The Mental Health Act Should Only Be Used as a Last Resort and With Extreme Care

2paulfarmer

It is very rare that society believes the state should intervene against someone’s will to restrict their rights to liberty and choice for the good of their health. We don’t go to such extremes to stop people smoking or binge-drinking or participating in dangerous sports. But if someone has a serious mental health problem or lacks mental capacity to make decisions for themselves, we accept that the state should step in.

In the case of a serious mental health problem, the law is designed to balance the rights of the individual with the need to protect them from harming themselves or others. Psychiatrists, psychologists, social workers, ‘patients’, families and politicians all agree on one thing – being detained under a section of the Mental Health Act is a last resort and it’s a power that should be used carefully.

Ask anyone who’s ever been ‘sectioned’ and you’ll understand why. It’s a painful, humiliating and dehumanising process. It usually involves an ambulance, the police, doctors and social workers and sometimes it involves officers in riot gear, physical restraint and a brush with the law. It is often experienced by people as violent and criminalising. It can destroy family relationships and set back prospects of recovery by years. Many people I’ve spoken to about their experiences tell me it was the worst day of their life.

For these reasons, we should all be concerned by the latest report by the Care Quality Commission. As part of its crucial role as the health regulator, it tells Parliament and the public how this powerful law is being applied. Today’s report makes for worrying reading.

Use of the Act is up, with many more people now being detained under section. Use of the new Community Treatment Orders, which enable people to be compulsorily treated outside of hospital, now far exceeds original government projections. In some parts of the country, you can only get a hospital bed if you are under section. Access to advocacy – a crucial safeguard to help people express their wishes when detained against their will – is patchy. Use of physical restraint is up. And the numbers of those detained from certain black and minority ethnic communities remains unacceptably high.

So why is this happening? There’s an easy conclusion to draw, especially when we know that services are overstretched – spend less money on mental health care and more people will be detained. If people can’t get help early on, their needs are likely to spiral into a crisis. The last resort becomes the first resort in a cash-strapped system where prevention and early intervention are scarce. Add to that the general rise in demand for mental health services and the challenge is clear to see.

But it doesn’t have to be a disaster. The CQC is for the first time reporting good practice, in places like Lancashire and East London, proving that services can work well. Mind’s crisis care inquiry, Listening to Experience, found examples of excellent practice, with staff treating patients with dignity and respect. Early intervention and crisis teams both have a vital role to play here – if help is available at the right time, sectioning can revert to its rightful place as a last resort.

Mental health is, slowly but surely, working its way up the agenda and into the public consciousness. There’s a good government-led, cross-departmental mental health strategy led by a committed Minister, Norman Lamb, and the new NHS Mandate has set an ambitious target for mental health over the next few years – to achieve equity or a ‘parity of esteem’ with physical health care. The way in which the numbers of people being treated under the Act change will be a powerful litmus test of this.

Follow Paul Farmer on Twitter: www.twitter.com/paulfarmermind

NATURAL JUSTICE And The DWP

I have quoted the important parts below and it should be used on every welfare claim and every appeal as this makes quite clear where decision makers stand they must be seen to be un-bias .
Would you say the DWP and it’s decision makers are un-bias when deciding on a claim and would you say the same of ATOS and it’s Healthcare Professionals I think not because to be professional everything you do should be un-bias.

 

NATURAL JUSTICE

What are the rules of natural justice?

The principles of natural justice concern procedural fairness and ensure a fair decision is reached by an objective decision maker.

Maintaining procedural fairness protects the rights of individuals and enhances public confidence in the process.

A word used to refer to situations where audi alteram partem (the right to be heard) and nemo judex in parte sua (no person may judge their own case) apply.

The principles of natural justice were derived from the Romans who believed that some legal principles were “natural” or self-evident and did not require a statutory basis.

These two basic legal safeguards govern all decisions by judges or government officials when they take quasi-judicial or judicial decisions.

Three common law rules are referred to in relation to natural justice or procedural fairness.

The Hearing Rule

This rule requires that a person must be allowed an adequate opportunity to present their case where certain interests and rights may be adversely affected by a decision-maker.

To ensure that these rights are respected, the deciding authority must give both the opportunity to prepare and present evidence and to respond to arguments presenting by the opposite side.

When conducting an investigation in relation to a complaint it is important that the person being complained against is advised of the allegations in as much detail as possible and given the opportunity to reply to the allegations.

The Bias Rule

This second rule states that no one ought to be judge in his or her case. This is the requirement that the deciding authority must be unbiased when according the hearing or making the decision.

Additionally, investigators and decision-makers must act without bias in all procedures connected with the making of a decision.

