Friday, 24 August 2012

24 August 2012 - Collusion and Control - The Reality of Mental Illness

The unholy trinity of restraint, seclusion and forced treatment in the psychiatric system can lead to collusion by agencies who should be protecting the rights of vulnerable people.  In an attempt to keep control, on the slippery slope of patriarchal power.  Where patients are treated like children and real family are sidelined, surplus to requirements.

Investigations into adult protection can be like shutting the gate after the horse has bolted.  Too late too little.  Diversionary tactics of blaming others.  Non system others.  Keeping up the appearances.  That force is justified if a person is mentally ill.  Does that mean they deserve it?

Families left to pick up the pieces.  Put their reputations back together again.  Shake off the disappointment but retain a modicum of distrust.  Learning from the experience that not everything does what it says on the tin.  Older and wiser and stronger.  Ready for the next round.

Where I live in Scotland the statutory agencies say that they are the guardians of welfare.  "Fife Council Social Work, NHS Fife and Fife Constabulary are working in partnership to keep people safe from harm."  According to the adult protection information on the Fife Council website.  I'm wondering how this translates into the psychiatric setting where restraint, seclusion and forced treatment are ways of working with vulnerable people?

Where locked wards and seclusion rooms within locked wards mean that vulnerable people/patients are out of sight and out of mind.  Where carers, family members and named persons are not allowed to go, except by permission and even then it could be by the back door.

What constitutes safety in the psychiatric ward?  Does it mean taking the pills and doing what you're told?  Being compliant and not questioning the decisions of professionals.  Accepting that they know best even if they don't know you.

Or should it mean person centred care, getting to know the patient and carer and family members?  Mutual partnerships and shared decision making.  Like it says in the new mental health strategy for Scotland.  But isn't happening where I live.

There are a number of safeguards in the Mental Health Act Scotland 2003, for people with a 'mental disorder' and under the Act, to "make sure your rights are protected".  The main ones are the Mental Health Tribunal, named person, advocacy, advance statement, Mental Welfare Commission.  In theory these pillars, along with the Principles of the Act, should ensure fair and just treatment for people in mental distress and under detention.  In practice it depends on the safeguards having the power and place they are meant to have, in my opinion.  (taken from recent blog post 'Mental Health Acts - Protecting Rights or Not?')

I have been concerned for some time about the gulf between the theory and practice, of safeguards keeping people safe, in the experiences of patients, carers and family members engaging with the psychiatric system.  Locked wards and the use of restraint, seclusion and compulsory/forced treatment are high risk places and procedures. Where basic human rights are in danger of being overlooked or ignored.  The right to adequate food, housing, water and sanitation; the right to freedom of expression.

As a 'named person' and carer I had limited rights of access to the psychiatric locked ward.  Advocacy was difficult to obtain and, in our opinion, not a voice for the locked-up patient.  The advance statement required more content to be taken seriously.  Another 'bulletproof' one has been written (we may be deluding ourselves).  The Mental Health Tribunal seemed to be on the side of the system and not the patient, having little impact on patient safety, staffed by ex-professionals.  As for the Mental Welfare Commission I want to believe it's a watchdog (with teeth) and a guide dog, helping shape policy, develop services and safeguard rights.  See MWC 'Influencing & Challenging'.

But in light of a report received this week, written by statutory agencies months ago, that attacks my character, motives and reputation, accusing me of "psychological harm", for daring to stand with the person I care for, I am left reeling from the shock.  A psychiatric system and its cohorts colluding to lay the blame at my door.  And I wasn't even there.

When the restraint, seclusion and forced treatment happened.  Resulting in injury and trauma.  The lock-ins for hours at a time in a seclusion room without toilet or water.  No recorded observations until they were caught out.  Freedom of expression denied.  Policies and procedures non-existent or made up as they go along "according to the patient population".  The forensic psychiatrist saying that people without capacity don't require advocacy.

This is the reality for people with mental illness in the psychiatric system when they dare to resist the treatment or challenge the status quo or criticise the practice.  I might have recovered, be a survivor, off all the psychiatric drugs, participate in national mental health groups, run events with international speakers, write blogs and websites that are read by many people.

But I am still the ex-mental patient (wrongly) diagnosed in 2002 with schizoaffective disorder or schizophrenia, depending on who's the scribe.  It's in the medical notes to this day so it must be true.  And no doubt helps to reinforce the stigma and discrimination when agencies are looking for somewhere to lay the blame, for system failure.

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