Mental health and human rights: Why aren’t human rights groups interested in mental health folks?

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Why aren’t human rights groups interested in the human rights of people with mental health problems, especially when there’s so much for them to get their teeth into? Is it just the same ol’ ignorance and prejudice?

When a human rights story is in the news, you’ll see me banging on about it on twitter and asking where the coverage of the human rights of mental health folks is. I’ll ask why human rights organisations don’t seem interested in this group of people, who can in many cases genuinely be classed as some of society’s most marginalised and vulnerable: sometimes locked up behind closed doors, often out of sight, with little credibilty and subject to state powers to impose forced treatment on people even when they have mental cacpacity. Why don’t we hear about that all day and all night from human rights organisations?

This silence from human rights groups is puzzling when mental health issues are receiving more publicity and prominence and where there is so very much for human rights groups to get their teeth into. That leads me to ask all sorts of questions. For instance:

• The Convention on the Rights of Persons with Disabilities

I’ll ask why human rights organisations don’t seem to be interested in a brand new developing area of rights, namely those under the Convention on the Rights of Persons with Disabilities (CRPD) which has been described as a paradigm shift in disability rights. Don’t they want to get in on the action on this hot new area, rather than sticking doggedly with familiar human rights aspects? Are human rights organisations bound to stay in the familiar niches they’ve carved for themselves, or will they look further afield?

• United Nations investigation into violations of the rights of disabled people

I’ll ask whether human rights organisation are looking at the fact that the UK is the very first country to be investigated by the United Nations for violations of the human rights of disabled people under the CRPD. Doesn’t that sound like an interesting and important human rights topic?

• Human rights section to the new Code of Practice to the Mental Health Act

I’ll ask what human rights organisations are doing about the brand new section at the front of the new Code of Practice to the Mental Health Act on … human rights. Isn’t it significant – something of note, something to promite – that the new CoP has at its very beginning a brand new section on human rights? I think so. Is it only me?

• Care Quality Commission’s new human rights-based approach

Are human rights organisations interested in the human rights-based approach all Care Quality Commission inspectors are to take to inspecting hospitals and other healthcare facilities?

• Restrictions placed on psychiatric detainees

Do they take an interest in the recent NICE guidance that all NHS hospitals should prevent smoking on their premises, even in the case of detained patients without leave and are there no human rights implications of that blanket policy (spoiler: yes)? And what of the blanket policies of some hospitals to remove patient phones or prohibit them from accessing social media whilst on ward?

• Routine use of force medication

Forced medication is used on some psychiatric wards as a matter of routine, as a first resort rather than a last resort, even when people have the mental capacity to make medication decisions for themselves. Aren’t the human rights of people subjected to forced medication in psychiatric detention of interest to human rights groups?

• Voting rights of psychiatric patients

Voting rights are meat and drink for human rights organisations. So why no campaigns or even interest in the voting righs of people with mental health problems?

Why is it? Why don’t human rights groups take an interest in those topics when there’s so much for them to get their teeth into and when mental health is such a hot topic at the moment, often in the news?

Mental health folks don’t seem to get a mention – unless we fall into an existing favoured category such as prisoners, death row inmates or deaths in custody

When I see human rights organisations talking about human rights, I notice time and again that, whilst all sorts of different niche groups and causes are trumpeted, mental health folks just don’t seem to get a mention – unless, that is, we fall into an existing favoured category, such as people in detention in prison or on death row, or deaths in custody. Why is that? And what – given important developments in human rights and current social and political changes giving mental health much more prominence – can be done to get violations of the human rights of mental health folks more of a focus and the enforcement of the human rights of mental health folks made into more of a priority?

Why am I told mental health folks are “too speciailst” when all sorts of other specialist groups are chosen for human rights campaigns?

I’ve tried to follow up with various human rights organisations to find out about the work they do on the human rights of mental health folks. I’ve tried. However, I’ve typically been ignored or, when I do get a response, I’m fobbed off with the line that people with mental health problems are a niche group that’s “too specialised” for them. This doesn’t seem to accord with campaigns run in respect of other “niche groups”, such as refugees, prisoners, LGBT people, trades union members, military personnel. Not at all. And it goes against the premise that human rights are most needed by those people who are most vulnerable – and people with mental health problems can be in very vulnerable postions. It’s niche groups who most need human rights.

Why the seeming lack of interest from human rights organisations? Why are people with mental health problems being marginalised, even by those organisations and individuals who purport to champion society’s most marginalised and vulnerable people? Why – at a time of expanding human rights provisions for people with disabilities including mental health problems, at a time of increasing promimence for mental health issues growth, development and prominence of issues surrounding people with mental health problems – why are human rights organisations not swinging into action and grasping the opportunties available to do good, high profile work and make a real difference to the lives of mental health folks?

Could it be that human rights organisations are simply prey to the same ol’ same ol’ stigma and discrimination that blights the lives of mental health folks every day? Is it a case of priorities and people managing mental health problems just aren’t as important as other groups – even though we make up such a large minority of the population? I’m still trying to find an answer.

I’ll keep on trying. The human rights of people managing mental health conditions are too important to overlook.

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Related links

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Some human rights organisations

• Amnesty International (UK) – I’ve never received a response from UK Amnesty
• British Institute for Human Rights – This organisation DOES take a real interest in the human rights of people with mental health problems
• Equality and Human Rights Commission
• Eurorights @eurorights
• Justice Hub @justice_hub
• Liberty (formerly the National Council for Civil Liberties) – Liberty says mental health is “specialist” (whilst at the same time runnning campaigns for what could also be consider for “specialist groups” – currently trades union members, military personnel)
• Reprieve – This organisation focuses on the death penalty, torture, Guantanamo Bay, drones and secret prisons

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Some human rights laws and conventions

• European Convention on Human Rights (ECHR) (European law)
• Human Rights Act 1998 (UK law)
• Mental Capacity Act 2005
• United Nations Convention on the Rights of Persons with Disabilities (CRPD)
• Universal Declaration of Human Rights

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Some twitter musings on human rights for mental health folks:

• Musings on human rights for mental health folks & discussions with human rights organisations on whether they cover this topic (February 2015)
• Legal training for mental health nurses (7th December 2014)
• Tone policing in mental health – Adam Wagner (1st December 2014)
• Human rights and mental health (28th November 2014)

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“He’s a psycho” – Professor Adrian Furnham on the importance of cleansing the workplace of undesirables

Harry Enfield as Kevin the Teenager (PA)

 

Have you seen this? Rachel Hobbs of mental health charity Rethink Mental Illness asked me this afternoon. She was referring to the charity’s response to a piece in the Sunday Times headed “I’m sorry, he’s not a differently gifted worker – he’s a psycho”. I’d just arrived home so hadn’t but, sadly, I had already seen the piece that prompted the rebuttal – and been shocked to the core.

The Sunday Times piece to which Rethink had issued a response advises employers of the necessity of screening job applicants and employees to weed out undesirable ones. The author writes:

“There are three important questions. The first is how you spot these people at selection so you can reject them … The second is, given that they have already been appointed, how to manage them … Sometimes it is a matter of damage limitation …  The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.”