A decision-maker must be impartial and must make a decision based on a balanced and considered assessment of the information and evidence before him or her without favouring one party over another.

Even where no actual bias exists, investigators and decision-makers should be careful to avoid the appearance of bias. Investigators should ensure that there is no conflict of interest which would make it inappropriate for them to conduct the investigation.

The Evidence Rule

The third rule is that an administrative decision must be based upon logical proof or evidence material.

Investigators and decision makers should not base their decisions on mere speculation or suspicion.

Rather, an investigator or decision maker should be able to clearly point to the evidence on which the inference or determination is based.

Evidence (arguments, allegations, documents, photos, etc..) presented by one party must be disclosed to the other party, who may then subject it to scrutiny.

50 Common Cognitive Distortions

A giant list of ubiquitous cognitive distortions.
Published on January 17, 2013 by Alice Boyes, Ph.D. in In Practice
cognative
Becoming mindful of these common cognitive distortions will help you understand yourself and other people better, and improve your decision making.
1. Personalizing.Taking something personally that may not be personal. Seeing events as consequences of your actions when there are other possibilities. For example, believing someone’s brusque tone must be because they’re irritated with you. (Tips for not personalizing.)2. MindreadingGuessing what someone else is thinking, when they may not be thinking that.

3. Negative predictions.

Overestimating the likelihood that an action will have a negative outcome.

4. Underestimating coping ability.

Underestimating your ability cope with negative events.

5. Catastrophizing.

Thinking of unpleasant events as catastrophes.

6. Biased attention toward signs of social rejection, and lack of attention to signs of social acceptance.

For example, during social interactions, paying attention to someone yawning but not paying the same degree of attention to other cues that suggest they are interested in what you’re saying (such as them leaning in).

7. Negatively biased recall of social encounters.

Remembering negatives from a social situation and not remembering positives. For example, remembering losing your place for a few seconds while giving a talk but not remembering the huge clap you got at the end.

8. Thinking an absence of effusiveness means something is wrong.

Believing an absence of a smiley-face in an email means someone is mad at you. Or, interpreting “You did a good job” as negative if you were expecting “You did a great job.”

9. Unrelenting standards.

The belief that achieving unrelentingly high standards is necessary to avoid a catastrophe. For example, the belief that making any mistakes will lead to your colleagues thinking you’re useless.

10. Entitlement beliefs.

Believing the same rules that apply to others should not apply to you. For example, believing you shouldn’t need to do an internship even if that is the normal path to employment in your industry.

11. Justification and moral licensing.

For example, I’ve made progress toward my goal and therefore it’s ok if I act in a way that is inconsistent with it.

12. Belief in a just world.

For example, believing that poor people must deserve to be poor.

13. Seeing a situation only from your own perspective.

For example, failing to look at a topic of relationship tension from your partner’s perspective.

More:

http://www.psychologytoday.com/blog/in-practice/201301/50-common-cognitive-distortions

My Letter to my MP regarding WCA Debate

Dear David Willetts,

The Work Capability Assessment(WCA)Debate on the 17th January 2013.

Dear Mr Willetts,

I write to you today with urgent matters regarding the WCA not only for myself but disabled society in general.

I watched this debate in full and quite frankly I was not shocked at what I was hearing regarding ATOS because there draconian behaviour has been ongoing for a few years now and despite the Harrington Report have seen no real change on the ground.

I was disappointed that you was not at such an important debate however I will not single you out because indeed attendance was poor by many specially from those who should be there like Esther McVey MP Minister for the Disabled do I need to remind her that she is our representative and far from working in Parliament for us she is working against us a fine minister indeed so shameful.

I hope that you will pass on our disgust to her and give me the assurance that she will at least read that debate in full.

During that debate although Conservatives and Liberal Democrats were putting across harrowing instances of failure by ATOS I still could notice the party allegiance coming across the house. May I point out that when dealing with such tragic matters there is no room for party allegiance and this must STOP all of you no matter what party you belong to must work together as one we do not care who started ESA and the WCA as Mark Hoban MP was quick to point out.

Whilst yes Labour started the WCA it was the Conservarives and Liberal Democrats that made it a lot worse under the guise of Welfare Reform so please stop the blame game as it makes you all look like fools and the nations citizens really do not care indeed many are waking up to this farce and all they want to see is change for the better and a WCA that is fair indeed I hope we get that with the Judicial Review that has just finished. Time will tell

Right now I ask you to make the WCA a top priority and that you to read the debate in full because if not you will have blood on your hands.

The WCA is an utter disgrace and should be scraped in full whilst protecting those already in the support group that is the only logical course of action nothing else will suffice.

