Monday, April 16, 2007

Are you normal?

Wonderful cartoon by Edward Monkton

The Mental Health Bill is being debated by MPs and I have my fingers crossed, for personal as well as political reasons, that it doesn't get through.

The bill is a reactionary load of tosh intended to make us all feel better about how society lets so many people down an attempt to make it easier to detain and 'treat' people who are at risk of causing harm to themselves or others.

Now, first of all, let's just make it clear that if you're a commonal garden person who just causes harm to others because you feel like it, that's ok. This bill only applies if you have 'symptoms' of a 'mental illness' or a 'personality disorder'. So, if you're perfectly normal except that you like to beat your wife, you're entitled to the normal niceties of the justice system including bail and trial by a jury of your peers. If your wife, however, engages in self-harm as a coping mechanism, possibly even says she feels too desperate to carry on, and ticks a few boxes for Borderline Personality Disorder, she can be held on the say so of just two people. Without bail. Without a trial.

So, back to the purpose of the bill - to detain and 'treat' people who are at risk of causing harm to themselves or others.

That would be me then. No no, don't panic! I wouldn't hurt a fly. I pose no risk to your safety, or that of your child / lover / bunny rabbit ... but from time to time I can be a bit of a challenge to my own. My own as in me, not my own bunny rabbit. That's why it's called self-harm. No! Shh! Don't feel bad ... it's ok - really it is, I'm perfectly fine. Well, sometimes I'm not, but that's not for you to worry about. Oh dear. It's tricky talking about self-harm, people do get themselves in a such tiz about it.

I'm not mental. Honest. I just have a kind of dissociative disorder. From time to time I get myself all wound up about something, I stop sleeping, I can't eat, and shortly after that it all goes tits up [technical term]. My particular coping mechanism just happens to be a bit on the risky side, but the good news is that these days I'm pretty good at managing and assessing those risks. And I'm a very coherent and polite individual even when I'm completely mental. I always say please and thank you to the doctors.

So, this brings me to my real concern about the Mental Health Bill. I'm exactly the kind of person who could be scuppered by it. Just before christmas last year I had a bit of a wobble. It was quite a big wobble even by my standards, and after being patched up by the super doctors and nurses in my local A&E, we all agreed that as I hadn't yet slept or eaten and was clearly still wobbling, it would be best for me to be admitted voluntarily to the local psych unit for a day or two.

Of course they couldn't find a bed.

So, 12 hours later I was driven in a strange ambulance / mini-bus to a psych ward almost an hour away. It was a mixed, locked ward, with no segregation between the dozen or so male patients (all with serious psychosis) and the female patients - who totalled 2, that being me and a deaf-dumb and learning disabled woman who was already sedated when I arrived. For obvious reasons I didn't really fancy staying there. I observed that the nurse's station was a good 20 meters down the corridor, realised that the television was drowning out any possibility of communication between me and those nurses, noted the lack of alternative exits, checked out the fact that there was no emergency alarm system, and made the decision to get out.

So, I went to tell the nurses my decision. After all - I was a voluntary patient. The nurses were not pleased to see me. They were busy watching TV for starters, and after ignoring me with an admirable persistance for a few minutes, they instructed me repeatedly to go back to bed. I told them that I wished to leave, and why, and they told me in no uncertain terms that if I tried to leave I would be sectioned.

I calculated. I thought hard about the possibilities, the ramifications. I calculated some more. I decided they were (probably) bluffing. The nurses told me that any one of them could hold me on a section 5 for up to six hours. I knew that they had to at least attempt to contact the on-call psychiatrist in order to do this. So I rolled the dice, knowing that if they didn't get through they would force me to stay, and probably sedate me. They dialled the number. The psychiatrist answered. Phew! She told them to stop being daft and let me go - so they immediately opened the doors and shoved me out into the car park. It was the middle of the night. In December. A friend was coming to collect me, but they wouldn't let me wait inside for the hour it took for her to get there. Meanies!

The next day I was prescribed risperidone. It made me feel like I was underwater. After a few days I couldn't tie my shoelaces. I was reversing like a straight girl. I walked like a thunderbird, much to Badger's amusement. I stopped taking it, against my psychiatrists wishes. Since then he has read a report saying that the drugs I was prescribed (risperidone and diazepam) are now contra-indicated for people who self-harm, because they increase dissociation and reduce inhibitions. Duh. I could have told them that!

This is where I really worry. The new MH Bill introduces Community Treatment Orders (CTOs) - a kind of psychiatric ASBO. It's a legally binding agreement about your self-care. I will take this medicine. I will not drink alcohol. I will not go to this place or spend time with that person. I will attend this therapy every week ... and if you breach it you've got bugger all defense against being banged up, or given a depot (a slow delivery system for the drug they've chosen for you, injected under your skin and almost impossible to remove once inserted).