Putting aside for one moment the reference to “maladaptive personalities” and the telltale use of “these people” (a clue that we’re about to experience a group of people being made “other”), this all seems fair enough. After all, what employer wants to end up lumbered with rogues or duffers, or people who are simply not suited to the post being filled?

In any recruitment process, whether to fill a new role or replace a departing employee, some sort of selection process is inevitable. Indeed it is welcome, since it will give both prospective employer and employee the opportunity to see whether post and candidate are a good fit. I’ve read plenty of books and done courses including interview techniques, networking, career development and workplace psychology. I’ve undertaken interviews and assessments. It’s an interesting field and one that can bear fruit for employers and employees.

So what’s the problem? The problem is that the premise of the piece is – regardless of the role to be filled – people fall into two categories: they are either desirable or undesirable in the workplace, and the “unemployables” are to be hunted down and excluded. “These people” are to be avoided at all costs. “These people” have “maladaptive personalities”.

“These people”, according to the piece, fall into 5 categories, namely people who exhibit what is classified as antagonism,  disinhibition (Harry Enfield’s Kevin the Teenager – pictured above – is the illustration the author provides for this category), detachment, negative affect or psychoticism (bear with me – this isn’t made up). Each, as described in the piece, has a clear link to mental health problems.

Reading the piece, I had several strong immediate reactions – to the extent I sat down and wrote out my thoughts (then, unhelpfully, lost the piece of paper; perhaps there should be a sixth category of “unemployables”, the abstent-minded).

First, I took away the message that (based on the characteristics of the people described in the 5 categories, some of which I share) I was most definitely not wanted in the workplace. I was not wanted in the workplace and there were armies of workplace psychologists devising tests designed to make jolly sure I wouldn’t be able to sneak in undetected.

It felt as if, when I finally feel able to re-enter the competitive employment market and, were I ever to make it through to a job selection process, there would be a head to head battle. On one side would be the selectors, trying to expose my “maladaptive personality”; and, on the other, me, desperately trying to keep my deficiencies and undesirable characteristics under wraps. Then, in the unlikely event I was able to pull the wool over their eyes and win on that occasion, I would always be at risk of exposure and therefore dismissal. And, even if I started a job mentally healthy but then (for whatever reason – even if it was because too much work was loaded onto me at work, causing unnecessary stress) I became unwell, my employer wouldn’t seek to support me, a valuable employee, through that illness – but instead try to get me out.

I was reminded of the recent disappointment of prospective cabin crew Megan Cox. Notoriously, her offer of a dream job with Emirates Air was withdrawn when she disclosed a past history of depressive illness. In Megan’s case, it was clear that the prospective employer had based their decision on generalisations about depressive illness rather than the individual under consideration. Perhaps they were administering a standardised workplace psychological assessment which sought to weed out the undesirables. Megan Cox was deemed undesirable by Emirates Air. Lucky escape for them that they were able to spot her during the recruitment process. The piece made clear that, similarly, I would be weeded out.

Second, the contents made me want to send the piece to all those people involved in making decisions about the social security support of people who, like me, are managing disabilities, to show them the high barriers we have in getting into employment. Only today, it was reported that Employment and Support Allowance and the Work Programme were costing more than the predecessor welfare benefit Income Support and were getting fewer disabled people back into work. Is it any wonder that a system based around the notion that disabled people are out of work because of a lack of motivation (and incentives – or, rather, penalties) to seek work will fail when the actual barrier is the attitudes of employers – fed by pieces such as these – towards people with disabilities?

Third, having assumed at first glance that the piece was written by a generalist journalist to meet a deadline, I was gobsmacked to find it was written by a professor of psychology. A renowned academic – Professor Adrian Furnham – of a renowned institution – University College London – was the author. It simply did not compute.

So then  I did a little reading around the subject on the internet. I discovered that Furnham hadn’t made up terms like “dark traits” or “psychoticism”. No: they were legitimate. These terms came from last year’s new version of the US psychiatric manual (DSM5) and from workplace psychology (for the past couple of years).  The meat of the piece seemed to be almost a cut and paste from ideas that would be familiar to people who’d studied the field: nothing new, surprising or out of the ordinary. This wasn’t some rogue piece by a lazy journalist in a hurry: it reflected current thinking in (US) workplace psychology. That was hard to swallow.

However, on reading the piece again, there were some flaws (whether of the author or in the editing) which meant it was skewed to paint a worse picture than US workplace psychology actually seems to do. Thank goodness. For instance, the professor conflates the DSM5’s “maladaptive personality traits” (undesirable characteristics) with “maladaptive personalities” (undesirable people). To confuse a trait with a person is a big leap – and a damaging one for the people on the receiving end of the “undesirables” label. Furnham also conflates mental illness (with references to “disorders” and “pathology”) with personality disorders (he lists the 3 DSM5 clusters) and personality traits. Thankfully, therefore, the piece isn’t an accurate representation of the current state of play. In fact, it’s a bit of a mess.

In addition – as is common with fear-mongering pieces – the particular damage “these people” could do in the workplace is left vague; but the fact that they will cause damage is made plain.

The trouble is, however, that anyone not familiar with the nuances in the field (and that might be your average Sunday Times reader) would easily be expected to come away with the very clear message that people with mental health problems – yes, people like me – should be excluded from the workplace at all costs. And that is a damaging message.

Which leads me to my fourth thought on the topic: I wonder (and I don’t know) whether the piece might breach disability discrimination laws.

Furnham argues for keeping “these people” – people with “maladaptive personalities”, people whose symptoms which, as described, fall within mental health diagnoses such as anxiety, depression and schizophrenia – out of the workplace. My understanding is that, where a condition impacts on someone’s health for 12 months or longer, that counts as a disability and is protected by law. In other words, discriminating against someone in these circumstances counts as disability discrimination.

I’m trying hard to see how advising employers on how to avoid employing or get rid of people with disabilities is any different to advising employers to not employ black people or gay people or women. Whether or not it amounts to disability discrimination, it’s clear it is not good to advocate discrimination in the workplace.

Rethink Mental Illness has been in contact with the author and are hoping to have a piece – written with other mental health charities – published in this weekend’s Sunday Times. Rethink reports that Furnham and colleagues were surprised at the reaction to the piece and believe it has been misinterpreted. It seems to me there is a clear opportunity for a dialogue, and for largely commercially-focused workplace psychologists to gain a greater understanding of the crossover between their work and mental illness and the role they can play in the negative stereotypes.

Until employers are willing to consider job candidates or existing employees as individuals rather than categories based on assumption, the prejudices and assumptions of employers will impact on people managing mental health problems like a form of modern straight jacket.

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The Sunday Times published a letter from Rethink Mental Illness and others on Sunday 22nd; and the following day Furnham wrote to explain, apologise and request that the article be withdrawn. Constructive engagement and a willingness to engage produced a positive result.

