[Magdalen] Washington Post article on involuntary hospitalization of the mentally ill

[Roger Stokes]

On 14/02/2015 20:12, Ann Markle wrote:
> http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html
>
> In rereading, this is written by an anthropologist, and contains results
> from some findings and discussion in Great Britain.  So I may have spoken
> wrongly.  But check it out - I'd be interested in your reaction.  I agree
> that findings/opinions change on this matter.

For various reasons I had not read the original article before but I 
have now done so.  My first reaction was that the British Psychological 
Society would advocate more talk therapy and less drug therapy.  
Psychologists are not physicians.  They are generally paid less than 
doctors and cannot prescribe medication.  In their various specialisms 
(medical, occupational, educational, counseling etc.) they focus on how 
the person operates and enabling them to function effectively in their 
particular context, or for occupational assessing an appropriate context 
for them.

That is not ideally suited to a few minutes consultation and then reach 
for the prescription pad.  It takes time to tease out what the 
underlying issues are and then helping the client address them through 
advice or an appropriate course of therapy.  Yes, some people may need 
medication to help them through a particular crisis or to achieve 
sufficient stability to be able to develop a new approach to life.  Some 
may need long-term medication to reduce excessive mood swings.  However 
the aim will be to allow the person to resume an appropriate position in 
society without relying on medication which becomes less effective over 
time.

Having said that I recognize that there are individuals who will never 
be able to operate effectively in wider society.  This may be because 
they are a danger to others or because they lack the capacity to do so, 
and I have met both types during my time as a prison chaplain.  A mental 
hospital is for those with a treatable condition, and some are not yet 
treatable but public safety requires them to be in a secure facility of 
some type.

Others have spent so long in institutions and other closely ordered 
contexts that, as one inmate observed to me, [he was] institutionalized 
and needed the security of a total society to provide a framework for 
him.  Another (in less enlightened times) had received a lobotomy and I 
asked our Principal Medical Officer (who was a consultant psychiatrist) 
what would be the best thing for him. The PMO said an old-fashioned 
asylum where he could earn a little money cleaning staff cars but have 
the security of a life ordered for him.

In all of this we need to recognize we are dealing with continua on 
which we also are.  We will move along them over time and distinctions 
between the sane and the insane can often be a matter of arbitrary 
judgement.  With regard to compulsory hospitalization in England and 
Wales (Scotland and Northern Ireland have their own legislation) for 
their own health and safety or the protection of others. Apart from an 
emergency order, which requires only one doctor and last for 72 hours, 
longer orders (28 days for assessment or 6 months for treatment) require 
the approval of two doctors, at least one of whom has received 
specialist training.  The courts can also order the detention of 
somebody charged with or convicted of a criminal offence.

Roger