Here's the glaringly obvious irony as I see it:

• Genuinely bonkers people probably can't think in terms of longer term consequences of their actions. Go ahead, lock me up, I don't care, the aliens are coming tonight!

• Genuinely suicidal people care even less. So what if I don't take my medication - what are you gonna do? Section my corpse?

• Thus, the only people for whom a CTO is going to be effective are those who have insight into their condition, can weigh up the consequences of not adhering to treatment, and have the will to get well (as they say - the lightbulb has to really want to change). And those people shouldn't be straightjacketed by medication or compulsory therapy against their will.

We currently section around 1 in 1000 people in the general population - but that disguises the many more people who are in treatment 'voluntarily' unless they ask to leave.

I'm fortunate that I now have a very good relationship with my local MH services, who have allowed me to design a package that meets my needs and fits their provision. In the absence of a straight forward solution to the "What do we do with someone like Stray?" problem, they've had to come up with some creative solutions. If the new Mental Health Bill had already been in place then I have a suspicion that a CTO would have been their first line of action.

Of course all of this rests upon the fact that the UK's current understanding of mental health / mental illness is a bizarre and overly pathological construct in which being "well" really means being "normal".

So - in thinking about the potential impact of this bill on your own life and liberty, you only really need to answer one question: Are you normal?


Read Mind's excellent guide to the MH Bill, including their objections, here.

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Blogger Caroline said...

If more people spoke about self harm, then the taboo would be removed and people may even try to understand. There are reasons why people harm themselves and not others. The self harm covers so many words

Normal? Nah. I don't fall into that circle and in all honesty if people like you fall outside it too, then I think that's where I'd prefer to be.

So glad you're my friend.

16 April, 2007 18:35  
Anonymous Daisy-Winifred said...

normal....mmm you can answer that you lived after a face to face meeting with me:0)

Think I might be in the queue ahead of you which just emphasises as far as I am concerned the tolat ( oh that was almost toilet) shite this bill is created out of and that it was drawn up by fuckwits - scuse my language but as you know that is me being mild but I am wild about the bloody bill in fact madly wild about it so I have probably just gone to the head of the queue.

Yes for many personal reasons I have my fingers crossed too. Yes thinking, informed even dare I say it enlightened people who understand and calculate their needs etc who actually can be plain bonkers as you put it some of the time - though there is never anything plain about it and as far as I am concerned its a spectrum of normal just more fuckwits - named society, that finds labels and locked doors so much more appealing than real people living and being normal which entertains bonkers, mad, barking, mental. Bizarre is one of my favourite words that and ecentric would be good to be remembered by and allowed to live as without the fear that this bloody bill could engender.

16 April, 2007 19:17  
Blogger Ms Melancholy said...

I admire your courage to say this stuff out loud, Stray. Pathologising - but not actually ever treating - people's coping mechanisms doesn't protect anybody, least of all people who are self-harming. I actually think it's fair enough that those with mental illness who are a danger to others should be held against their will for either asylum or treatment - however, we have a perfectly good mental health act (1980) that provides such measures. This current bill is another example of the government looking for cheap votes from daily mail readers who think that the streets are full of people with mental illness who will cut their throats at a glance. They are refusing to listen to the experts who, without exception, do not agree with the new bill. I have posted on this here and Tom Hamilton at Let's Be Sensible has written some good stuff on it (see if you can find the post with the speeches from the House of Lords. Will post up the link if I find it. Very good speeches against it. )

16 April, 2007 20:10  
Blogger Ms Melancholy said...

Okay. here is Tom Hamilton on the speech by Baroness Murphy, which is well worth a read. And Tom Hamilton here on the manipulation of stats to suit the government's ends.

16 April, 2007 20:17  
Blogger Stray said...

Caroline, I am very glad you're outside the circle with me too :)

Yes, I think the taboo is still a big part of the issue. I took a long time today thinking about whether to post this or not. The upside is that I did all the boring jobs like visiting the post office and bleaching the bins whilst I was deliberating!

DW - ah, I shall excuse your anglo-saxon as it is said in such lovely valley tones ;) Bizarre is a good word, and yes, the spectrum is very real.

Ms M - thanks for your links - yours is a really good piece. Yes, I've read the wonderful comments made by the dudes in the Lords. I agree that there are people who do need confining, but I don't think that the new act will do anything about that.

Like you say - it's a load of hysterical paranoid nonsense - we are still at so much more danger from people we know than any crazy stranger.