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The Sunday Times story and rebuttal:

• I’m sorry, he’s not a differently gifted worker – he’s a psycho’ (title since changed to ‘… – he’s troubled’) – By Professor Adrian Furnham in the Sunday Times newspaper (Sunday 15th June) (see below for the full text of the article)
• Why we’re challenging Sunday Times article featuring advice on how to weed out job candidates with ‘abnormal’ personalities – Rethink Mental Illness (Thursday 19th June)
• University College London
  • UCL’s student disability service
  • Professor Adrian Furnham
• Tweets on the subject:
  • My original tweets and subsequent conversations
  • Responses by others to the piece
  • Discussion between Rethink Mental Illness and Furnham
• The Myers Briggs personality test to which (presumably) Furnham is alluding in his piece

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Employment and Support Allowance

• ESA sickness benefit is ‘failing’, government documents say – BBC news (Thursday 19th June)

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Emirates Air and depression

• British woman ditched from dream air hostess role after Emirates Airlines withdraws job offer ‘because she once had depression’ – Daily Mail newspaper (23rd May)
• Emirates Airline withdraws flight attendant job offer over woman’s history of depression – Independent newspaper (22nd May)
• I lost my dream job with Emirates because of depression – By Megan Cox, Guardian newspaper (26th May)

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Here’s the full text of the piece written by Adrian Furnham and published in the Sunday Times on 17th June under the heading “I’m sorry, he’s not a differently gifted worker – he’s a psycho”:

TWO things account for the success of a popular personality test: extensive marketing and the reassuring message you get with your results. Whatever profile you have, or type you are, “it’s OK”. We have different gifts. We can’t all be the same. Everyone is fine. Celebrate your quirkiness.

The message makes it easy for consultants and trainers. Researchers, however, know that one of the best predictors of success at work is (raw) intelligence, along with emotional stability and adjustment. But too many in the selection business are afraid of using well-proven tests to assess these factors for fear of having to deliver feedback such as: “Sorry you were unsuccessful in your application: the reason is that you are too dim and too neurotic.”

However, the message of “we are all OK” is not true. There are people with a distinctly unhealthy personality. There are many words for this. Some talk of “dark-side” traits, others of “abnormal” traits. And for more than 20 years, clinicians have talked about the maladaptive personality.

Researchers have recently tried to spell out traits that are most clearly manifest in the maladaptive personality. There are five of them.

Antagonism
This is defined as manifesting behaviours that put people at odds with others. It has components such as manipulativeness, deceitfulness, self-centredness, entitlement, superiority, attention-seeking and callousness.

Antagonistic people put everyone’s back up. They are selfish, self-centred and bad team players. The clever and attractive ones are the worst, because they use their skills and advantages to get what they want, come hell or high water.

Disinhibition
Defined as manifesting behaviours that lead to immediate gratification with no thought of the past or future. It has components such as irresponsibility (no honouring of obligations or commitments), impulsivity, sloppiness, distractability and risk-taking.

Think Kevin the Teenager. It can mean enjoying shocking others with unacceptable language, outlandish clothing or poor manners. This may be amusing in the playground but hardly acceptable in any form in the workplace.

Detachment
This is defined as showing behaviours associated with social avoidance and lack of emotion. It has various components, such as a preference for being alone, an inability to experience pleasure, depressivity and mild paranoia.

These are the cold fish of the commercial world. They seem uninterested in nearly everything and certainly the people around them. Some seem frightened by others, most just not interested in being part of a team.

Negative affect
This is defined as experiencing anxiety, depression, guilt, shame, anger and worry. It has components such as intense and unstable emotions, anxiety, constricted emotional expression, persistent anger and irritability, and submissiveness.

These are the neurotics of the world. They can be very tiring to engage with and highly unpredictable because of their mood swings. The glass is always empty, and they seem always on edge.

Psychoticism
This is about displaying odd, unusual and bizarre behaviours. It includes having many peculiar beliefs and experiences (telekinesis, hallucination-like events), eccentricity and odd thought processes. Some may see such people as creative, others as in need of therapy.

Psychiatrists have grouped those with personality disorders into three similar clusters: dramatic, emotional and erratic types; odd and eccentric types; and anxious and fearful types.

There are three important questions. The first is how you spot these people at selection so you can reject them. This is easier with some disorders than others. It is virtually impossible to spot the psychopath or the obsessive-compulsive person at an interview. Clearly, you need to question those who have worked with them in the past to get some sense of their pathology, which many are skilled at hiding.

The second is, given that they have already been appointed, how to manage them. There is, alas, no simple method that converts the antagonist into a warm, open, honest individual or the disinhibited worker into a careful, serious and dutiful employee. Sometimes it is a matter of damage limitation.

The third is how to rid your workplace of these maladaptive personalities, and that is the toughest question of all.

Adrian Furnham is professor of psychology at University College London and co-author of High Potential: How to Spot, Manage and Develop Talented People at Work (Bloomsbury)

 

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Section 136: Mental health, places of safety and criminal records

My Enhanced Certificate from the Disclosure & Barring Service, April 2014

This is a photo of the Enhanced Certificate I received yesterday from the Disclosure & Barring Service (DBS) which last year took over from the Criminal Records Bureau in providing criminal records checks.

Here’s a twitter conversation yesterday about places of safety, mental health and criminal records, including the law relating to section 136 (and yes, it is an arrest; and yes, it’s up to police to decide whether to include it in an enhanced DBS check) from the perspective of award winning police inspector Mental Health Cop.

I’ll write this up into a blog when it’s not bedtime! I’m having to be strict with my bedtime routine at the moment to try to get back on an even keel.

Night night.

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Related links:

• The new Mental Health Bill and criminal records checks (a “career death sentence”) – An earlier blog post (September 2012)

• Policing Mental Ill Health – An article by Inspector Jan Penny, mental health lead for Thames Valley police (August 2012) for the Oxford Mental Health Forum

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Starting a family when you have a mental health diagnosis: unfit to be a mother?

Photo by Bicycle Bill

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Scroll down to the web links section for links to all the coverage & commentary on the Essex forced caesarean & adoption story

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On starting a family when you’re managing a mental health problem: reality and scare stories

Earlier today, a story about a mother with a diagnosis of bipolar disorder broke which was so utterly grotesque that it has caused a storm of protest on twitter and elsewhere. Questions are to be asked in the House of Commons. Although so far we only have a story reported in the Telegraph newspaper (based on incomplete information), there appear to be 2 main aspects. These fall into familiar media narratives:

1. “Evil social workers steal our children.” And, in this instance, rip a baby from it’s mother’s womb in an enforced caesarean the mother didn’t know about till she came round to find the scar in her abdomen. As reported in the Telegraph, a woman with a diagnosis of bipolar disorder, visiting the UK for two weeks from Italy, was sectioned and taken to a psychiatric hospital. Without informing her, social workers went to court and a judge made an order that a caesarean section could be performed on the woman and the baby taken away. Without warning, the woman was forcibly sedated and, when she woke up, a caesarean section had been performed on  her and her baby removed. She has never seen the baby.
2. “Women with mental health problems are unfit mothers.” The Telegraph reports that, subsequently, the mother went to court to seek the return of her baby. The judge decided against returning her baby because – despite the fact she was currently well – he said her lifetime risk of relapse meant she was an unfit mother.

