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?


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