Mental health patients complain of 'zombification'Excessive use of forced detention and coerced treatment by the NHS means patients have little control over their treatment
http://www.guardian.co.uk/society/2011/mar/15/mental-health-patients-forced-detention
Share32 Comments (3) Mark Gould guardian.co.uk, Tuesday 15 March 2011 16.00 GMT Article history
Between 2008-09 and 2009-10 there was a 17.5% increase in the number of people being sectioned under the Mental Health Act. Photograph: Alamy
"I became 'zombified' for nearly 12 months when I was forced to take mood stabilisers and antipsychotic medication," says Reka Krieg. The 30-year-old has bipolar disorder, so has periods of manic activity and psychotic episodes, which led to her being forcibly detained and treated in hospital in 2009.
Krieg's case exemplifies the crisis in NHS psychiatric care, which is resulting in excessive use of coercive detention and treatment of people with mental illness. Latest statistics released in January show a 17.5% rise in the number of people being "sectioned" – under the Mental Health Act (MHA) – from 32,649 in 2008‑09 to 38,369 in 2009-10. This means that nearly 40% of patients in NHS psychiatric units are there under legal duress.
Years of drastic bed cuts mean wards are full of only the most unwell patients – those seen to be a danger to themselves or others. This includes rising numbers coming into hospital via the judicial system. Eight hundred and thirty women detained under the MHA came into hospital via prison or the courts last year, a rise of more than 85%, while the number of men rose by 48%, from 1,982 to 2,935.
The use of community treatment orders (CTOs) has also rocketed. Since they were introduced in 2008, more than 6,200 have been served – 10 times the expected number. Under a CTO, patients are released from detention, but can be forcibly returned to hospital if they fail to take their medication or other treatment. However, patients complain that once given a CTO, it takes them too long to get it removed, obliging them to stick with medication they believe they no longer need.
CTOs are "a complete waste of money," says Krieg. "I had a history of repeat hospital admission, but I was better when they decided to impose the CTO, which I hated. I felt I had no control over my human rights." She was finally released from the CTO after two appeals with the help of a specialist lawyer.
And it seems that CTOs have not eased the pressure on psychiatric wards. Last November, the Care Quality Commission, which oversees patients detained under the MHA, found that some hospitals were reporting 125% bed occupancy rates, and nearly a third of the 486 locked NHS wards in England and Wales had occupancy rates of 100% or more, meaning they were forced to send patients home early to accommodate new arrivals.
Mental health charities and senior psychiatrists say the situation is appalling, and they are lobbying for changes to the health and social care bill currently going through parliament, to make it harder to impose compulsory treatment.
Tony Zigmond, the Royal College of Psychiatrists' lead on mental health law, says the situation is "a disgrace". He fears some mental health services are becoming so focused on the risk of patients harming themselves or others that they make excessive use of compulsion and coercion.
He describes detention under mental health law as "a lobster pot – easy to get into but hard to get out". His college and the Mental Health Alliance, an umbrella group of charities, civil liberties organisations and lawyers, are lobbying MPs to amend the health and social care bill to make it harder to impose CTOs. Otherwise, he fears the use of CTOs could spiral out of control. "The top line is that CTOs have increased the number of detentions," he says. "In effect, they are prisons without walls so the numbers on them could be limitless."
Paul Farmer, chief executive of mental health charity Mind, says he is "extremely worried" about the rise in CTOs, "especially as 30% of them are being imposed on people who have no history of not co-operating with treatment". He adds: "CTOs are a looming threat of readmission hanging over the heads of people who are trying to rebuild their lives and independence."
Lee Milner, 41, has schizoaffective disorder, which results in episodes of elation or depression coupled with hallucinations. A volunteer and campaigner with mental health charity Rethink, Lee has had extensive experience of detention in hospital since 1992 when, following the suicide of his father, he tried to set fire to the family home. He was last sectioned in 2010 and agrees that hospitals are packed with only the most serious cases. "The ward was like being in the dark ages. How the nurses qualified I never know ... When I tried to talk to the consultant about spirituality, he just asked if I wanted more medication."
Zigmond wants a more consensual approach to treatment, and more space set aside in hospitals for patients to use as sanctuaries in times of crisis. "Why not give patients the option of coming off medication and being able to come into hospital if they need to?" he says.
Paul Burstow, care services minister, recognises the need for caution. In opposition, he warned that CTOs were an overly coercive instrument whose remit was too wide. Now Burstow says that officials are keeping a close watch on the rising rates of CTOs. "People who need compulsory treatment … should be treated fairly, and mental health services are responsible for making sure that they use the powers in the Mental Health Act appropriately," he says.
The Department of Health says that the MHA contains legal safeguards for people on these treatment orders, including the right to appeal and to have an advocate. But, a spokeswoman says, clinicians are best placed to know if a CTO means patients get appropriate treatment.
Marjorie Wallace, chief executive and founder of mental health charity Sane, says that when she set up the charity 25 years ago, more than 90% of psychiatric inpatients were there voluntarily. She says the NHS needs more beds: "People who are in crisis tell us they have nowhere to go. We are told that it is harder to admit people voluntarily than it once was, and, for those who do find an inpatient bed, our experience is that psychiatric wards offer very little sanctuary, with overworked staff and few therapeutic services."