There are other troubling aspects to the news story too, but these are the two that relate to mental ill-health. I comment below on these aspects. In summary:

1. We don’t yet know all the facts around the caesarean section in 2012. It seems so grotesquely barbaric and traumatising that there must be more to it. A c-section is a medical matter, not one for social services. Other seemingly plausible explanations have been put forward and what’s been reported doesn’t ring true. Court of Protection cases are not routinely reported, so we may never see the judgment in this case and the local authority involved may be unable to comment. The main source of information for media coverage is the original Telegraph report, which is based on information provided by only one source (the mother’s solicitor). As a comparison, the Telegraph report refers to a “panic attack”, whereas other commentary refers to a psychotic episode. And the Telegraph story is  written by a journalist who has been criticised for writing misleading court reports in pursuit of his cause. He is a journalist with an agenda. At best we can say for certain that the information we have is incomplete.
2. As written, it appears that the fact that the woman had a diagnosis of bipolar disorder was the judge’s justification for refusing to return the child to its mother.  This is appalling. This – and the real problems women managing mental health problems face in accessing the support they need – are the real issues for debate.

This scare story contrasts sharply with the reality of women’s experiences of managing a mental health problem and wishing to start a family (for instance this by Erica Camus, 33, diagnosed with paranoid schizophrenia and contemplating whether she can become a mother; or these comments by Seaneen Molloy, in her twenties, diagnosed with bipolar disorder and also wishing to become a mother).

Many women’s mental health problems will start during child bearing years – so there are a lot of us affected. Women and couples make decisions every day about sex, contraception, psychiatric medication and abortion. With so many of us living this reality daily, the real conversations should be about the following issues:

• The provision of supportive mental health care in partnership with women, so they don’t fear asking for help in case they risk losing their autonomy or children
• The provision of sufficient specialist maternity mental health services, both outpatient and inpatient, so mother and baby or babies can be cared for together, no matter how unwell the mother is  (it was recently reported that, “Only 50% of areas have any kind of specialist perinatal mental health services“)
• Ensuring worst case scenarios are planned for in advance, in partnership with the woman (to hopefully reduce the risk of such heartbreakingly sad events as the deaths of Daksha and Freya Emson)
• Researching the effects of psychiatric medications on unborn babies (this research project is currently recruiting women participants for a study on pregnancy and antipsychotic medication)

Let’s hope that the furore generated by this seemingly sensationalised scare story provides a window of opportunity to discuss these real issues women face daily. And let’s hope that women who are wrestling with these very issues now will not decide to have a termination, or to not have children, or to not seek help with mental health concerns as a result of such scare stories.

Allesandra Pacchieri with her youngest daughter, Baby P (Daily Mail, 4th December 2013)

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Here are my thoughts (tweets edited only slightly due to the lateness of the hour) in response to the initial Telegraph story:

The Telegraph reports that a judge ordered – without even telling her – that a mother could be forcibly sedated & her baby delivered by caesarian section then taken. And that a new judge has ruled that a bipolar diagnosis – just the diagnosis – makes a mother unfit to have her child with her.

Can you imagine a mother with Crohn’s disease who experienced a relapse being forcibly sedated and having her baby removed by secret caesarean? Just like bipolar disorder, doctors diagnose Crohn’s as a lifelong relapsing and remitting condition. At times of relapse, a parent with Crohn’s may be unable to take care of their child. Would anyone say that a mother with Crohn’s was, by virtue of that diagnosis alone, unfit to keep her child just in case she relapsed? No. That judgment seems reserved for those of us with a mental rather than physical health diagnosis.

My impression is that society, doctors and the courts infantilise women who are pregnant. And that certainly happens to people with mental health problems. That’s a double whammy for pregnant women who are managing mental health problems if their case comes before a court.

One question that arises in reading the Telegraph story is where was the perinatal psychiatric service? The point of perinatal psychiatric services is to support mothers through pregnancy and delivery. Since pregnancy is linked to bipolar relapse, it’s all the more important for women to get proper perinatal psychiatric care. That doesn’t seem to have been the case with this mother, though there is a perinatal psychiatric service in Essex.

However, the scary message from these two legal cases, as reported, seems to be this: if you have a bipolar diagnosis, you shouldn’t tell anyone that you’re pregnant because, if you do, you could lose your baby. That you should steer clear of mental health services at all costs.

Wouldn’t a better message be that, if you have a bipolar diagnosis and you want to become pregnant, you should get in contact with a perinatal mental health service so you can plan the pregnancy? Wouldn’t a better message be that, if you’re already pregnant, you should make contact with a perinatal mental health service so they can support you during and after your pregnancy? Wouldn’t a better message be that, if a woman gets a bipolar diagnosis – or any other mental health diagnosis – she is still a full human being. She is not merely a womb. She is not merely a piece of meat to be sedated and sliced open without her knowledge. She is not merely a risk to children. She is a full human being.

At the moment, we know only a partial view of what has happened. The report is based on instructions the mother gave her solicitor. We don’t know why the caesarean was performed. There must have been some medical reason. We are told that the mother wasn’t warned about the planned caesarean and that the child was taken away without the mother seeing it. We are told that the child hasn’t been returned to the mother for the apparent reason of the mother’s bipolar diagnosis and therefore possibility of relapse.

Let’s hope this is just some really, really badly reported media story that’s actually a bit dull. That would be better than the alternative. It will be interesting to see what comes of this story when it’s reported fully. I wonder if either journalist has relevant expertise. I wonder if either has form for whipping up a storm of controversy for a story that turns out to be far more straightforward.

But basically, if you’re a woman with a bipolar diagnosis, you’re an unfit mother. What a sweeping generalisation that infantilises women & reduces us to no more than our diagnoses.

I can guarantee that, when this story is picked up more widely tomorrow, there will be people who will defend the court’s decisions purely on the basis that the woman had mental health problems. Some – who see a diagnosis, who see risk, rather than a person – will see mental health as a trump card, a byword for dangerousness and unpredictability.

Does a bipolar diagnosis make a mother unfit? No, not in and of itself. No more than would a diagnosis of another relapsing and remitting condition like Crohn’s disease. Yes, the mother might relapse. Maybe relapse is not a possibility but a certainty, so the only question is when the next relapse will happen, not if it will.  That’s equally true of Crohn’s disease.

If a mother has a bipolar diagnosis, that’s an argument for supporting the family, not removing her children. Supporting the family is a far cheaper option than taking children into care of putting them up for adoption. Both are astronomically expensive options financially. If a mother has a bipolar diagnosis, that’s an argument for supporting the family, not removing the children. That’s the humane and compassionate response.

Let’s hope this case receives such an outcry that women with a bipolar disorder will be viewed more realistically. Not infantilised.