It does boggle me how we can follow the USA on such matters knowing full well the disgrace it has caused over there leading to many court cases involving UNUM should we not be learning from their mistakes and grave errors?

I now to turn to my own case which I insist you help me with and prove that you are my representing MP in parliament.

As you know I had a very serious SAH Stroke which left me with many mental and physical disabilities including executive dysfunction which is getting worse not better as time progresses it has also left me in a lot of pain due to severe spasticity in my right hand, arm, shoulder, hip, leg, ankle and foot.

On top of this last year I was diagnosed with Keratinizing squamous metaplasia of the bladder leading to incontinence and thus had to get a disability radar key due to the poor toileting in the Havant area.

All this I made known on the ESA Form when migrating from IB please tell me then why I was put straight in the WRAG Group without an assessment because despite how much I despise these assessments I should have been given the opportunity to have an assessment with a mental health champion at Portsmouth Assessment centre I should also have been given the opportunity to have a home assessment indeed my rights have been denied.

I was unable to appeal simply because 30 days was not enough time to return the documents indeed you know about this difficulty as I raised it with you when my ESA Form was late back and thus receiving a non entitlement letter from DWP.

I worked for 17 yrs post stroke indeed as long as I could due to the pain and joint degeneration so tell me why is the Government not looking after me after all far from being a scrounger I worked full time during difficult times for me and my family and never claimed a penny in help indeed self supporting.

The nature of my issues with ATOS, DWP, and Government relating to my health is truly disgusting and I now call on your help because it is all becoming too stressful.

Please I would like a meeting at your surgery in Havant the debate brought me to tears please do not let my own issues do the same.

Yours sincerely,

‘This brutal new system’: a GP’s take on Atos and work capability assessments

Via Guardian Comment is free.

I see work capability assessments damaging patients struggling with mental health issues and serious illness

Anna Pilkington

I had not seen Eileen for some time, until a few months ago when I was asked to phone her. She sounded distressed, confused and frightened and did not understand what was happening to her. She has been a patient of mine for 10 years and over time, I’ve tried to help her cope with her mental illness. A few years ago her mental health had deteriorated so much that she needed to be in hospital.

All her benefits had been stopped, Eileen explained, and she was in arrears with her rent. She was assessed by Atos, a private company employed by the government to carry out what it calls the “work capability assessment” to decide whether people receiving incapacity benefits should be sent back to work. Eileen found the form she was asked to fill extremely long and bewildering. The assessment is a tick-box exercise, with points scored depending on the patient’s replies. The assessors do not ask GPs like me to provide any medical information about patients to help them make their decisions, even though someone may have received incapacity benefits for many years.

Later, Eileen was sent a letter. She was fit for work, she was told, and so she would no longer be receiving benefits. Instead, she would need to go out seeking work. She had no money and soon fell behind with her rent and bills. She told me she didn’t understand why all this was happening to her, but having no money, she decided to leave London to look for work elsewhere. But she had nowhere to stay, and ended up sleeping on the streets. Nor could she find work, despite the government’s mandate that she do so. She eventually returned to London to seek help. She has no insight into her mental illness and doesn’t believe she is unwell.

I have watched with mounting horror as my patient, an extremely vulnerable woman, has been put at risk of homelessness and deteriorating illness as a result of government policy. I am very aware of the importance of work, and as a GP will always encourage people to look for a suitable job if I think they can. But I also know my patients, and I am outraged that some are being put through the punishing stress this assessment causes. Many of my patients have gone through the Atos assessment to be told that they are fit for work with all their benefits stopped without notice. The financial impact is extreme. Several of my patients have shown worsening symptoms of depression, and some have become suicidal. Because we were so concerned about a patient’s mental health – which worsened as a result of the stress caused by these assessments – we have had to involve a psychiatric crisis team.

The government will say that there is an appeal process built into the system for those who have been passed capable of work and disagree with the outcome. True, but it is very expensive. In my experience, patients whom I consider unable to work or even look for work usually win their appeal. In a recent appeal hearing, the tribunal judge read my medical report and concluded on the back of it that, contrary to the Atos assessment, my patient was indeed incapable of working.

I have witnessed a woman in her 20s who has a condition that means she is slowly dementing, and will eventually die at a young age. She is unable to walk, and now even unable to talk. She is looked after round the clock by her family. Her family has been forced to endure great stress from the work capability assessment. I believe that this could have been avoided had I been asked to provide a medical report explaining her disability, prior to the assessment process.

