What it's like to be on both sides of a mental health section

Figcaption What Its Like To Be On Both Sides Of A Mental Health Section
Posted at: Author: Rain TV UK

W hen I was first admitted to hospital, far away from where I now live, it was with the threat of the Mental Health Act (1983) hanging over me. The horror lives with me still, with surprising clarity. The idea of losing one’s liberty and being powerless to prevent it, whatever you say, is not easy to imagine. In fact, the more you say, the worse it gets, and there is a feeling of duality – of wanting to say all you are really feeling and thinking and also wanting to say anything that might get you out of the situation.

The result, for me, was that I was de facto detained, in that I agreed to admission only under duress, so had none of the rights that should come with actually being detained, even though that would happen if I tried to leave. Fortunately, it was a short admission, but it was very frightening.

In addition to lost liberty, I believed, wrongly, that being detained would mean I could never become a psychiatrist. I had been told this as a medical student, and it had stuck. I was training as a GP at that time, but hoped later to switch to psychiatry. I also thought that travel to certain countries could become impossible.

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It felt far more like being a criminal than a patient; the use of the word patient doesn’t feel apt here, as it hardly describes what it is like. “Sectioned” – meaning to be detained under one of the various sections of the act – is a word that is still used fairly frequently, and it has developed some unfortunate connotations. Recently, the law has been independently reviewed, and that review formed the basis for a white paper published by the government in January. The aim is to “to put patients at the centre of decisions about their own care and ensure everyone is treated equally”. This is a good thing to aspire to, but I doubt if it will always turn out that way, even after reforms are implemented.

Liberty is a human right that many of us don’t even think of until it’s at risk. But it can never be unconditional. The rights of all interweave in such a way that makes it impossible. People who are mentally ill may present a risk to themselves and need protection; risk to others is far less common, but can have tragic consequences if not acted on. Sometimes illness is obvious, but sometimes it can be very challenging to assess. It may be difficult to know whether this is a crisis that will quickly resolve or a more serious illness requiring assessment and treatment.

I managed to get on the wrong side of the act on one or two further occasions after returning to Scotland, which has a separate Mental Health Act, also currently undergoing its own independent review led by John Scott QC. Both were fortunately brief; my memory of the circumstances is very poor and I have chosen not to remember them, in so far as I can. More distressing was another occasion when I was an informal inpatient, and asking to leave. The threat of detention hovered once more, but the consultant came to see me and allowed me to go home, perhaps recognising the distinction between unhappiness and illness. And I was probably lucky as he knew me well; the outcome could have been very different.

There is always a power imbalance between psychiatrist and patient, and this is only increased by the possibility of detention. The proportion of inpatients who are detained has grown, as a natural result of decreasing overall bed numbers, and that must impact the experience of being in hospital for all patients. Nurses aren’t jailers, but they can’t let detained patients leave. Psychiatric medication can be distressing to take at the best of times but some people have no choice, and it is up to the nurses to administer it.

I work in addiction psychiatry, and few of my patients ever get detained. There are many other reasons why I chose it, but I am very grateful for this aspect. Having glimpsed the other side, I find it personally very difficult to use the Mental Health Act. This doesn’t mean that I think it shouldn’t be used; on the contrary, it undoubtedly saves people’s lives and reduces suffering. I recently spoke with one of my trainees about this, and it made me realise that it is right to feel bad when you detain someone. Few doctors entered medicine or psychiatry to be in a position of depriving people of liberty. Trainees, in particular, need to understand that it is a huge thing to do, and that it isn’t supposed to come easily.

The Mental Health Act can be complicated to understand, and a combination of misunderstanding, acute illness, and being prevented from leaving hospital is terrifying. The resulting distress should not be underestimated, and may not be fully alleviated by recovery and removal of detention. I think this is because both parties know that a line has been crossed, and that it could happen again. As a patient, this can be very difficult. As a psychiatrist, it should be.

  • Rebecca Lawrence is a consultant psychiatrist

  • In the UK, Samaritans can be contacted on 116 123 or email jo@samaritans.org. You can contact the mental health charity Mind by calling 0300 123 3393 or visiting mind.org.uk

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