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[15th April 2014] The final chapter for mother and child; and the Guardian

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Related web links:

The following topics are covered:

• Statements from the parties involved – including court judgments (including the judges’ reasons), Essex County Council, the mother’s solicitor & MP, and the hospital where she was treated
  
• Other court cases related to pregnancies
• Mainstream media coverage
• Commentary and blogs – Birthrights charity, British Association of Social Workers, blogging barristers & others
• Other relevant material – Eg research, perinatal mental health, Court of Protection, twitter conversations

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Statements from the parties involved:

• Mr Justice Mostyn, Court of Protection – August 2012 caesarean judgment – Includes  (a) preface by judge (b) judgment (c) transcript of hearing and (d) copy of the Order made – Court of Protection, Mr Justice Mostyn, Re AA (Thursday 23rd August)
• His Honour Judge Newton, Chelmsford County Court – February 2013 child placement judgment – The judge’s reasons for why baby (P) should not be returned to her mother –  (A) – His Honour Judge Newton in the matter of  Re: P (a child) – Chelmsford County Court judgment (February 2013)
• Essex County Council – Essex County Council responds to interest in story headlined “Essex removes baby from mother” – Key dates, context and statement (Monday 2nd December)
• Brendan Flemming, solicitor – Statement of the mother’s UK solicitor on his website – Brendan Fleming, solicitor, was “unable to discuss the facts, evidence or information in this case” and had “a duty to ensure information relating to ongoing proceedings remains confidential. As such, we are unable to offer any comments or information relating to this case.” (Monday 2nd December)
• North Essex Partnership NHS Foundation Trust– Statement on Caesarean Case (the hospital where the mother was treated) (Wednesday 4th December)
• John Hemming MP – Various statements on Hemming’s blog
• Mr Justice Charles, High Court – Reporting restrictions link (prohibiting the identification of the child or her carers) (Wednesday 4th December) Here’s the reporting restrictions order (version 2 – version 1 named the child) & here’s the judgment transcript (erronerously dated 2012)

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Other court cases relating to pregnancies:

Case 1 (1998): Forced caesarean was unlawful, despite High Court judge’s ruling

• Summary: Court-ordered caesareans in the UK – Sheila Kitzinger’s Letter from Europe in Birth – Issues in Perinatal Care (September 1998, Vol. 25.30) –
• Full court judgment: Louize Collins, Pathfinder Mental Health Services NHS Trust & St Georges Healthcare NHS Trust ex part “S”

Case 2 (May 2013): Court upheld autonomy of woman with bipolar diagnosis who had changed her mind and wanted abortion

• Full court judgment:Re SB (a patient; capacity to consent to termination)
• Mental capacity, mental illness and pregnancy – Miss B and the “bipolar abortion” case (May 2013) – My commentary <== This post includes links to other commentary and coverage

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Mainstream media coverage:

Saturday 30th November:

• ‘Operate on this mother so that we can take her baby’ – “A mother was given a caesarean section while unconscious – then social services put her baby into care” – Telegraph newspaper, by Christopher Booker – the original story
• Woman has child taken from her womb by social services – “Essex social services have obtained a court order against a woman that allowed her to be forcibly sedated and for her child to be taken from her womb by caesarean section” – Telegraph newspaper, by Colin Freeman – follow up a few  hours later

Criticism of Christopher Booker:

Christopher Booker is the journalist who wrote the original Telegraph piece.

• Must journalists attend court hearings to report accurately? “I posted last week on a judgment given by His Honour Judge Bellamy in a family court case involving a mother’s abuse of her baby The judge took the unusual step of criticising media reporting of the case. He said the Telegraph’s Christopher Booker’s reporting was “unbalanced, inaccurate and just plain wrong”.“ – UK Human Rights blog (May 2011)
• The superhuman cock-ups of Christopher Booker – “The journalist makes so many errors that you would be forgiven for thinking he did it deliberately to waste everyone’s time” – Guardian newspaper (October 2011)

Sunday 1st November

• ‘Am I crazy to want a baby when I’m schizophrenic?’ After a decade-long struggle, one woman tells of her fears as she contemplates starting a family. “Erica Camus, 33, has lived with paranoid schizophrenia for ten years.She manages her mental illness with daily medication and therapy.When she was first diagnosed she was convinced she was a fugitive. She is now pondering how her schizophrenia would affect a child” – Daily Mail newspaper
• Baby taken from mother by UK social services in ‘forced caesarean’ – RT.com (Russia Today)
• Council forces caesarean on mother – Sunday Times newspaper (£)
• Forced C-section was ‘the stuff of nightmares’ – “Social Services condemned for forcibly removing unborn child from woman” – Independent newspaper
• MP queries ‘forced’ caesarean section – “Child still in Essex social services’ care 15 months after Italian woman with mental health problems had baby removed” – Guardian newspaper
• Pregnant woman has unborn baby girl forcibly removed by caesarean after social workers obtain court order because she had suffered a mental breakdown – “Italian woman claims she was not warned she would be given a ceasarean. Essex council obtained order allowing them to sedate her against her will. The case has now escalated into an international legal row” – Daily Mail newspaper
• Social Services forcibly remove unborn child from woman by caesarean after she suffered mental health breakdown – Independent newspaper
• Woman’s Baby Taken From Womb By Court Order – “An MP is to raise the case of a woman whose baby was taken from her after she suffered a mental breakdown.” Sky News
• Woman’s baby taken from womb by social services – video – “A pregnant woman from Italy, in Britain on business was given a Caesarean section against her will, and had her baby removed by social services. The child is now in the process of being adopted.” – Channel 4 news, with Katie Razzall (twitter @katierazz)

Monday 2nd December

• British Social Services Sedate Woman, Take Child from Her Womb, Confiscate It Indefinitely – National Review (USA)
• Caesarean case mother denied chance to keep baby in hospital – “Doctors’ suggestion that baby forcibly removed from mother’s womb by court order should stay in hospital with her was rejected by court” – Telegraph newspaper
• Child taken from womb by social services: it’s not always wrong – “We must not get distracted by vilifying the Court of Protection when children’s rights are at stake. The system needs to be respected and supported, argues solicitor-advocate Sophie Khan” – Telegraph newspaper
• Council claims concern over risk to mother and child led to forced Caesarean – “Concerns about “risks to mother and child” led a health trust to apply for permission to deliver an unborn child by Caesarean section, a local authority said today.” – Independent Ireland
• ‘Forced caesarean’ mother ‘sends message of thanks’ – Video with MP John Hemming – ITV news
• ‘Forced’ caesarean case – Italian mother in talks with MP – “John Hemming says he hopes to raise matter in parliament, and has been in touch with Italian officials to see if they can help” – Guardian newspaper
• Judge intervenes in case of mentally-ill mother whose baby was delivered by caesarean section after court order – ITV news (2 min video)
• Judge intervenes over woman made to have caesarean – “Britain’s top family judge has taken over the case of an Italian mother whose baby was taken into care after an enforced Caesarean section.” – Times newspaper (£)
• Social workers ‘seize unborn baby from the WOMB’ after mother has panic attack – “Italian woman visiting UK on work training trip subject of bizarre legal action – it is claimed social services obtained High Court order for enforced birth by caesarean section” – Daily Mirror newspaper

