and the evidence is clear but I continue to smoke. In fact I would
defend my right to smoke if I thought there weren't more important things.
However I would defend an individual's right to make a choice that
reduces my life expectancy. It is my body, it is my life and it is my
choice as long as it is a well informed choice. The right to make an
uninformed choice not as clear cut and would require much more mental
wrangling but an individual who knows what they're doing has every right
to do something someone else may, perhaps, consider stupid.
The 2007 amendments to the Mental Health Act 1983 reduced the right to
free choice for the severely mentally ill. It gave psychiatrists the
power to use the Community Treatment Order. This forces patients into
treatment and punishes them with reincarceration. Their liberty is under
threat and their only crime is refusing medical treatment, and in
practice this often means refusing medication.
I don't know how the law works in practice. I think there's a test for
capacity and they may use the Gilick competency test to assess whether a
person is capable of making the decision. I'm afraid I'm not confident
that this test is used effectively in practice.
What's clear from some of the evidence so far is that the CTO is being
overused. This was expected because the tool gives psychiatrists a new
option of coercion and given the chance many of them will use this
measure without consideration of the human rights they are violating.
They are human and as human as the psychiatrists who thought a lobotomy
or a leucotomy was a suitable treatment for mental illness. The evidence
is that in the UK the CTO has been overused ten-fold. This is higher
than the worst case estimates and far higher than the overuse of this
protocol in other countries.
The stereotype of severe mental illness is a caricature of reduced
capacity however this is not true. Many people even in their worst
states can still make good decisions. They can also make informed
choices about what treatments they will accept and what they won't. That
is their human right but in the UK that ain't fucking there any more.
Part of the reason for the reason for this is the fear of the psychotic
killer. The work of the Zito Trust pushed the image of a murdering
schizophrenic and the media love to promote the idea of the psychotic
axe killer as much as film makers love to use the psycho bad guy. There
is high quality evidence showing an association with some mentall
illnesses and increased rates of violence and homicide, however there's
also vast amounts of evidence that men are the associated with higher
levels of violence and homicide and significantly higher than drug users
or the severely mentally ill. None of the diagnostic criteria I am aware
of includes homicidal tendencies as part of the diagnostic cluster of
symptoms however I don't know much about personality disorders. It's not
one of the cluster of symptoms empirically derived using modern
statistical techniques used in creating DSM-IV's definition of
schizophrenia.
Part of the reason is to deal with "revolving doors" patients. These are
people who are quickly rehospitalised or have a crisis in the community.
It's been observed that many come off medication. Forcing medication on
people so they don't end up in hospital is cheaper though this reasoning
seems contradictory if the punishment is hospitalisation. Over 50,000
people refuse secondary mental health services every year however most
of those people don't end up as revolving doors patients. There may be
other reasons as well.
The CTO may, perhaps, save a lot of lives through fewer suicides and
maybe spare one or two people from homicide by a severely mentally ill
person. That does not make it right nor good. The cage bed would be an
even better and cheaper treatment. This is a barbaric treatment where
the individual spends their life in a small cage built around their bed.
I've not heard of it used in the UK but it is still used elsewhere in
the world.
I hope elucidates on the concept that measuring lives saved is not
enough. Such a tactic is a powerful argument however the consideration
of what is being done is also vital. The decision to take away a
person's ability to choose is one that should only be done with extreme
care and careful judgement. There should be a stringent judiciary
process for what is an obvious violation of basic human rights. The
preference is never to do it at all, ever, and in my opinion that ideal
is worth more than the lives lost. Instead this protocol is overused ten
times more than expected and significantly more often on Black people.
(The UK is already guilty of a significant rate of overdiagnosis of
schizophrenia in black men as was noted in the New Horizons
consultation.I can't remember if the gender ethnicity breakdown but it
would be useful to see.)
This is a very heartless viewpoint but it's not without understanding.
I'm one of those untreated 'mentally ill' people. I know the suffering
that comes my choice. I currently don't have a diagnosis but I read the
research and I know the outcomes across a number of measures, and I know
that there are always exceptions to the rule and I know the critical
evidence about the mental health system as well. When it gets bad I seek
treatment but I do so with the foreknowledge that I risk my right to
choose and my liberty by accessing the UK mental health system and
engage with a system that stigmatises me inherently by calling me ill.
I have the capacity to make very hard decisions even when I'm at my
worst. I have not always had this capability. I had to learn it the hard
way. I know about treatments and I can learn the options so I can make a
decision that's informed, even though it may be stupid to you. That's
what free will is all about.
I've not had the experience of having a loved one murdered. I don't know
how it would feel to loose a child to a psycho. I would also defend a
person's right to live free of homicide and by anyone but to achieve
that takes different measures. In my opinion the Jesus had it right. The
commandments were a simple way to remember the things people shouldn't
do. Murder is one. Suicide should probably be on there but my personal
view is that I have the right to take my life when the time comes. It is
a horrible part of me. It is probably the most evil thing about me.
Perhaps. It is knowledge of the impact of suicide on my friends and my
family. I am a shit person because of this. ) :
I can understand why people would want to force treatment on me but I
have the capability to learn how to survive without and through that
process I have got so much more and more to offer. I found a reason to
live. I've reached a point now where I'm not suicidal and not having
suicidal thoughts even though I'm in a bad way. My life is hard but I've
developed a resilience to extremes of mood and unusual states of
consciousness, unhappiness, misery and poverty. I've had many
opportunities to make different decisions such that my life wouldn't be
so hard and made decisions that may have looked foolish to the
uninformed. I've also learnt about mental illness from the inside and
the outside - that's something very few psychiatrists could say. This
capability would never have been achieved had I used the medical mental
health system. The pain and the hardship I've been through has been
pretty bad but the life experiences I've had in this journey have
enriched my life and enriched other peoples. And bored them to tears. So
at this point I end this ramble.
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