Table of contents for All Change
- All Change 1: New sectioning powers for nurses
- All Change 2: Learning to Love the Mental Capacity Act
- All Change 3: The Treatability Test
So let’s wade into the biggie. The really controversial one. The changes to the treatability test in order to enable the detention of dangerous people with personality disorders.
Quick summary: under the old act detention powers rested on the so-called “treatability test”. For somebody to be detained under the mental health act, their mental illness had to be treatable. This led to cases where people with personality disorders were released into the community despite being dangerous to others, because their conditions weren’t considered treatable. If it’s not treatable, so the argument goes, then they shouldn’t be in a hospital.
Under the new act, the treatability test is replaced by the concept of “appropriate treatment”, which allows for the detention of such individuals.
This change, it is argued, prevents the release of dangerous psychopaths into the community. To its critics, this is psychiatry acting as pre-emptive judge, jury and prison officer.
Okay, get debating. I give it three replies before people start screaming at each other.
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*hides*
16 Comments
(I shall avoid the obvious, so no comment on the ethics of this proposal). I shall simply ask what will an ‘appropriate treament’ look like if the patient is considered to have an ‘untreatable’ condition?
I think this sounds good, but only in theory.
I don’t agree that anyone is “untreatable”. There must be *something* out their for everyone. I am mentally well, but could still benefit from some kind of “treatment” -as could anyone!
Although Personality Disorders tend to be classified as “untreatable”, I notice that Dialectical Behaviour Therapy has been getting touted a lot recently as a treatment for PDs, including psychopathy. I have no experience of Dialectical Behaviour Therapy, so can’t really comment further.
Question: Can Dialectical Behaviour Therapy be administered as a compulsory treatment or does it require at least some degree of positive engagement from the patient?
More fundamentally if PD’s are afterall ‘treatable’ then I am even further confused by this proposal. In this case PD’s would meet the old ‘treatability test’ and this amendment to the Mental Health Act is thereby rendered unnecessary.
However I think there is contradiction at the heart of this proposal. Through all the green papers, white papers, draft bills, Government statements etc. there was an explicit agenda that this amendment was being introduced in order to address the problems associated with patients deemed to be ‘untreatable’. In which case I return to my original point; isn’t ‘treatment for the untreatable’ an oxymoron?
. . . what will an ‘appropriate treament’ look like . . .
If there is no way to “treat” the person to effect major improvement or cure, the treatment is containment.
And with no hope of resolution, that’s containment for ever.
I guess that then begs the question, if one of us were to have assessed Ian Huntley or Beverley Allitt some time before they’d committed their crimes, and noticed their dangerous tendencies, would we feel happy about pre-emptively detaining them, possibly for life?
The social libertarian in me says that no, we shouldn’t detain people for crimes they *might hypothetically commit* rather than ones they actually have committed.
That said, I also suspect I’d have great difficulty explaining the social libertarian argument to the parents of Holly Wells and Jessica Chapman.
Thank you Shrink. I was under the misapprehension that any containment would be to faciitate treatment, I didn’t realise that it will, of itself constitute ‘treatment’. That opens up a whole new can of worms…
I think The Shrink has hit the nail on the noggin. For some people, the treatment will be the containment, to avoid them expressing some of the more serious “symptoms” of their disorder i.e. violence towards other people.
I don’t necessarily think this is a bad thing. I’m sure we’ve all come across scary-ass individuals who perhaps we’ve suspected really shouldn’t be walking around among the general public, or if we haven’t then I’m sure we can think of some famous cases where preventive detention might have been appropriate.
zarathustra - beverley allit has a diagnosis of munchausens by proxy, not a PD, so i’m not sure where she fits into this argument really … presumably there is some recognised form of treatment for this otherwise she’d be in prison rather than rampton.
