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A shameful silence: Why aren’t mental health professionals screaming about the Mental Health Act?

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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.

 
References

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.

 

 

Photo courtesy of imagerymajestic at FreeDigitalPhotos.net

16 thoughts on “A shameful silence: Why aren’t mental health professionals screaming about the Mental Health Act?

  1. Don Karp / Reply 29th January 2018 at 6:30 pm

    I’m glad you’ve addressed this very important topic and ask: “What do you think are the main reasons for professional inertia around the MHA?”

    There are two main reasons: corporate profits of Big Pharma and its ties to the psychiatric profession, and the “guild” membership with control and power wielded by professionals.

    I’m more interested in what can be done about this, besides encouraging awareness of the problem.

    The United Nations has declared that treatment of the disabled against their will is considered an act of torture. Here across the pond, President Obama signed a bill to abide by this UN proclamation, but Congress did not follow suit.

    FYI: Here is an international group of lawyers with strategies to do something about this problem: http://www.chrusp.org/

    • Gary Sidley / Reply 12th February 2018 at 9:44 am

      I agree that the symbiotic relationship between big-pharma and the psychiatric profession, together with the guild interests of the professional groups, are central to the inertia around the MHA and the passive acceptance of the bio-medical paradigm. Also, I share your desire to focus on practical ways to change the current system which – if we are to be effective in this endeavour – must, I believe, involve a multi-level approach involving survivors, the general public, professionals, professional bodies & trade unions, lawyers, politicians and journalists. In this regard, thank you for your helpful link to the international group of lawyers.

  2. We Care About MH / Reply 29th January 2018 at 7:13 pm

    As someone who has lived with a diagnosis and used MH services for more than 35 years, my view is that we do not operate very effectively as a political group. You cannot expect others, however well meaning, to fight your battles for you. Racism has been addressed because large numbers of people from other ethnic groups united against racism. The fight against sexism came about through the feminist movements of the 1960s and 1970s. There has been no corresponding widespread political movement that has united people with mental ill-health against the stigma and prejudices we all face. I don’t know why that is and maybe we will see such a movement unite in the coming decades. But that is the only way in which change will happen. We cannot expect others to fight our fight for us.

    • Gary Sidley / Reply 12th February 2018 at 9:48 am

      You make an important point; uniting the various factions who are critical of biological psychiatry could be the crucial step to realising meaningful change. Unfortunately, finding a focus, or a key issue, around which we can all unite has been difficult. I’d hope that the rejection of the MHA could be one of the aims that might unite us all?

  3. John / Reply 5th February 2018 at 11:21 pm

    Gary maybe human rights is not the best way to think about the issue?

    In many cases the state may have good reasons to use laws to confine a person. A person may be a high risk of harm to them self or others is the usual rationale given – rightly or wrongly.

    The more interesting question for me relates to the idea that if the state has a rationale for infringing an everyday right -why is it okay to do so in such a blatantly unkind way. Perhaps the state needs to reverse its logic – if we infringe a persons rights because it is deemed necessary then that person needs to be well looked after. At the moment the system works on a poorhouse logic of deterance and responds only to crisis.

    In relation to the complicity of clinicians they are somewhat deluded and are accepting of the status-quo but in many ways this results from working in an unkind system where they are often poorly treated by the system too, and are mostly passing this on to those who least need it.

    • Gary Sidley / Reply 12th February 2018 at 9:52 am

      That’s an interesting angle to consider, John. However, I do believe the human-rights infringements are so crass that the priority must be to radically revise the legislation, a campaign that – given adequate publicity – would, I believe, win over the majority of the lay public.

      • john / Reply 16th February 2018 at 12:44 am

        Thanks Gary

        Yep, maybe but sometimes I wonder if publicity about rights violations reinforces the publics views that this is all hopeless and they switch off as result. In turn it provides a justification for more funding of a crisis focused system.

        Maybe, we need to focus on civil liberties more than rights. I might be confused here but to me the idea of ‘rights’ suggest that a minimal low standard of ‘treatment’ must be met. As long as the laws are obeyed everything else can be poorly done. With a civil liberty, if a liberty is infringed it requires not only a good justification for doing so but the state has a duty to make amends for its infringement of this liberty.

        I think this attitude changes the tone of ‘treatment’ because the state is immediately put on the back foot. If decision are made to detain a person then its is not good enough to argue that procedures were followed and boxes ticked.

        The civil liberties approach holds that the state needs to work hard to ensure that persons liberties are respected and not treat them as a risk that needs to be crisis managed efficiently. To me it is this crisis focus that creates many of the problems, creates antagonism and creates a poor culture – a wicked problem.

        Maybe we are talking about the same thing but thinking through this helps me to think through the nature of the this problem.

        • Gary Sidley / Reply 27th February 2018 at 11:42 am

          Thanks, John, for your thoughtful comments. I think we are probably on the same page, although I’m trying to get my head around the difference between a ‘civil liberties’ approach and a ‘human rights’ one. I’ll have to think about this some more.

          Thanks again for your interest.

  4. Initially NO / Reply 6th February 2018 at 10:01 pm

    Whitecoat greed is an exploitative, violent condition, combining perpetration of poisoning and other violence forcibly through corrupt governments. These violations inflicted from whitecoat greed are perpetrated on groups of people deemed to be easy eugenics stigma targeted groups. The whitecoats inflicted with greed, then victim-blame, concocting evidence to persecute visionaries, creative artists such as novelists, as well as whistleblowers, victims of crime, the financially and/ or socially disenfranchised killing and maiming potential inventors, innovators, curbed from reaching their potential when forcibly and violently exploited by the greed of whitecoats.

    Depending on the symptoms, whitecoat greed can be broadly defined as a medico with a greed component, or a lack of compassion and a pleasure in controlling people through violent measures, with an interest in invading human bodies.

    The course of whitecoat greed reaches a point where the whitecoat has committed thousands of murders and maimings, assaults and perverted violations for the lucrative trade of human research. (For more about why this particular exploitation racket caused by whitecoat greed occurs click here) http://notachemicalimbalance.blogspot.com.au/2018/02/whitecoat-greed.html

  5. Duncan Double / Reply 17th February 2018 at 7:49 am

    Is there no justification for the Mental Health Act?

  6. Bill Hutchinson / Reply 27th February 2018 at 4:47 am

    What we HAVE, is a process-centered process, and a system-centered system.
    What we NEED, is a person-centered process, and a services-centered system….
    Psychiatry is a pseudoscience, a drug racket, and a means of social control.
    It’s 21st Century phrenology, with potent neuro-toxins.
    The DSM-5 is nothing more than a catalog of billing codes.
    So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but not more real….
    you’re welcome!

    • Gary Sidley / Reply 27th February 2018 at 11:44 am

      I don’t think there’s anything in your comment, Bill, that I’d disagree with.

      Thanks for reading and responding.

  7. Paul Dixon / Reply 1st March 2018 at 6:43 pm

    Yeah …
    I’ve been promoting on social media the “coming out” of nurses who see what is going on and don’t like it.
    We the abused must clear a path for any of these nurses coming through. It is going to take strength and unity … humanity … to open this up, really see the horror … and progress with compassion.

    • Gary Sidley / Reply 19th March 2018 at 9:39 am

      Great to hear we are on the same wavelength, Paul. And you are right, it will require strength and unity to promote change.

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