Avoiding Becoming A Patient

I had a very bad day at work again.

It was similar to the event I discussed before (I Mental Nurse Am An Idiot) and again entirely my own fault. The problem is usually I don’t lose the plot quite so badly. My current job seems to be sucking life out of me.

No that is not correct. Not the job. It is the ward and the ward atmosphere. There is a culture of fear on my ward and it is not pleasant.

I feel myself being driven to cross the staff patient divide … though often there is not that much of a divide.

That is why this post may not be quite what I am intending, which is to finish off the Guide to the Mental Health Act sequence of posts.

The following is entirely from the top of my head, I am not in the best of moods, you take your chances if you read any further. It is of course entirely my own opinion and should not be considered to be the opinion of any other person.

Cynics Guide To Mental Health Act : 5 : Why We Are Allowed To Lock You Up

I have actually heard the following:

Client: Why are you putting me on a section ?

Nurse: Because we are allowed to.

This is an awful awful answer.

It is true though. We are allowed to.

Previous posts have made this clear, legislation allows the mental health system to detain people within fairly clear circumstances. One of the factors is dangerousness; either to yourself or to others.

Wanting to hurt people is not a sign of insanity tough, neither is wanting to hurt oneself. Go down to many a pub on a Saturday and you will see many examples of both types of behaviour.

Another factor is suffering from mental health problems.

Again this is not enough to get someone sectioned. Not even if someone is considered to be dangerous. Plenty of people suffer from mental health problems, many of them may be dangerous or violent to themselves or others.

I remember speaking to a man who had a long term diagnosis of paranoid depression. He had been admitted following punching one of his neighbours. It turned out, following the trend of housing the mentally ill in rubbish areas, that his neighbours were not the nicest people in the world. They knew he had some psych history. They used to shout abuse at him as he walked down the street. Being idiots they called him a paedophile, shouting this for all to hear. He also had stones and other objects thrown at him. Eventually he hit someone.

Followed by an admission to an acute psychiatric ward.

I’ll leave that as something to think about. My source for the above tale was the man himself. I believed every word.

Things come to a head when the system decides people don’t have the capacity to make a decision. Generally capacity to make sensible decisions about their treatment and their life.

The High Court held that an adult has capacity to consent [or refuse consent] to medical treatment if he or she can:

(a) understand and retain the information relevant to the decision in question.

(b) believe that information, and

(c) weigh that information in the balance to arrive at a choice.

That’s the best definition I could find with 30 seconds of Googling about. If you have a better (UK) definition go right ahead and leave a comment.

Most of my experience of working with sectioned people with diminished capacity is when they are feeling depressed and suicidal. Most of my opinions are based on this background.

I Believe In Detention

I personally think that the mental health system should be allowed to detain people against their will in particular circumstances. By and large I think the Scottish Mental Health (Care and Treatment) Act seems to have the best setup. It defines when people can be sectioned and tries to ensure adequate protective measures are in place to protect the client and prevent abuses. I hope to hear cries of ‘Least Restrictive Practice‘ bellowed from the psychiatric hospitals. We will have to see how it works in practice.

I am quite happy to see people detained, as a last resort, to prevent them from doing something quite horrific they would not do if not suffering from a mental illness.

Right I have come back to this post after about three days. Having had a horrible set of shift I think I’ll just try to tidy up and finish this post.

Patient: (shouting) What gives you the right to detain me ?

Mental: I have the right to detain you because …

1. Society has given me the power to do so.

Read the mental health acts. Society via courts, parliament or whatever governs what we can and can not do. If you don’t like this bit complain to your MP, sign petitions or even speak to an expensive lawyer.

2. You have been judged to require detention.

For one or more of several reasons someone with training in mental health has decided that it would be better all round if you were kept in hospital for a limited period of time. Normally we try to avoid detaining people unless we have to (last resort) or because significant prior experience shows in your case it would be best.

There are roughly three ways this happens:

a) you want to kill or severely harm yourself.

I quite happily presume almost anyone who makes that decision is suffering from some kind of mental health issue. Everyone I can think of has had flawed reasons for wanting to end their life. Often based on a significant misunderstanding of the world. For example someone suffering from a psychotic illness may think God is telling them to end it all. Very depressed people may think the world would be ‘better off’ without them in it. I’ve had discussions with other nurses about so called ‘rational suicides’ I can’t think of anyone I have worked with who could be put in this category.

Though I can imagine feeling like the above and being convinced I was right …

b) you want to hurt or kill someone

There are probably many ‘not mad’ reasons for wanting to do this. Still we are going to stop you. One of the prime duties of nurses is not only to look after the patient but to also protect the public. This is true in general nursing as well. I would imagine if a person is a carrier of some horrific disease and can infect other they will be kept in hospital, whether they like it or not.

For those people, suffering from mental health problems, who have ’sane’ reasons for wanting to harm others you are probably better off spending a brief time in hospital than being allowed to carry out your desires and going to prison.

c) you have no ability to care for yourself

If you are refusing to eat because all the food and water is poisoned you are better of in hospital. Or if you are to ill to care for yourself (or others) you are better off in hospital. In my opinion.

The examples above are picked to be fairly blunt and provocative. They are not picked to show the many grey areas of the decision making process.

Personally I think they are all good reasons for restricting freedom; if there is no other choice.

And there are safeguards. You can appeal against all but the shortest sections. If you suspect you are going to be in and out of hospital make use of advocacy services, friends any other sources of support. Nurses will help.

Good nurses do not mind their decisions being questioned and asked to explain things. If we are going to use mental health act powers we better know why and that we intend to achieve !

If you want less use of mental health act powers then campaign for better services. More community support. Whatever you need. Fax letters to your MP support the mental health charities. One of the reasons people end up in hospital is because there is no other option.

Right I have to go hopefully this makes some sense.

My dinger has just dung to tell me my Pot Noodle is ready.

Mental