The last 100 years has witnessed substantial progress towards countering the blights of racism and sexism within Western societies. Although discrimination on the grounds of ethnicity and gender persist today, the more blatant examples of these types of prejudice will evoke expressions of outrage and condemnation from a variety of sources. Yet people struggling with emotional pain and overwhelm routinely endure flagrant examples of injustice and bigotry that rarely evoke screams of disapproval. This discrepancy demands explanation.
Mental health legislation – such as the Mental Health Act (MHA, 1983, 2007) in England and Wales – constitutes a form of legalised discrimination, trampling roughshod over the basic human rights of people deemed to be ‘mentally disordered’. Whereas energetic, high-profile campaigns against sex and race inequality eventually led to new laws outlawing discrimination on these grounds, prejudice against people with mental health problems continues unabated in the absence of any notable protest. Particularly intriguing is the collective silence of mental health professionals, who you would reasonably expect to advocate for the rights of the people they serve.
The state sponsors psychiatric professionals to implement the requirements of the MHA so, as such, they are the individuals administering these human-rights violations on a daily basis. So why do we rarely hear outrage about these injustices from psychiatrists, psychiatric nurses, social workers, psychologists and occupational therapists? Furthermore – and, arguably, even more remarkable – why are the professional bodies and trade unions who formally represent these professional groups not clamouring for a change to a law that compels their members to routinely dispense acts of prejudice?
Given the dearth of published debate in this area, my attempts to account for this collective apathy can only be speculative:
Explanation 1: The assumption that the political-legal context is beyond the remit of mental health professionals
One potential explanation for the inertia in responding to the MHA is that frontline professionals might view the politico-legal context in which they operate as being outside of their sphere of influence, a background ‘given’ that can only be reshaped by politicians and lawmakers. So the nurses, doctors and therapists within mental health provision keep their noses to the clinical grindstone, rarely thinking about the discriminatory laws underpinning their work.
Explanation 2: Collusion with discriminatory laws as a means of retaining professional power and status
The MHA instils psychiatrists with widespread powers – via the process of ‘sectioning’ – to restrict the freedoms of those citizens deemed to be troublesome and challenging. In this role they have been construed as acting as agents of the state, imposing a range of constraints on the general population as dictated by the government of the day (for example, Szasz, 1973). This formal role, referred to in England and Wales as that of a ‘responsible clinician’, might contribute to the maintenance of a profession’s status and security.
Professions other than medical psychiatry might also benefit from the MHA, albeit to a lesser extent. Since 2007, clinical psychologists (as well as psychiatrists) can legitimately fulfil the role of responsible clinician, although very few have opted to perform this position. Social workers typically take on the work of the ‘approved mental health professional’, another formal cog in the sectioning wheel. Also, the legislation grants mental health nurses profession-specific power to detain a voluntary hospitalised patient for up to six hours if they assess the imminent risk of freedom to be high. It is conceivable that all these legally-sanctioned roles furnish the mental health professions with enhanced status, leading to a reluctance to reject the MHA.
Explanation 3: Acceptance of the ‘inherently defective’ model of human suffering and overwhelm
A crucial assumption underpinning the MHA colludes with the myth that people suffering emotional distress and overwhelm are displaying ‘an illness like any other’ and that the primary cause of affliction is some underlying brain abnormality. Many (maybe the majority) of mental health professionals, particularly those who traditionally lean towards the biological end of the spectrum, may endorse the idea that internal deficits underpin mental health problems.
An acceptance of this ‘inherently defective’ model may lead professionals to collude with the idea that all those labelled with a ‘mental disorder’ do not possess capacity to make their own decisions and therefore require special legislation to manage and control them. In this explanation, mental health professionals may view the human-rights violations, intrinsic to the MHA, as a necessary measure to protect their patients and the general public; in their eyes, the current legislation is deemed fit for purpose.
What do you think are the main reasons for professional inertia around the MHA? Please share your thoughts in the ‘comments’ section.
Mental Health Act (1983). Retrieved 6th Jan 2018 from http://www.legislation.gov.uk/ukpga/1983/20/pdfs/ukpga_19830020_en.pdf
Mental Health Act (2007). Retrieved 6th Jan 2018 from http://www.legislation.gov.uk/ukpga/2007/12/pdfs/ukpga_20070012_en.pdf
Szasz, T.S. (1973) The Manufacture of Madness: a comparative study of the
inquisition and the mental health movement. Routledge & Keegan Paul.
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