similarly with ian huntley - i’m not sure he was ever diagnosed with anything other than being a nasty piece of work. i think he tried to use mental health problems as a defence & he’s taken an OD whilst in prison, but i reckon that could probably put down to a reaction to his circumstances rather than an underlying problem …
i’ve been involved in the campaign against the new act since 2002 & this one still baffles me. on one hand, the department of health publishes a document called “personality disorder: no longer a diagnosis of exclusion” which sets out that - hooray! - there are ways to treat PD after all, and on the other hand there’s a draft mental health bill on the table trying to close the so-called treatability loophole. well, didn’t their own, DH published document just do that? without having to enshrine in law the ability to detain anyone pre-emptively? *brain melt*
it’s all very well bringing out emotive arguments along the lines of “well tell that to the parents of x who was just murdered”, but at the end of the day, if you look at the inquiries into murders committed by people with mental health problems, 9 times out of 10 all the signs were there but the mental health teams didn’t act on them for various reasons - lack of resources, poor communication between agencies, failure to realise the seriousness of the situation etc etc - it wasn’t because they were prevented from intervening by law. the mental health system needs to learn from its mistakes highlighted in these inquiries rather than being given new powers. after all, these powers are not going to improve communication, create beds and services where there weren’t enough before, predict the future etc etc …
rant over :o)
Perhaps there are several people already detained and deaths have been prevented at the present moment?
That woulld be rather immeasurable don’t you think?!
(trying to see a positive here)
well yes, precisely … until we’re capable of building a time machine, all we can do is guess.
i read an article a while back by tony zigmond (vice-president of the royal college of psychiatrists i believe) who said that, assuming risk assessment techniques are 85-90% accurate (which they aren’t) that you’d have to detain anything from 2,000-5,000 people to prevent one homicide.
Since someone asked, I do not believe DBT can be a compulsory treatment, as one has to make a serious commitment to the therapy and contract to engage with it and to stay alive for the course of the therapy. It also involves thought changes, which can’t be administered by IM injection!
As my understanding of personailty disorder (I may be mistaken) is that the theory is it develops from understandable reactions to invalidating/traumatic early life experiences, I do not understand how it can be said to be “fixed” and “uncurable”. Surely what has developed through experience (rather than, say, genetics), can be worked upon and changed or managed?
My impression is that the medical model still teaches that personality disorder is “incurable”. Horribly disheartening for doctors, and those diagnosed as PD. Other schools of thought hold out more hope for change.
As I’ve mentioned elsewhere, I was excluded from nurse training at one university, and told “we don’t want another Allitt on our hands” by the occupational health staff at another. I have never been diagnosed as having had a PD, munchausens by proxy, but had been open about my past history of eating disorder/depression/self harm.
The Shrink has posted some further thoughts on this subject at http://lakecocytus.blogspot.co.....nment.html
I’ve just spent a year on a PD ward finding out the hard way that treatability and compliance (with treatment) are pretty much the same thing. I’m currently working in a forensic MSU, and the vast majority of my patients would rather return to prison than accept their diagnosis and subsequently comply with the treatments on offer. Sometimes I wonder if we shouldn’t just send them back to prison and offer the beds to someone who agrees with the diagnosis?
i think a big part of the going back to prison thing is the fact that with prison they have a definite release date - with hospital there’s no such thing, not at the beginning anyway. as for accepting a diagnosis and “complying with the treatments on offer”, i think you’ll find that a lot of people with mental health problems struggle with the former - i didn’t agree with my diagnosis for a long time, does this mean i didn’t deserve treatment? as for the latter, let’s be honest here, it’s not as if the service users get all the treatment options laid out for them and are able to choose - if they’re lucky they get to ask a few questions at their cpa review and maybe sign a care plan. therapy is bloody hard work, i reckon a lot of people would rather scoop out their own intestines with a blunt spoon than be coerced into confronting painful truths about themselves, their past, family, upbringing etc. if beds in MSUs were available only to those who agreed with their diagnosis & to comply with treatment, prisons would be even fuller than they are already and MSUs would be very very empty …