The legality of psychiatric medicine and why our mental health system is so inadequate

A service user reflects on her experience

In 2016, can it really be said we have an adequate mental health system for the one in four of the 60 million people living in the United Kingdom who has, or will develop, a mental illness?

The experiences of many patients and their families — as well as the opinions of carers and mental health professionals — suggest that we do not.

Only recently, a report found that mentally ill patients in the north of England were being admitted to hospitals in London due to budget cuts, wards closing and beds being lost more so in psychiatric medicine than general medicine.

When comparing psychiatric medicine to physical ailments, why is it that psychiatric medicine is considered less worthy than general medicine?

Drawing on my experiences of psychiatric medicine as a mental health service user who suffers from depression, I feel that a mentally ill person’s treatment is comparable to a person with a broken arm going to A&E and being told “here are some painkillers to numb the pain, but we’re not going to treat the underlying condition of your broken arm.”

Shockingly, once a person has been sectioned under the Mental Health Act for the first time, they usually never leave the psychiatric care system (which includes NHS trusts, the police, Social Services, social housing landlords and many more.)

This is not the fault of psychiatrists and psychiatric nurses, but the fault of the national government reducing NHS funding for psychiatric medicine.

The legality of being sectioned

When a professional talks about the Mental Health Act they are usually referring to the Mental Health Act 1983, however a modern Mental Health Act was implemented in 2007 by the Labour government.

The 1983 act — brought onto the statute books by the Thatcher-led Conservative government — was a money saving idea that has proven a legal minefield over the 30 years since it was implemented.

Ss2 and 3 are the most commonly used in the Mental Health Act 1983 and a Community Treatment Order (CTO) is the most commonly used ‘section’ of the Mental Health Act 2007. Although ss 2 and 3 are for hospital-based settings only, its 2007 equivalent — the CTO — can be enforced in a patient’s own home. A s3 and a CTO can be enforced for a maximum of six months but can be renewed at the request of the consultant psychiatrist also known as a responsible clinician.

Other sections can be used to make sure dangerous criminals with diagnosed psychiatric conditions are detained for long periods of time (many months, sometimes many years). The most notable of these is the criminal partner of Myra Hindley, Ian Brady.

The appeals process

Once sectioned and admitted to hospital a patient can request that they be discharged via two options:

1. An Independent Mental Health Tribunal, where the patient will usually be represented by a lawyer or advocate specialising in mental health, or
2. The Hospital Managers Appeal Board, though a potential conflict of interest arises here: how can the managers of the hospital who employ the providers of care (doctors and nurses) also decide on the legal rights of the patient (notably whether to discharge the patient)?

Legal ethics of psychiatric medicine

A mental health patient can, if necessary, be made to take medication against their will with force being used if necessary. It’s worth noting a doctor could not and would not be legally allowed to force a diabetic to take Metformin against their will if necessary to maintain their optimum health. Does this distinction stem from the old lunatic asylums (before community mental health treatment became available) or is it a recently modern medico-legal issue?

Non-medical professionals and the mentally ill

Is it right for non-medically trained professionals like the police to be dealing with the mentally ill on a regular basis without proper training or resources put in place?

At this moment in time, Cheshire police are making use of psychiatric nurses when attending an incident involving a person suspected of having a mental illness. I think that this is a forward-thinking initiative, but it simply doesn’t go far enough.

An idea of mine is for all police forces to have psychiatrists and psychiatric nurses working directly for the police rather than a medical trust, with mental health professionals at the police force HQ, each divisional HQ and then each individual station. If the police can have a medically trained mental health professional to go to, then the police may deal with the mentally ill better — the police deal with the mentally ill on evenings and weekends when the NHS effectively shuts down.

The media and its perceptions of the mentally ill

When someone is killed by a mentally ill person, they are always depicted as mad, someone to be avoided at all costs.

Statistics have shown that the likelihood of being murdered by a mentally ill person — even someone with paranoid schizophrenia — is lower than the likelihood of being murdered by a relative. So why the perception of crazed maniacs? It sells papers but in reality it is not the truth.

There is a minority of mentally ill individuals who are dangerous to the point of needing detaining for life to prevent a crime from happening, and there is a minority of mentally ill people who do not have the mental capacity to know what they are doing or to accept responsibility for their actions. However, most mentally ill people — including myself — are highly intelligent and are safe to be around. Life goes on whether you have a mental illness, a physical illness or are blessed with no ill health.

Samantha Fogg is a law student at the University of Manchester. She wishes to put her personal experiences of the mental health system to good use by becoming a lawyer specialising in mental health.