I’ve been in and out of psychiatric hospitals for 20 years – it’s no surprise that patients are being abused while detained under the Mental Health Act. Dr Jay Watts in The Independent.
I have been coming in and out of psychiatric hospitals, first as a patient, later as a professional, for over 20 years. In this time, I have met people whose lives have been saved by compulsory detention under the Mental Health Act. But I have also met many others who have been traumatised, silenced and degraded by their experiences. It is yet to be seen whether the new government-commissioned report on the Mental Health Act, published today, will provoke the revolution in inpatient care that psychiatric survivors have been demanding for over 40 years.
Being detained under section is a disorienting experience. Suddenly, you are in a strange environment that you cannot leave, at least not straight away. Other people dictate what you eat, who you share space with, where you sleep. You are surrounded by other people in acute distress.
Professionals may decide you need medication whether you like it or not, meaning you might be subjected to an injection in the bum. You may be physically restrained if you become agitated.
If you are under observation at level one or two, a nurse will either be watching you at all times or checking in every 15 minutes – and this experience of proximity can feel extremely threatening.
A survey of over 2,000 patients found that only a third felt they had been treated with dignity and respect throughout their detention. Many felt subject to “potential coercive mistreatment, abuse and deprivation of human rights leading to physical and psychological harm”. This included “witnessing physical violence, verbal abuse and threats, bullying and harassment, sexual predation, pain-based restraint, coercive rewards and punishment systems for access to open air, leave or family contact”.
Even those who later thought that being detained had been the best course of action for their mental health often raised serious concerns about the manner in which they had been detained and subsequently treated.
Mentally distressed feel ‘unsafe’ while held under Mental Health Act
Thankfully, the current review has a particular focus on improving the experiences of young men of African and Afro-Caribbean descent who are more likely to be detained under section, restrained and overmedicated. As the interim report suggests, these experiences are partly due to health professionals’ unconscious biases, such as believing that black men are more likely to be aggressive. Acting upon prejudice reproduces a “hostile environment” on hospital wards that reinforces BAME communities’ distrust in mental health services. Seni’s Law, already in the legislative pipeline, offers hope of real change on this.
Another focus must be on an international movement called Trauma Informed Care, which changes the focus from “What is wrong with you?” to “What has happened to you?” Staff are trained to consider how gendered, cultural and historical contexts, as well as experiences of childhood trauma, have an impact on who breaks down and how.
TIC emphasises the need to reduce Iatrogenic Trauma, broadly defined as anything that a health professional or health system does that unintentionally causes patient trauma. Consider female inpatients, for example. Research shows that 46 per cent of women on inpatient wards have been sexually abused as children. Yet few women are asked about their experience of abuse and violence, despite the fact that the Department of Health has required staff to do so since 2003.
This means that understandable reactions to abuse that persist into adulthood, from dissociation to emotional turbulence and self-harm, are read as signs of illness rather than desperate attempts to cope. Lack of awareness means that abuse survivors are also forcibly restrained and injected, often by a team of male professionals, without consideration of how this might be triggering.
Experiences of sexual predation and assault by fellow inpatients and, occasionally, staff are often ignored or minimised, with friends of mine having been told not to report this as their diagnosis means that they are perceived to be unreliable narrators.
The traumatic impact of poor psychiatric care is something people struggle to keep in mind. This is one reason why services have failed to maintain the momentum of change ignited by former initiatives, such as attempts to reduce institutional racismfollowing Rocky Bennett’s tragic death in 1998, and calls to stop mixed-sex psychiatric wards following testimonies of abuse collated for 2003’s Mainstreaming Gender and Women’s Mental Health Strategy.
The current review of the Mental Health Act gives us an opportunity to do something different.
We could fund alternatives to inpatient care, such as crisis houses, that are more palatable to patients and avoid the need for compulsory admission in the first place. We could reverse cuts to community services and outreach programmes that build links with people from communities who have historic reasons for distrusting psychiatry and are therefore more likely to have a coercive, traumatic pathway into care. We also need to provide staff with the skills to be aware of patients’ pain rather than trying to keep patients at a distance.
It is easier, psychologically speaking, to “other” people who suffer from a profound breakdown, and treat patients as objects to be assessed, categorised and chemically coshed. It is easier to divorce “them” from the social contexts, structural discriminations and life experiences that so often provoke a breakdown. But what may be easier in the short term comes at the cost of the ethics of care and opportunities for healing that we must insist upon to be able to call our society humane.
Dr Jay Watts is a consultant clinical psychologist and psychotherapist, and honorary senior research fellow at Queen Mary, University of London
If you have been affected by this article, you can contact the following organisations for support:
If you have been affected by sexual violence, you can find help via RASA Merseyside or NHS Rape Crisis offers specialist support for women and girls; and the The Survivors’ Trust supports people of any gender
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