Responsibility / Punishment?

The SAGB (Schizophrenia Assoc. of GB) in its latest Newsletter has published an article entitled " INDIVIDUAL RESPONSIBILITY,
PSYCHIATRY and the paradox of PUNISHMENT". Dr. Sally Baker and Dr. Brian Brown discuss the peculiar case of a mental health system where no one is responsible except the client." The following are excerpts:
"The idea that people with mental health problems, even those deemed ill enough to have been detained or 'sectioned' under the Mental Health Act, should take responsibility, is becoming very deep rooted within the mental health services. These developments have left the older generation of mental health professionals aghast at the tragedy and brutality of vulnerable people finding their way into the prison system. Mental Health practitioners who qualified before the 90's have spoken of the change in climate, of how a new generation of mental health professionals has been educated to accept this idea uncritically, and of the inhumanity that they believe is arising from it. Some practitioners feel that there has been almost a complete abdication of mental health professionals' responsibility to care for their clients. Our attention was initially drawn to this issue when we became interested in the extraordinary reasons why some mentally ill people were being brought into contact with the criminal justice system and were even ending up in prison. Far from being serious offenders in the making, the events involved in these cases are often tragic and the so-called crimes extraordinarily trivial, i.e. the case of a sectioned patient being pursued through the courts for two years for calling an NHS manager a 'fat idiot'. The police expressed clearly that they were unhappy about charges being pressed, and possibly also unhappy that the man who had been called a fat idiot called them eight or nine times in the course of a single day to complain about this particular incident and insist that charges be brought. These charges are often pressed in the context of the 'zero tolerance' policy of threat to NHS staff."
"The notion of individual responsibility is extremely elastic, and it is this versatility that contributes to its usefulness as a means of undermining the status of the client. In the case of people who have been sectioned, the client by definition has had choice and responsibility removed from them. In many of these cases there seems to have been no discussion of the legal principles of McNaughton where the intentions and presumed responsibility of a person committing an offence can be called into question if they are mentally disordered."
"Many of the adult mentally ill are being cared for by parents entering old age and we have heard of carers themselves being told that they must also take responsibility when, at breaking point, they make demands on the services."
"In the course of our work so far we had many conversations about 'individual responsibility' with practitioners, discussing the possible ideological or political reasons why, after generations of seeing the mentally ill as predominantly not responsible for their actions, we should now be encountering such a forceful promotion of the opposite notion - that they should 'take responsibility' is clear that as our prisons swell with the mentally ill, as they continue to become destitute and as they (and
sometimes their carers) kill themselves, that some people cannot take responsibility, no matter how severe the sanctions. At a time when our mental health services are scandalously inadequate, one of our interviewees observed: 'if we deem the mentally ill responsible, it absolves us of our responsibility to help them'. EXACTLY WHO IS REFUSING TO TAKE RESPONSIBILITY?"

RISK ASSESSMENTS - THE KEY TO A PATIENTS TREATMENT

From a survey of complaints received by the K&C MH Carers Association.
Risk Assessments (AOR1 and AOR2) often contain subjectively written assumptions and misunderstandings and exaggerate the "danger" of particularly African Caribbean & BME patients. A history of forensic assessments is often created even without orders from the criminal justice system, thus prejudicing the patient for life and impacting on referrals to more secure wards and hospitals, loss of liberty, long hospital confinement, denial of mainstream rehabilitation programmes including talking therapies, misdiagnosis, higher dosage of medication, fierceness of restraint, limited or compulsive choice of accommodation in the community and lack of prospects of employment. Psychiatrist tend to protect their sole responsibility by "erring on the side of caution", - which is an 'error' nevertheless and against the interest of the patient.
Because of the absence of "Strength Assessments" (cultural, creative, spiritual, religious,academic, occupational,capability, belief & value system etc.) the perception of the person is biased and out of proportion measures are taken.- A human rights issue.
Carers and family concerns are logged in the medical notes of the patient and equally assessed as a risk.
All carers feel very strongly that carers concerns for confidentiality reasons should be kept on a separate file and not be part of a patient's medical notes.
A patient can obtain his risk assessments and medical notes under the Freedom of Information Act and Data Protection Act from the hospital manager, but nevertheless often 'sensitive' information is witheld at the discretion of the psychiatrist.

SAGB

These are excerpts from the last SAGB Newsletter Oct. 06. "Please WRITE to the Home Secretary, John Reid, to express your disgust at the large-scale imprisonment of the mentally ill offender. The Rt.Hon John Reid House of Commons London SW1A 1AA DISREGARDED MCNAUGHTON RULES: Thus we punish, in increasing numbers, the mentally ill offender. The McNaughton Rules of 1843 seem to be totally ignored these days and yet these rules made it clear that if an accused person was of unsound mind they should not be punished for any criminal action they had committed. It is a most terrible indictment of our present-day society that we so often add cruel punishments to the suffering endured by the mentally ill.
URGENT NEED FOR MORE HOSPITALS AND NOT MORE PRISONS
The discovery of the NEUROLEPTIC DRUGS was undoubtedly a blessing, but they certainly are not a cure. If the drug is withdrawn then the symptoms return. And they have their own side effects. There are also reports that they can alter the structure of the brain. The real answer for cure will only come when the cause of the brain symptoms is discovered.
IT IS THE CAUSES WHICH MUST BE THE FOCUS OF ATTENTION AND NOT MORE NEUROLEPTICS.
Research on physical causes of mental illness has been going on through the 20th C. The hypothesis of a genetic link between mental illness and coeliac disease is still being investigated. For details write to the SAGB (The Schizophrenia Assoc.
of GB, Bryn Hyfryd, Bangor, Gwynedd, LL57 2AG) for a copy of their No.42 Newsletter.