Tuesday 3rd December:

• Caesarean and adoption mum’s treatment ‘brutal and invasive’ – “Stefano Oliva’s client was forced to undergo a Caesarean section and give her baby up for adoption because of fears for her mental health” – BBC news

• County council explains actions amid storm over caesarean section case – “The county council at the centre of the media storm after the baby of an Italian woman was delivered by enforced caesarean section has issued a statement explaining the background to its actions.” – Local Government Lawyermagazine
• Explain why you snatched baby girl at birth: Judge’s order to social workers behind forced caesarean – “Sir James Munby has demanded answers in extraordinary case. The child was taken from the 35-year-old Italian in forced caesarean. The case shines light on murky secrecy of Court of Protection” – Daily Mail newspaper
• Father of forced caesarean child is ‘over-stayer’ in Italy – ITV news
• Forced caesarean case: Italian woman ‘suffering like an animal’ – Guardian newspaper
• The forced Caesarean case proves that light must be shone on social services and the courts – Spectator magazine
• It’s not the caesarean but the adoption that is an act of violence – “The sedation of a bipolar woman for a caesarean is a medical issue. It’s what happened next to her baby that’s truly alarming” – Guardian newspaper, by Zoe Williams
• Italian woman who was given forced caesarean section: I want my baby back – Guardian newspaper
• Pregnancy and mental health & here – BBC Woman’s Hour, including an interview with Sarah (@HackneyBird)

Wednesday 4th December:

• Caesarean case mother ‘was six weeks off due date when baby was forcibly removed’ – “The lawyer of an Italian woman whose baby was removed by caesarean section and put up for adoption says the procedure was done weeks before she was due to give birth” – Telegraph newspaper
• Corrections and clarifications – Guardian newspaper correcting factual inaccuracies in earlier pieces
• Essex caesarean pregnancy ‘not full term’ – “Stefano Oliva’s client was forced to undergo a Caesarean section and give her baby up for adoption because of fears for her mental health” – BBC news
• Forced caesarean was ‘manifestly’ in Alessandra Pacchieri’s interest, says judge – “Papers from secretive Court how that a forced caesarean section on the Italian mother Alessandra Pacchieri was allowed because of fears for mother and baby” – Telegraph newspaper
• I could feel my baby kicking inside me. I was crying as I begged them not to cut me open: Mother whose baby was snatched from her womb by the State talks to the Mail – “Alessandra Pacchieri’s baby was taken into care from forced caesarean birth. Sinister decision was approved by shadowy Court of Protection. The distraught mother says her body was ‘invaded’ and her baby ‘stolen’.” – Daily Mail newspaper
  

Thursday 5th December:

• Court: forced C-section was medically justified – Las Vegas Sun
• Court judgment: Cesarean section forced on Italian woman in UK justified medically – Ottawa Citizen
• Caesarean case mother: Italian government to step into Alessandra Pacchieri adoption battle – “Italian government stepping into British legal battle over Alessandra Pacchieri and her baby delivered by forced caesarean” – Telegraph newspaper
• How the court ruled caesarean of Italian mother whose baby was snatched from the womb must be kept secret – “Girl was born to mother, who has bipolar disorder, by court-ordered caesarean 15 months ago. Her Italian mother, 35, says she has suffered ‘like an animal’ at having child she wants to raise taken away from her.” –Daily Mail newspaper
  
• The mother, the C-section baby and ‘secret British court’: the reality behind an ‘inhuman’ legal case is now emerging – Independent newspaper
• ‘Social workers stole my baby’: Forced caesarean mother tells of horrific ordeal – Independent newspaper
• ‘They have stolen my baby,’ insists Caesarean mother – Times newspaper (£)

Friday 6th December

• Court approved caesarean section for mentally ill woman because of two previous caesareans – BMJ (British Medical Journal (£)
• Court judgment: Cesarean section forced on Italian woman in UK justified medically – The Province (Canada)
• The inhumanity of a forced caesarean – “The Italian woman forced to have a c-section was effectively treated as a fetal container.” – By Barbara Hewson for Spiked
• I was tricked into having a caesarean – Essex Echo (twitter @essex_echo)
• The mother, the c-section baby and ‘secret British court’ a secrecy scandal – or the birth of a scare story? – Independent newspaper
• What about the mental effects on the mother of a forced caesarean? – “After a week of revelations about the Italian mother whose baby was snatched from the womb by social services, Beverley Turner speaks to a bipolar mother and a human rights lawyer about the broader ramifications.” – Telegraph newspaper

Saturday 7th December:

• Judge must unravel saga of baby snatched from womb – “In the shocking case of an Italian mother whose child was removed by caesarean, the head of Britain’s family courts will be looking closely at social workers’ actions.” – Telegraph newspaper, Christopher Booker. He’s back.
• Father of caesarean scandal woman: Why I DON’T believe she should keep the baby – “Alessandra Pacchieri’s baby was taken into care from forced caesarean birth. Controversial decision was approved by secretive Court of Protection. Father Marino has backed the court’s decision to put child up for adoption. Says daughter is a ‘threat’ to the baby because she suffers ‘manic delusions’.” – Daily Mail
  

Sunday 8th December:

• Father of woman forced to have caesarean backs British court’s decision – “The father of a woman forced to have a caesarean so her child could be put into care has backed the decision by British courts over fears of his daughter’s mental condition” – Telegraph newspaper

Saturday 14th December:

• I’m not scared by the forced caesarean row, I’m reassured… and I’m bipolar and pregnant, too – “Kerry Hudson suffers from a bipilar-type mental illness. She is pregnant and has come off medication for the duration. Kerry is reassured she has doctors to help her make decisions.” – Daily Mail newspaper
  

 

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Commentary & blogs:

Sunday 1st December:

• Pregnant woman has unborn baby girl forcibly removed by caesarean after social workers obtain court order because she had suffered a mental breakdown – A Conservative Edge blog (Philadelphia, USA)
• Hemming helps woman in forced Caesarean and adoption case – Liberal Democrat Voice website

Monday 2nd December:

• BASW hits out at social worker scapegoating in Essex caesarean row – BASW (British Association of Social Workers)
• Forced caesarean: a legal perspective – Birthrights (“Birthrights is the UK’s only organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights”)
• Italian woman continues legal battle for return of her child after court-ordered caesarean birth – Marilyn Stowe blog
• Italian mother: Statement by John Hemmings – Statement by the MP in contact with the mother
• A mother was given a caesarean section while unconscious – Obiter J blog
• Media portrayals of social work  – By David Niven (twitter @davidniven)
• Never let the facts get in the way of a good story eh? – By Pink Tape blog (family law barrister Lucy Reed)
• Opinion: Child taken from womb by social services. Really? – Lib Dem Voice by Evan Harris (part of Hacked Off)
• Our response to media reporting on forced caesarean and continued separation of mother and child – “The forced caesarean and continued separation of mother and child is, we believe, unprecedented.” – Bipolar UK (national bipolar charity)
• Untimely ripped – Suesspicious Minds blog (an overview of the legal points) (twitter @suesspiciousminds)