The courage thing is funny. I think I'm just tired of being in the closet :) I believe that unless those of us who use the system, and are blessed with good communication skills and good contacts, start talking about our experiences there is little chance of change.

Treatment? The NHS has never offered me any treatment (other than medication). Not that they don't believe I need it, they just aren't in a position to provide it. Thank goodness for private practitioners and charities!


16 April, 2007 20:27  
Blogger brumcunian said...

As a psychiatric nurse I will have to add my thoughts and sum up the new mental health act in one word... crap.

The mental health act (1983) is still perfectly workable and relevant to this day. If it ain't broke, don't fix it. Community Treatment Orders are nothing new. They have just come up with a new name for one of the current sections of the act. I forget which numbers they are but one section specifies that treatment must be provided in a patients best interest and that nursing is a treatment. So that covers depot injections or whatever ongoing community treatment someone receives. There's another section that covers non compliant patients being given treatment against their will in their best interest and/or for the safety of others.

Specifying that people should be detained if they pose a risk to themselves leads to a corrupt system. Am I sectionable because I self harm and I drink too much? According to the new act I probably am (as is every weekend binge drinker).

This new mental health act has been in the pipe line ever since I started my nurse training in 2001. The hold up has been arguments over whether to include personality disorders in the act. It has been included but again I think that's a bit dodgy seeing as personality disorder is such a generalised term and an all too easy label for psychiatrists to stick on patients that they are struggling to manage the care of.

Yes the Daily Mail readers will think 'hoorah the nutters will be locked up and I'll be sheltered from reality'. Once all other minority groups are rounded up and put in a place as far from the home counties as possible I'm sure the readers of 'The Daily Tory' will be jumping for glee.

17 April, 2007 17:26  
Blogger Stray said...

Hey Brum - I quite like the idea of all us misfits being rounded up to go to somewhere far from the home counties. Mind you, I'm thinking Lost (without the dodgy monsters) or possibly Castaway without Ben Fogle ... not anything dark and sinister and circa 1942.


17 April, 2007 17:30  
Blogger PurpleSparkleBright said...

Crumbs, I thought they'd chucked this one out of parliament ages ago. I read about it first here : I'd hate to get caught in the middle of a harmless harming session and locked up! I would never ever be able to sign anything binding like that "I will not" set of statements... I'd sooner die.
I agree with you here:
< bizarre and overly pathological construct in which being "well" really means being "normal".>
My friends have been mentioning to me that I'm the most normal person they know, and well Stray, you are one of the most normal people I know too. In the meaning of normal=sane, articulate, intelligent. Well done for posting about this... reading as a person that has known you for a long time, its like the last tiny piece of the jigsaw that is you has now fitted into your blog. :)
Ms Melancholy- pathologising symptoms, yes. I hate that. My psych does not do that I am very lucky. And she is very pretty too.

19 April, 2007 20:13  
Blogger PurpleSparkleBright said...

Look, guys.. this
Is from 2002!!!!
I thought it had been scrapped

19 April, 2007 20:17  
Blogger Drak said...

Hmm I'm now wondering if I need to take up some overt measure of self-harm. Not because 'all the cool kids are doing it' or such nonsense, but rather so I can have a measurable indicator of how far off normal I bloody well am.
As a hyper-rational, very strong-willed person, I fall right into the category of people who definitely don't need a 'one-size fits all badly' CTO type prescription.
I was reminded of this as I joined my new local doctor and had to go and ask for my fluox to be re-prescribed. As the nice doctor went through the sheet of indicators, I could hear her thinking 'but he isn't all that ill'. Well - duh! That's because the medication is actually at the right level - so don't suggest I come off it, or try a lower dose or any of those things. They've been tried and found lacking.

I'm a fairly functional member of society, and can probably coun't as 'well' by many standards, but not one of my friends or family would call me normal. Nor would I want such a label.
Wish I could remember who said this, but it is one of my favourite quotes:

"The problem with Normal People is that they don't exist."

Hmm I have rambled - sorry. But I have been blog-hopping reading about this mental act and it has filled my mind with incoherent desire to point out how stupid it is. I'll leave it to all you coherent people, then stick my hand up and go 'yeah, what they said!'

21 April, 2007 11:57  
Blogger Böbø said...

Darling Stray, this is a wonderful post: tender, funny, heartbreaking, cogent (very cogent), and sadly all to real in it's mapping of a unique personal experience with the bizarre popular notions of "mad people" that drives the government.

And yes, the lightbulb does really want to change. Compulsory therapy, indeed.

PS: Being rather a fan of Thunderbirds, I'd very much like to see that walk. Also reversing like a straight girl. ♥

25 April, 2007 10:50  

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