TIME TO BRING PSYCHIATRY BACK UNDER THE LAW
By Hazel Griffiths
This is a carer representative view on her involvement in the government’s independent review of the Mental Health Act and her perspective on co-producing recommendations for the final report. I have to be honest when Theresa May PM announced on the TV, she was appointing a previous chair of the Royal College of Psychiatry to lead the review. I had reservations on how objective this role would be, in light of the denial I had already witnessed from the college and some professionals that abuse happens to SU in psychiatry and under the MHA. Despite the many high-profile scandals surrounding psychiatry and the MHA, like Winterbourne view, C4 Dispatches programme, Under Lock and Key, Southern Health Mental Health Trust and the Bournewood case, to name a few. Some families and organisations who are no longer prepared to accept this and are working really hard to stop further scandals. I cannot go about my daily life and not be affected by all of this.
Are these scandals due to a system failure or down to bad apples in the system?
I have to say having met Simon Wessley, the chair appointed by the PM, he seems to be trying to do a thorough job and listening to all sides, I feel I am involved in the review process, having many opportunities to have a voice, hopefully listening , seeing for myself the work that is going on behind the scenes. Steve Gilbert, SU and co-chair is doing a fantastic job bringing calm to the proceedings, as you can imagine we all have opposing views and range of experiences on the MHA. I also want to pay tribute to my fellow SU and carers in my team, who have shown such strength, shared their stories, some good some bad experiences under the MHA and recommendations to reform the currently flawed MHA.
It has to be said that I'm grateful to the PM for commissioning this review and remaining a strong supporter. However, we need SU with learning disabilities and autism on the topic group. However, what would help with the ever-increasing workload of processing the huge amount of information generated from surveys, focus groups, 16 topic groups, personal emails form SU, Carers and professionals, from all backgrounds, was to have had more civil servants to take the pressure off all involved and ensure this review leaves no stone unturned. We may not get this opportunity again for some time and many families want to see meaningful recommendations that can be implemented asap, not in five years or 10 years.
We have to remind ourselves why the review was called upon, in the main, is to investigate, quite rightly, why a disproportionate number of black, Asian and minority ethnic people are detained under the MHA. I am in no doubt the advocates on this issue will do their best to ensure this happens. The reason I'm involved in the review, is due to not only the burning injustice my son with autism and Catatonia experienced under the MHA, but, for others who I have met on our journey of trying to change practice and culture in psychiatry. Some families have lost their loved ones, deaths that were preventable.
My response will focus on people like my son who is a gentle soul, people who are vulnerable, not street wise, or a forensic SU, think everyone is sincere, but find themselves caught up in a system that fails them. Far too many find themselves, sectioned inappropriately, some cases unlawfully, left with little hope, quite often trapped, for many many years in hospitals that are not therapeutic or safe, experience abuse and neglect. Where in the MHA does it say you can do that?
Judges on a tribunal need to be mindful of this when assessing the evidence and settling a dispute. They don't know if where a person is been sent is safe, or if the quality of care is good, or how effective or safe the compulsory treatment is. There is too much disconnect in the MHA process. Quite often some SU and families innocently agree to go into hospital informally, to then find huge concerns around safety. Let us not also forget over half safeguard alerts come from commissioned services.
I have asked the Dept, of Health to analyse the winterbourne cases, quite rightly the nurses were convicted, but, they were not responsible for repeatedly renewing the sections, that was the RC and everyone involved in the tribunal process. I believe this may show the unacceptable flaws in the MHA.
What strikes me out of all the scandals I hear about and after reading, quite often 900 page reports can be narrowed down to two common themes where on the one hand, SU and families are not listened too or believed and on the other hand, professionals who are not always confident in crossing professional boundaries, exercise their independent duties, speak up about bad practice, challenging their fellow colleagues and unsafe, and in some cases, unlawful practices. I know this is not an easy thing to do. This is not easy for me writing about psychiatry this way. Lessons need to learned, but we are still facing the same themes today. I make reference to this case, because for me, it demonstrates the unacceptable culture, which is still about today and feel unless we deal with this and drive culture change. No matter what recommendations we make to the legal structure of the act, the technical process, these pockets of malignant culture will contribute to the unacceptable families experiences. https://www.gov.uk/government/publications/the-kerrhaslam-inquiry-report
The Kerr/Haslam Inquiry report - GOV.UK
This document contains the following information: The Kerr/Haslam Inquiry report on female patients been abused by psychiatrists and despite the victims repeatedly telling their GPs, consultants in other disciplines, ie cardiologist, the victims were not believed. Some GPs, nurses and consultants, started to have concerns, but, did not have the confidence to cross the professional boundaries and stop the abuse, which, in turn allowed further patients been abused. The complaints service PALS was introduced, due to this scandal. Yet, several years on, victims still struggle with this culture and fight to be believed. This can be even harder if you are under the MHA.
