I have strong views about mental health legislation and am reasonably well read. Would this book inform, irritate, support or undermine my beliefs? It is a very personal and detailed view of what should be the legal and clinical grounds for non-consensual hospitalisation and treatment. Much of what is written is as pertinent in the UK as in the USA. There is little discussion of American law in the text.
Many of the arguments have been expressed before, although not in one relatively easy read. Anyone wishing an overview of the issues will be greatly assisted. This does not mean that there is nothing new (to me) here. The presumption that enforced treatment in the community is less restrictive than admission to hospital, without compulsory medication, is challenged. Indeed, the idea that if, for example, a patient is to be made subject to compulsion to reduce the risk to others he or she should be offered this choice (assuming that admission without medication would reduce the risk) is interesting.
There is discussion of the role of advance directives: should patients be able to make advance refusals only after they have once been compulsorily treated for a particular condition? The argument is that they cannot know the pros and cons of treatment v. illness until they have experienced both, but they will be sufficiently well informed to make a decision after they have.
The eye-openers for me were the statements and descriptions that showed the similarities and differences between psychiatric practice here and in the USA. ‘The Los Angeles County Jail is the biggest mental hospital in the country’ and ‘The central problem facing the mental health system today is not treating unwilling patients but failure to provide treatment to willing patients. There is simply not enough care for those that want it’ are both statements that will strike a chord.
The chapters on seclusion and mechanical restraint were also a revelation to me. The civil-libertarian author considers that grounds for seclusion should be ‘limited’ to danger to self or others or antisocial behaviour such as undressing in front of other patients on the ward. This, however, is unexceptional compared with the description of the use and regulation of tying patients spread-eagled on the bed for hours or days at a time. The resulting morbidity and mortality is detailed. I have been left wondering which, if any, practices in the UK would cause equal horror in other countries.
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