Tuesday 3rd December:

• ‘Essex council should be commended for speaking out on the forced caesarean case’– “It’s time for councils to reconsider their position of not commenting on individual cases” – Community Care (twitter @communitycare)
• Forced caesarean case: Italian mum ‘suffering like an animal’ after baby taken by social services – “She was heavily pregnant when she fell ill at an airport, taken to a psychiatric hospital where her baby was delivered against her will” – Daily Mirror newspaper
• Forced caesarean: the mother’s story and the judge’s – Heresy Corner blog by Heresiarch (twitter @Heresy_Corner)
• Forcible caesarean section authorised for Italian national present temporarily in England – 39 Essex Street Chambers newsletter (barristers) (page 9)
• Lessons learned from the ‘Forced C-section’ case – UK Human Rights blog (by human rights barrister Adam Wagner)
• More questions than answers – on the ‘forced caesarean’ case – The Small Places blog by Lucy Series (twitter @thesmallplaces)
• A piece that is not about forced caesareans – Mental Health & Mental Capacity Blog – by Dr Nell Munro of Nottingham University Law School
• When we don’t know what we don’t know: the “forced C-section” case – “What concerns me about the reporting of this case is the lack of detail surrounding legal issues. Without detail speculation fills a narrative vacuum, resulting in some possibly unfounded conclusions – and frightening people, especially women with mental health issues, in the process.” By Charlotte Walker (twitter @bipolarblogger)
• Why The “Forced Caesarean” Story Was Wrong – “The case is complicated, unusual and tragic. But social services did not force a woman to have a caesarean so that they could take away her baby.” – Buzzfeed by @flashboy

Wednesday 4th December:

• Booker, Hemming and the ‘forced caesarean case: a masterclass in Flat Earth news – Head of Legal blog by Carl Gardner (barrister) (twitter @carlgardner)
• Caesarean sections, autonomy and consent – Practical Ethics, University of Oxford
• The judgment from court of protection in the caesarean section case – Suesspicious Minds blog – a quick overview of the legal points following the publication of the judgment – (twitter @suesspiciousminds)
• A post which is about caesarean without consent – Mental Health & Mental Capacity Blog – by Dr Nell Munro of Nottingham University Law School
• Update on the Essex c-section case – By Pink Tape blog (family law barrister Lucy Reed)

Thursday 5th December:

• The Court of Protection and the new Family Court: can publishing judgments prevent moral panics? – Cardiff Law School, by Julie Doughty and Lucy Series
• Comment: Forced C-sections and stolen babies – “The Alessandra Pacchieri case looks like the ‘stuff of nightmares’, but the problems it highlights are real.” By Jennie Bristow for BPAS (British Pregnancy Advisory Service)
• One flew over the Hemmings nest – Ministry of Truth blog (twitter @Unity_MoT)
• Views on the forced cesarean judgment – Birthrights (“Birthrights is the UK’s only organisation dedicated to improving women’s experience of pregnancy and childbirth by promoting respect for human rights”) by barrister Elizabeth Prochaska ‏(twitter @eprochaska) – “All in all, a depressing case for anyone concerned with modern maternity care and the rights of people with mental illness. The comment by Lucy Series on twitter best sums up my reaction: “If you were trying to convince somebody the Mental Capacity Act was progressive, empowering, person-centred, the caesarean judgment would not help you.””

Saturday 7th December:

• A forced Caesarean? Concerns still linger – Diary of a Political Hack blog by Martin Shapland ‏(twitter @MShapland)

Sunday 8th December:

• Caesarean Escalation, Judges on Human Rights and Happy Birthday – the Human Rights Roundup – UK Human Rights blog

Monday 9th December:

• Turning realisable rights into real rights – Mental Health & Mental Capacity Blog – by Dr Nell Munro of Nottingham University Law School

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Other relevant material:

The Court of Protection:

• Revealed: How UK justice is dispensed out of hours down the phone line – “The Court of Protection is facing fresh questions about transparency, as The Independent reveals that its judges are making life-or-death decisions over the phone, with incomplete evidence, in proceedings that are not always recorded.” – Independent newspaper (June 2013)

Perinatal mental health:

• All Babies Count: spotlight on perinatal mental health – NSPCC (June 2013)
• Guidance for commissioners on perinatal mental health – Royal College of Psychiatrists
• We are recruiting women for a study on pregnancy and medication – “Have you used psychotropic medication and had a child in the last three years? If so, we would like to speak to you” – McPin Foundation (27th November)

Research:

• McPin Foundation – Recruiting women participants for a study on pregnancy and anti-psychotic medication – “Have you used psychotropic medication and had a child in the last three years? If so, we would like to speak to you. When women with a severe mental illness want to start a family, or find that they are pregnant, they may have to make decisions about whether to keep using medication, change it or stop it altogether. This can be a difficult decision. We want to find out more about how women decide what they want to do and what could have helped them to make that decision.”

Twitter conversations:

• Bipolar disorder and pregnancy: unfit to be a mother (Saturday)
• Bipolar disorder and pregnancy: unfit to be a mother (Sunday)
• Starting a family when you have mental health problems (Sunday 1st December )
• Starting a family when you have a mental health problem (part 2) (Sunday 1st December)
• My tweets on the subject on Monday 2nd (with links)
• My tweets on Tuesday 3rd
• My tweets on Wednesday 4th
• My tweets on Thursday 5th
• My tweets on Friday 6th

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So long, farewell: the Asylum “scary mental patient” horror maze is no more

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See the little yellow”update”  tags below for latest on the story that keeps on giving – you couldn’t make it up!

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The Asylum – Thorpe Park’s “scary mental patient” live action horror maze – is no more. It closed at the end of the 2013 Halloween season and will not reopen. Thorpe Park has – at long last – agreed to change the name.

After so many weeks of campaigning, how has this agreement been achieved? Appeals to Thorpe Park’s humanity and kindness seem to have fallen on deaf ears: all we met with brush offs and no promise of action. What made the difference? In the end, Thorpe Park’s agreement to change the Asylum’s name came only after Surrey police investigated them for hate crimes.