But Simon Lawton-Smith, head of policy at the Mental Health Foundation, fears NHS psychiatry is "moving in the wrong direction". He wants people to feel able to engage voluntarily with doctors before they become really unwell. "We need the [Mental Health] act when people are a danger to themselves or others, but we want a system where it's used less and less, not more and more."
http://www.guardian.co.uk/society/2011/mar/15/mental-health-patients-forced-detention
Share32 Comments (3) Mark Gould guardian.co.uk, Tuesday 15 March 2011 16.00 GMT Article history
Between 2008-09 and 2009-10 there was a 17.5% increase in the number of people being sectioned under the Mental Health Act. Photograph: Alamy
"I became 'zombified' for nearly 12 months when I was forced to take mood stabilisers and antipsychotic medication," says Reka Krieg. The 30-year-old has bipolar disorder, so has periods of manic activity and psychotic episodes, which led to her being forcibly detained and treated in hospital in 2009.
Krieg's case exemplifies the crisis in NHS psychiatric care, which is resulting in excessive use of coercive detention and treatment of people with mental illness. Latest statistics released in January show a 17.5% rise in the number of people being "sectioned" – under the Mental Health Act (MHA) – from 32,649 in 2008‑09 to 38,369 in 2009-10. This means that nearly 40% of patients in NHS psychiatric units are there under legal duress.
Years of drastic bed cuts mean wards are full of only the most unwell patients – those seen to be a danger to themselves or others. This includes rising numbers coming into hospital via the judicial system. Eight hundred and thirty women detained under the MHA came into hospital via prison or the courts last year, a rise of more than 85%, while the number of men rose by 48%, from 1,982 to 2,935.
The use of community treatment orders (CTOs) has also rocketed. Since they were introduced in 2008, more than 6,200 have been served – 10 times the expected number. Under a CTO, patients are released from detention, but can be forcibly returned to hospital if they fail to take their medication or other treatment. However, patients complain that once given a CTO, it takes them too long to get it removed, obliging them to stick with medication they believe they no longer need.
CTOs are "a complete waste of money," says Krieg. "I had a history of repeat hospital admission, but I was better when they decided to impose the CTO, which I hated. I felt I had no control over my human rights." She was finally released from the CTO after two appeals with the help of a specialist lawyer.
And it seems that CTOs have not eased the pressure on psychiatric wards. Last November, the Care Quality Commission, which oversees patients detained under the MHA, found that some hospitals were reporting 125% bed occupancy rates, and nearly a third of the 486 locked NHS wards in England and Wales had occupancy rates of 100% or more, meaning they were forced to send patients home early to accommodate new arrivals.
Mental health charities and senior psychiatrists say the situation is appalling, and they are lobbying for changes to the health and social care bill currently going through parliament, to make it harder to impose compulsory treatment.
Tony Zigmond, the Royal College of Psychiatrists' lead on mental health law, says the situation is "a disgrace". He fears some mental health services are becoming so focused on the risk of patients harming themselves or others that they make excessive use of compulsion and coercion.
He describes detention under mental health law as "a lobster pot – easy to get into but hard to get out". His college and the Mental Health Alliance, an umbrella group of charities, civil liberties organisations and lawyers, are lobbying MPs to amend the health and social care bill to make it harder to impose CTOs. Otherwise, he fears the use of CTOs could spiral out of control. "The top line is that CTOs have increased the number of detentions," he says. "In effect, they are prisons without walls so the numbers on them could be limitless."
Paul Farmer, chief executive of mental health charity Mind, says he is "extremely worried" about the rise in CTOs, "especially as 30% of them are being imposed on people who have no history of not co-operating with treatment". He adds: "CTOs are a looming threat of readmission hanging over the heads of people who are trying to rebuild their lives and independence."
Lee Milner, 41, has schizoaffective disorder, which results in episodes of elation or depression coupled with hallucinations. A volunteer and campaigner with mental health charity Rethink, Lee has had extensive experience of detention in hospital since 1992 when, following the suicide of his father, he tried to set fire to the family home. He was last sectioned in 2010 and agrees that hospitals are packed with only the most serious cases. "The ward was like being in the dark ages. How the nurses qualified I never know ... When I tried to talk to the consultant about spirituality, he just asked if I wanted more medication."
Zigmond wants a more consensual approach to treatment, and more space set aside in hospitals for patients to use as sanctuaries in times of crisis. "Why not give patients the option of coming off medication and being able to come into hospital if they need to?" he says.
Paul Burstow, care services minister, recognises the need for caution. In opposition, he warned that CTOs were an overly coercive instrument whose remit was too wide. Now Burstow says that officials are keeping a close watch on the rising rates of CTOs. "People who need compulsory treatment … should be treated fairly, and mental health services are responsible for making sure that they use the powers in the Mental Health Act appropriately," he says.
The Department of Health says that the MHA contains legal safeguards for people on these treatment orders, including the right to appeal and to have an advocate. But, a spokeswoman says, clinicians are best placed to know if a CTO means patients get appropriate treatment.
Marjorie Wallace, chief executive and founder of mental health charity Sane, says that when she set up the charity 25 years ago, more than 90% of psychiatric inpatients were there voluntarily. She says the NHS needs more beds: "People who are in crisis tell us they have nowhere to go. We are told that it is harder to admit people voluntarily than it once was, and, for those who do find an inpatient bed, our experience is that psychiatric wards offer very little sanctuary, with overworked staff and few therapeutic services."
But Simon Lawton-Smith, head of policy at the Mental Health Foundation, fears NHS psychiatry is "moving in the wrong direction". He wants people to feel able to engage voluntarily with doctors before they become really unwell. "We need the [Mental Health] act when people are a danger to themselves or others, but we want a system where it's used less and less, not more and more."
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