We need brave people to speak out

Angela Gilchrist on the launch of ‘Understanding Psychosis and Schizophrenia’ , a new report from the British Psychological Society

This is a critical moment in mental health history: never have so many decision makers wanted things to change. That’s according to the National Clinical Director for Mental Health, Dr Geraldine Strathdee, speaking last week at the launch of ‘Understanding Psychosis and Schizophrenia', a report from the British Psychological Society’s Division of Clinical Psychology.

The event, described by many as 'ground-breaking and momentous', was remarkable in that it brought together numerous and disparate voices in the mental health community including psychiatrists, psychologists, policy makers, third sector workers and people with lived experience of psychosis. Among the guests were the Shadow Minister for Public Health and Mental Health, Luciana Berger; and the founder and principal theorist for the Hearing Voices Movement, Professor Marius Romme.

Electroconvulsive Therapy: Whose decision is it?

@steweatherhead & @THEAGENTAPSLEY

What does consent to treatment mean?

Lisa is a 42 year-old woman. She has had a difficult life. She has experienced multiple traumas and has at times struggled with her emotions. Lisa has a few close family members and a small social circle, though she does at times feel a bit oppressed by them. In 2010 Lisa contracted HIV. She has been treated medically and was stable for some time, however in 2013 she started to deteriorate. She was seen by a psychologist as well as by medics. After a further twelve months she had had enough of interventions and decided she wanted to live the remainder of her life in her own way. Her family and friends objected as they could see she would rapidly deteriorate. However with support from professionals, Lisa utilised the Mental Capacity Act (MCA) to set some advanced directives. She was found to be capable of making these decisions under the MCA, and was legally allowed to refuse further intervention. Lisa did indeed deteriorate, and died a few months later in her own home with her family and friends around her.

Is it time to call time on Community Treatment Orders?

John McGowan

The Mental Health Act 2007:
Alternatives to hospital or
 curtailments of liberty?

Every so often I come across an article on Community Treatment Orders (CTOs). Usually the view expressed is critical and it always produces a stab of disquiet. More on the bad feelings in a second, but before that, it’s worth just establishing what we’re talking about. The norm that people with mental health problems can be given treatment against their will and detained in hospital is well established.  In the United Kingdom the Mental Health Act 2007 extended this principle by allowing people such compulsory treatment at home (i.e. without admission). The twinge of unease comes because I, in the face of a good deal of criticism from colleagues, thought this change was a good idea.

Let’s leave aside whether such compulsory powers are right or wrong. Feelings run high but there is no sense in which the abandonment of enforced treatment is on the table. Let’s also leave aside the idea of confining compulsory treatment to cases where people lack the capacity to consent. Unlike physical health (where any of us has a right to refuse treatment unless we lack capacity) the UK the Mental Health Act allows treatment on the basis of   mental illness While there are powerful arguments that this situation is unjust, these have struggled to gain traction.  Here I want to focus on the narrower question of whether, in a world were compulsion is established, CTOs have been helpful.