In another case, a man in his 40s had been homeless for many years. He has learning difficulties, alcohol problems and also has insulin-dependent diabetes. He is unable to read and write. A charity worked closely with him and managed to find accommodation and medical care for him, and they encouraged him to engage with the local drug services. In our GP clinic, we were working closely with him to help him to manage his diabetes better, in the hope of avoiding acute emergency admissions had his diabetes remained uncontrolled. Despite all this intensive help, Atos bulldozed their way in and found him capable of work. All his benefits were stopped immediately, and he is now in arrears. He has appealed and is waiting a tribunal hearing – a process that can take up to six months. Meanwhile, all that precious rehabilitation work we were offering him has also stopped as he has become so stressed, depressed and at times suicidal.

I am fearful that more of my patients will be put at risk of homelessness and suicide by this brutal new system. From my perspective, the most disadvantaged in our society are being punished. Work is good for all of us, if we are lucky enough to be in employment. But not all of us have the skills to work and some of us are so unwell or damaged by past experiences that they cannot do a job. We should accept that some people, for many different reasons, need supporting.

Instead of forcing vulnerable people onto the streets, why not concentrate on helping young people find worthwhile, fulfilling jobs? Leave patients like Eileen alone. She does not deserve the punishment that is currently being wrought upon her. For her safety and well-being, and for the sake of a humane society, I hope she wins her appeal.

• The name of the patient, and details of her case, have been changed to ensure confidentiality

http://m.guardian.co.uk/commentisfree/2013/jan/04/gp-atos-work-capability-assessment

My letter to the Daily Mirror

Dear Daily Mirror,

I write to you today with regards to the grossly unfair Work Capability Assessment (WCA) undertaken by ATOS Healthcare on behalf of the Secretary of State for Works and Pensions (DWP), as you may well know their is a Judicial Review of the WCA bring brought by the Mental Health Resistance Network (MHRN) on behalf of two anonymous mental health claimants I am told that it will be covered by press and media but I hope this is the case for you given your good coverage of this matter.

The result of this Judicial Review will have an impact of my own claim for the following reasons:

In April of 1990 I had an SAH Stroke it was so bad only surgery to clip the bleed would work and thus I had a deep invasive craniotomy to clip the bleed from the middle cerebral artery this resulted in causing a stroke and 2 mths of induced coma to aid healing indeed this is testament to our great NHS that our Government is intent of destroying.

At this point I was left disabled with right sided spasticity through no fault of my own I may add as I was born with this weak blood vessel indeed a ticking timebomb waiting to happen and thus my life from that point was going to be a hard uphill struggle because back then post stroke care was very limited indeed since then stroke care had improved greatly until the con/dems took office and we are now seeing services cut and thus a return to days of old.

Now I do not regret this tragic event that happened in my life in fact I am thankful because it has made me open my eyes and see things our politicians do not and so I find myself having Humanity, Compassion and more of an Understanding than those born with a silver spoon in their mouths.

Now I did and still do have morals and did not want to be a stay at home shirker with my curtains closed as Ian Duncan Smith puts it but wanted to get myself fit as can be so I could return to work after all I was only 27 then this I managed to archive 18 months later and it is where I stayed until 2007.

During this time although I had an entitlement to Disability Living Allowance, but I never claimed a penny why should I after all I had morals and thus because I was earning a good wage I did not need the extra money and rightly or wrongly thought their was others in more need than me.

However because I did my part for the Government in saving them cost and paying my taxes and national insurance I did claim in September 2007 on getting made redundant due to the financial bubble that was the real reason for this mess we are in now, although what I got was not a fair refection of my disabilities, but was happy I got the middle rate of the care component which helped along with the incapacity benefit so did not add cost by appealing this decision.

Now roll forward to the middle of 2012 and I found my self having to gather evidence and filling forms to claim ESA despite the DWP already having this information due to my DLA Claim indeed my mental and physical disability’s will not get any better not after living with it for almost 23 years.

I wrongly thought I would be put in the support group given my issues with working memory, executive functioning and motivation which is all clinical due to damaged frontal and temporal lobes and not laziness but no I was put in the wrag group without even an assessment so they only had documentary evidence to go on and as I am not all that good at putting things across on paper I found my self in a battle again.

My ESA form was back late due to my health conditions and I was first refused ESA and had to get my MP involved to reinstate my claim but again I was late on my appeal for the same reason and thus stuck in the wrong wrag group until the end of this year when my claim will end, 30 days is clearly not enough time for citizens like me and as the judge will draw on at the JR really they should gather the evidence themselves.

I am still not a scrounger as they put it because although I cannot get full time work due to the current economic climate and my disabilities I work voluntary in the community and about to take a role with the Stroke Association plus also caring for our disabled elderly mum at home who is 89 years old.

I hope you can print some or all of this in your paper because reality needs to be told, indeed for we have done and do we deserve a medal and certainly not the daily attacks we have dished on us.

Kindest Regards

Leon Carter