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Apart from the awkwardness of the manoeuvres required to inject your own butt-cheek, why not? I seem to remember hearing of a patient who gave his own depots while on a long holiday in the Australian outback.

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Thanks for the link there E. I recall the story and not sure if I recall the actual photo too - but I immediately recognised the “mental institution look” of the dying daylight casting shadows of helpless and hopeless bars upon the heavy shoulders of the despairing man in a dressing gown..

… that was probably the Charge Nurse.

Ok, I’m probably beat on the Next Generation MHA… but only by a slightly unanimous majority.

My next idea will be something like letting patients give their own depots….

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Unless of course you are “diagnosed” with an anti social personality disorder in which case you never see the inside of a special hospital/ secure unit or iof you do it is not for very long.

http://news.bbc.co.uk/1/hi/england/1079727.stm

I have never worked in a special hospital or a prison but have visited both and if given the choice I know where I would rather spend my time.

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nephron:
Not sure on NoK giving terms of time for detention - it’s a thought in progress, but I agree with the abuse potential. Guardianship is a current practice that could be amended to account for that tho?
Protection of NoK/family - hmmm… that’s a strong point and I’ll have to think on that. However, my initial (and final) thought is it would be wrong to expect family to take that risk.

I suppose I could have started the post: If the MHA was abolished and an alternative process had to be found -
what might alternative involuntary admission method be? (Which is similar to what they’ve done already with the MHA UK I believe - but simply widening the powers to others?)

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My problems with that are two-fold. Firstly, much of the time, the next of kin doesn’t have the best interests of the patient at heart, as evidenced by the number of family members I’ve seen come in and try to get patients to sign over all their assets.

Secondly (and this was the case with my family), the next of kin may be unable to make a recommendation contrary to the patient’s wishes, for fear of retribution upon discharge.

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And anyway, renewable detention is already part of criminal justice - the Criminal Justice Act of 1991 allows for sentences that are longer than usual where issues of public protection arise.

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My main issue is not whether in-hospital care is effective or worthwhile but is on the moral or ethical substance that justifies the indefinite nature of mental health act detention

Please keep them coming while I think up some good counters!

Input from patients and carers would also be much appreciated.

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I didn’t say it wasn’t aversive. But not for everyone.

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My experience is that mental health errs on clinical judgment of risk which, due to historical data always tends to be high with offender populations. The Home Office does not acknowledge that a detained mentally ill murderer is the same as a non-mentally ill murderer (probably as they are detained under different statutory instruments)- the statistics available show detention for murderers as being the comparable to all s41 restricted patients (as they may be liable to recall as a lifer on parole). However, s41 is not only for the offence of murder so available stats are skewed. (Stuff I did back in 1998 or so with DoH material - sorry can’t relocate source).

My own professional experience has been that it is harder for people to get discharged from hospital from a s37 than it is to get parole from jail.

I’ve seen people with minor charges ’serve’ excess of 12 months - because they’re not well. However, if the nature of the offence they commit is not such that it warrants longer than, say, 6 months, why do we allow hospital detention to continue indefinitely?

Beakie:
If it’s not aversive, why do we have to do it on an involuntary basis? Why aren’t they flocking in?
Hospital is a preferable refuge to prison for some I agree, and to some a welcome respite from life. I’m not against hospitalisation but I don’t see the moral rationale for keeping people detained indefinitely.
Working to make it less aversive I agree, but that’s a general consensus with hospital settings.

Is it still the case that a person tends to remain in hospital longer than possibly necessary because of concerns of ‘risk’ and lack of provision of services?

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Where is the evidence for this? Most peoples perception (including mine) is that detention for treatment is a soft option compared with serving a prison sentence. I would say that most people diverted from the courts into the mental health system “serve” less time in a special hospital than they would have in prison and generally have an easier time of it.

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Detention for treatment statistically exceeds the length of sentence for non-mental offenders. This is because in MH we are allowed to predict risk. In mainstream prison, no such prediction is permitted to defer someone’s release if their time is up. Why is MH allowed to treat detained offenders discriminately based on presumptions of mental health issues?

Treated or punished? Ask the detained patient. Most I know still feel it’s punishment, especially when “I’d be out now if I’d gone to jail” is actually true.

Unfair - agreed, but judicial review like MHRT could still allow patients early release. The sentence is a maximum prescribed time only. A minimum time could be set - like s47 can have a restriction of time (tho rarely ever is).

“Considerably unwell” is a problem, but does not justify incarceration. Services should assist the person to live in the community or at least in a supported open unit accommodation. Mental illness is not a crime. Indefinite detention is pretty inhumane. If the unwell person does not act unlawfully, is it lawful or ethical to keep them detained?

Agreed, there has to be some kind of ‘involuntary’ process, but I think it needs to happen with a greater degree of scrutiny than simply 2 doctors or ASW/GP etc. Recommendations only by healthcare staff perhaps, but ‘permission’ only to be given in accordance with next of kin or guardian. Again, processes for displacing next of kin or guardian can be made available if necessary but I don’t see why next of kin or close personal other isn’t given more credibility. Perhaps there’s an issue as to whether a close person *should* carry that burden, as it can be quite daunting - the blog by Mr Mans Man show the dilemma that happens in a voluntary admission - involuntary would be pretty traumatic I guess.

However, my issue remains I guess that people with MH issues tend to serve longer than those who don’t have MH issues as an excuse. Something just doesn’t sit right for me with that.

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It would also be unfair, as someone who was considered well before their “sentence” was up would not be able to be discharged.

On the flip side, someone who was considerably unwell at the end of their sentence would be in an extremely vulnerable position - dumped out of the hospital into a community that doesn’t want them or welcome them, possibly knows of their offence and could target them accordingly.

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