certain
incidents. I remember fleeing the doctors interview and feeling wounded
to the core by his expression of exasperation as he tried to deal
with psychotic me and his suicidal phone call at the same time, and
yet some minutes later I remember the warmth in the nurses voice who
coaxed me away from my corner of the yard in the hospital.
I remember the
concern I got from the nurse to whom I showed my cut wrist when I
returned to the ward and the anger in the doctor's voice as he stitched
me up. I also remember boredom, frustration, fear, tiredness, anger,
sympathy, kindness, interest and care from the nurses who were specialling
me. Each
of these different emotions gives me different perspectives.
I have felt they
took away my freedom, they didn't see me as human and they did not
reach out to me. I should have had rights and I should have had things
explained to me. I should have had justice. And yet nowadays I wonder
what I would have done and I feel that my life was saved by the nurse
and doctors and hospital and that there were moments of tact and warmth
which took away all the infringements that I felt that I saw.
Coercion and compliance
- they are at extremes and yet go hand in hand. In order for someone
to coerce me successfully, I have to be passive and comply to an extent
otherwise everyone under a section would be under constant restraint,
but whether they are always wrong or can be stopped I am unsure. I
am devoutly grateful that I was coerced and extremely glad that I
accepted it.
However sometimes
I wonder to myself whether it was all necessary. Sometimes when I
look back I can see myself acting out a horrible game. From the moment
I threw away my razor blade I think I knew that I couldn't damage
myself to the extent that I really wanted to. Sometimes I think the
cocoon of protection, which I fought against, created a whole set
of rules for me to fight against in relative safety. It gave me a
framework that allowed me permission to stop harming myself.
Sometimes it all
became very hard work. I have a very clear memory of someone telling
me about a teenager who eventually committed suicide saying that it
was sometimes totally exhausting staying psychotic. I have talked
about this with other people many of who have agreed that sometimes
there is an element of just thinking 'lets stop this and be normal
for at least a little bit'.
I think there
are elements here which make me think about how much we conform to
expectations and how much risk people should be allowed to experience
if they wish it. But what is it that we wish for? My story so far
is of wishes that contradict themselves.
It is more than
this. We will have all heard of the story of people being escorted
into a ward by the police taking huge precautions for safety and then
the supposedly violent person being put in the charge of a physically
weak nurse. Our perceptions of being forced to do something and our
reaction to it can be highly influenced by our stereotype of the person
concerned.
In mental health,
especially in hospital, the possibility of coercion, being put into
place with the force of the law behind it, is ever present and can
lead to anything being interpreted as an infringement of a person's
autonomy or freedom and on occasion it is.
When we are voluntary
patients we are (if we choose and if we have the wrong staff), always
at risk of being put into the wrong places in our minds where our
illness can escalate and our response to treatment change because
of our fear of what may happen. Everything can go out of control because
our minds are vulnerable and we are frightened and dependent in ways
we have not felt before, and where we meet the wrong people or environment
this situation can escalate into one where rightly or wrongly, we
are put under the threat of force and of being sectioned.
In the HUG response
to the review of the Mental Health Act we talk about a number of things
that touch on this subject.
For many people
there is a 'them and us' atmosphere in hospital and treatment connected
to different cultures, classes, status, ages and environments and
so on. It means that it is possible that two people, one who is ill
and wants to get better, and one who has a training that could assist
in this, can find themselves so entangled in the reality of their
respective institutions, that they remain forever suspicious of each
other, and forever open to accusations of passivity or control.
Both can be saying
to themselves "let us stop mistrusting each other" and yet
neither is able to do so. How do you make a connection between a young
psychotic person who is homeless and has a drug problem, with a well
paid well settled professional?
Sometimes you
do, but often the use of power intervenes to stop any useful connection
that can lead to cooperation. We don't want this atmosphere and neither
do professionals. To change it I can think of a number of things:
Rights
Presumably if you are a voluntary patient and are being forced to
do something against your will you have a lot of rights to challenge
this already. It is important that people realise this and have assistance
in getting them.
Attitudes
Stereotypes and stigma of people and services need to be challenged
to remove the knee jerk defensive reactions we can all exhibit, whether
they be against people with a mental illness or workers in mental
health.
Culture
Power is frightening but can be useful. The exercise of authority
can make someone safe and can make someone agree to treatment that
they couldn't admit the need for before.
Equally the perception that a hospital environment can be place that
just gives rules for someone to rebel against can be treated as a
positive thing, or something to be removed to allow people to take
the risks we all take with life.
Blame
Where government and society needs scapegoats for anything that goes
wrong it is very difficult to take risks by passing over control to
a user if the failure of that gesture and mark of respect exposes
you to pillory from the wider community.
Information
With information we will generally make informed decisions and act
reasonably. We will have difficulty in acting reasonably if information
is withheld from us.
Stigma
If society could accept we are all prone to illness and that we have
a common goal to help people to a healthy lifestyle in an environment,
which encourages diversity, then the misuse or use of power over another
could decrease.
Status
If hospitalisation did not often mark a fall from grace, we might
be treated and act better partly because we would react better too.
Consultation
If my friends and wife were consulted more about what I needed when
was ill then there would be more appropriate treatment.
Advocacy
If, as is likely, we are to have power exercised over us when we are
too ill or cannot easily express our views, then we should have access
to advocacy.
Advance Directives
The use of these may sanction powers that people are reluctant to
take when it is clear that we cannot give very clear consent to what
is happening.
Participation
Where we can join in as we get better and know that we have a clear
say in what is happening to us, and even have some optimism about
the prospect of getting better, the concepts of compliance and coercion
begin to dissolve.
The use of the
Mental Health Act will always have an influence but it is important
that voluntary patients have access to rights and representation and
that the training, education and cultural issues outlined here, are
acted on to minimize the bluntness that compulsion conveys.
There are a whole
range of issues that we can talk about here. Attitude is often the
key. Nothing can stop a section, whether right or not, acting as an
infringement of a person's liberty, but where it is carried out with
love and respect for that person, then its impact becomes less.
A section can
both save lives, protect families, bring hope to people who were fast
losing it and do all the opposites. Its use whether justified or not
can ruin a persons life and relationships whether with their workers
or others. So to end on a preaching note, handle the issues with care
and as I am sure you know, remember that the closer treatment is to
a persons wishes and experiences, the more productive it can be, and
the less is the need for the sort of use of power that damages people.