It's such a shame, because these pockets of malignant cultures, lack of duty of care and poor clinical judgements, decisions, not only fail SU, but the good psychiatrists, out there. We do have some fantastic psychiatrists and service providers, who do not cross that moral and ethical line. Having said that we cannot have the not so fantastic, not sincere professionals and providers, having access to a powerful piece of legislation, such as the MHA. This is why I'm calling for extra safeguards, through robust due diligence and policing the processes involved in the MHA. We need to get the culture right, we owe it to the future psychiatrists coming into the profession, we are letting them down, if we don't.
It was the Bournewood case, my family owes a huge debt to. It gave us the confidence to help our son and his family, challenge detention and brought home how an RC, the accountable officer, seems to have the full force of the law behind them, how an RC can tell you where you can live, who you can see, including when you can see your loved ones, if at all, especially if you challenge their clinical judgement and decision making, and what treatment you can have. I am calling for the following to be considered.
- Human rights based approach.
- Strengthen Code of Practice
- STOMP in the MHA
- Advanced directive
Transparency, accountability, duty of candour, has to be consequences if the MHA is not followed
Compliance with the other acts, EUHR, Autism Act, Equality Act
Continued inclusion of autism in MHA contributes to the marginalisation of autistic people .
Improved co-produced psychiatry training and CPPD, professional development, as some psychiatrists state how they cannot understand why families feel the need to challenge their clinical judgement and decisions or even feel the need to use their right to a tribunal, especially as they have gone through medical school, keep up to date with CPPD, we know what's best for our SU attitude and yet, here we are reviewing a MHA and uncovering some unacceptable SU experiences whilst detained, this is not solely down to workforce issues or resource issues, we need to look at the bigger picture and acknowledge the points families are raising. A total disregard to how well families know their loved ones, who often live and breathe autism on a daily basis.
Urgent culture change, in how psychiatrists view and work with families, some of the families I know, who have experienced injustice, are the most traumatised I have seen. https://www.gov.uk/government/publications/lenehan-review-into-care-of-children-with-learning-disabilities
Lenehan review into care of children with learning ...
Review on care and support for children and young people with complex needs involving mental health, learning disabilities and/or autism. Bringing Us Together. Group of families who have experienced unacceptable care. Instead of staying angry, have put together survival guides for other families. The general public who have never accessed MH services and find themselves in situations that are failing their loved ones, some would never have agreed to detention or go into hospital, if they knew they loved ones would not be safe or cared for by staff who were not caring or compassionate. How can the review through legislation ensure this?
MHA professionals and advocates, exercise their independent opinion, even if it goes against the RC and hospital. Extra safeguards and stronger protection for SU and families, currently the act is failing to guarantee, for some, their safety, ensure receive quality of care, evidence based compulsory treatments, other than medication, which can do more harm than good and affect physical health.
Equip and provide education to Families on how to challenge detention that traps SU in unsafe hospitals.
Review of the diagnostic classifications and definition of a mental disorder
Better meaningful data collection on psychiatrists using the MHA, data from tribunals and robust research, evidence on some of the compulsory treatments psychiatry uses. Especially, on the contraindications of psychotropic medicines, where the research is poor, in hope, the MHA becomes a fair, safe and lawful process.
The review needs to focus and really listen more to the awful experiences from SU, who have been on the receiving end of the MHA, rather than the technical side of the act.
Mechanism to rescind the act if, inappropriate detention and unlawfully detained.
I conclude and hope by sharing some of our story and through this review, we change practice, to ensure the MHA is used lawfully and for the right reasons. Otherwise, sadly, it needs scrapping because we cannot continue the way things operate currently. Standards we walk past become standards we accept. Let's use this opportunity to work together and be a legacy to the families of loved ones, who are no longer with us and died in hospitals, whose deaths were preventable. Hazel is a retired ED nurse, advisor on the NHSE STOMP campaign and asks we use psychotropic medications wisely, review, monitor, remove if no longer of any benefit or cause unacceptable side effects. Coproduces autism training with mental health professionals, parity of esteem, reasonable adjustments, triangle of care and human rights.