That’s right, the police. Thorpe Park did not agree to make any changes to the Asylum as a result of:

• direct approaches via twitter, email, letter and phone call
• over 4, 250 uses of the #AsylumNO hashtag since 17th October
• almost 6,000 signatories of Katie Sutton’s petition hand-delivered to their Surrey HQ on 30th October
• a plea from the Royal College of Psychiatrists, mental health charities Rethink Mental Illness and Mind, the editors of the Lancet and the Lancet Psychiatry, anti-stigma campaign Time to Change and Professor Graham Thornicroft (and Katie Sutton and I) (24th October)
• waves of press coverage on national and regional TV, radio and newspapers (for example, this story from the Metro, 21st October)
• a plea from their local mental health trust, with a mental health hospital based just 3 miles from the theme park (31st October), appealing to Thorpe Park’s “humanity and kindness”

None of these, it seems, counted as (to quote Thorpe Park) “serious complaints”. It was only when psychiatrist Dr Nuwan Dissanayaka reported Thorpe Park to Surrey police for hate crimes on 25th October, and the police started to investigate, that (a full two weeks later, just after the Asylum had closed for the 2013 season) Thorpe Park apologised – via the police – and agreed – via the police – to change the name. In the words of Surrey police in their letter to Dr Dissanayaka of 5th November (pictured below right):

“… due to concerns of yourself and others, Thorpe Park have agreed to change the name of this particular maze for 2014 Fright Nights. In addition, the management have given their apologies for any distress the maze may have caused to any individual or group.”

When concerns were raised with Asda about its “mental patient” fancy dress costume, Asda promptly withdrew them from sale. Asda also paid the profit it would have made from the sales to mental health charities. Tesco did the same.

In contrast, Thorpe Park kept the Asylum open throughout the Halloween season and only announced the name change after the season ended and only then after having been reported for hate crimes. The agreement to change the name is good news. It is to be welcomed. But it is only a start. Why? For two reasons.

First, the action agreed by Thorpe Park does not go far enough, and the linguistically-guarded (in other words, mealy-mouthed) “apology” appears to reflect a lack of understanding of the seriousness of the issues. For instance, what is the point of changing the name of the horror maze if there are still “scary mental patients” chasing guests around to make them afraid?

That’s why Dr Niall Boyce – editor of the Lancet Psychiatry and author of the joint letter from the Royal College of Psychiatrists et al – is still pressing for the Skype call we’ve been asking for since October. Earlier today, Dr Boyce spoke with Lionsgate, Thorpe Park’s partners in the Asylum horror maze. Thorpe Park didn’t answer the phone. Let’s hope Lionsgate have a better sense of corporate social responsibility than it appears Thorpe Park has.

In the proposed Skype call, we will ask for the actions set out in Appendix II of my open letter to Thorpe Park fans of 21st October, namely:

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Some suggested steps which would cost no (or hardly any) money:

• Apologise for the harm caused by evoking the “scary mental patient stereotype – no excuses, no hedging, no fudging, and to come right from the top (if it doesn’t sound like an apology, you’re only making it worse)
• Make the Time to Change mental health pledge, get involved with other anti-stigma actions and encourage staff to do so too
• Include links to mental health information on its website page, facebook and videos
• Invite mental health charities to do the following:

• to hand out leaflets at the park
• to host an information stall at the park
• to discuss what further steps would help improve the mental wellbeing of management, staff and customers

Steps that would involve expenditure:

• Rename the Asylum and change the scare actors’ costumes so they no longer have any connection to the outdated, inaccurate and damaging “scary mental patient” stereotype
• Donate the profits from this year’s the Asylum to a mental health charity such as Rethink Mental Illness (which started the #AsylumNO and #AsylumOK hashtag campaign), local mental health charity and/or anti-stigma campaign Time to Change
• Provide training and support (for instance, through mental health charity Mind), including:
  • mental health awareness training for its senior management team, PR team and HR department
  • making mental health support services available to all staff
  • training staff in mental health first aid (in addition to physical first aid) and provide parity of esteem between mental and physical health first aid services to customers and staff throughout the park’s operations

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However, given the actions Thorpe Park  has taken since that, these very reasonable steps may no longer be enough to redeem Thorpe Park’s position.

Secondly, despite the letter from Surrey police saying that Thorpe Park had agreed to change Asylum’s name, this morning Thorpe Park tweeted me as follows:

“To clarify, we have not agreed to change anything, but take all feedback seriously.”

These denials have been repeated. Apart from these tweets, there has been no statement whatsoever from Thorpe Park. It seems that, apart from these tweets, at present  Surrey police are acting as spokesperson for Thorpe Park.

So will Thorpe Park’s “scary mental patient” live action horror maze rise from the dead like a zombie in 2014? Or is it perhaps that someone on the Thorpe Park twitter or PR team hasn’t quite woken up to what’s been happening and the seriousness of the issues. Let’s hope they do soon because, the longer this drags on, the more poorly it reflects on perceptions of Thorpe Park’s business ethics.

And, the longer this drags on, the more material it provides for business and public relations course tutors for case studies on how to get it wrong.

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Related web links:

• Petition – Thorpe Park: Close down the stigmatising Asylum maze – Started by Katie Sutton and to date with 5,944 signatories
• Thorpe Park – an open letter (Thursday 24th October) – Letter from the 9 signatories
• Thorpe Park – an open letter (Thursday 31st October) – Letter from Jo Young, Director of Quality (Nurse Director) for the Surrey & Borders Partnership NHS Trust to Thorpe Park’s Head of Integrated Communications and the CEO of Merlin Entertainments (Thorpe Park’s parent company)

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Mainstream media coverage:

• Thorpe Park denies agreeing to change Asylu maze name – Get Surrey (Wednesday 13th November) by Charlotte Talbot
• Thorpe Park ‘backs down’ over Asylum maze name row – Metro (Saturday 9th November) by Sarah Kerr
• Trust joins plea to park bosses over Asylum ride – Get Surrey (regional press) (Thursday 7th November)

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Theme park industry coverage:

• Surrey police confirm contact with Thorpe Park – Airgates Attraction News (Tuesday 12th October) – “Surrey Police have confirmed claims that they spoke to Thorpe Park staff during an investigation into the Asylum maze: yet Thorpe Park deny any contact with the police.”
• Thorpe Park believed to rename Asylum maze – Airgates Attraction News (Sunday 10th October) – “Following claims that the Asylum maze at Thorpe Park constitutes hate crime , there are now reports the name of the maze is to change. Thorpe Park denies these claims.”

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Tweets collated on Storify:

• Dr Dissanayaka’s tweets about making a report to police for hate crimes (to date)
• Thorpe Park’s tweets this week denying they’ve agreed to change Asylum’s name (to date)
• Further Thorpe Park tweets this week denying they’ve agreed to make any changes (to date)
• Dr Dissanayaka’s update after speaking with Surrey police on Wednesday 13th November
• When hashtags go bad: #ThorpeParkMoment – The latest comedy offering from Thorpe Park, who didn’t get quite the response on the hashtag they were hoping for (Thursday 14th November)

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Public relations:

• Chartered Institute of Public Relations code of conduct
• Bart Simpson’s PR strategy HT Dr Boyce
• Job advert for a new PR public relations manager at Thorpe Park – feel free to apply online if you think you could do a better job!
• Why Do Brands Need Big Ears? The Perils of Not Listening to Consumer & Professional Feedback – A comparison of the strategies of Asda and Thorpe Park by Anne Tynan (Tuesday 19th November)

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Blogosphere:

• #AsylumNO – The fight is almost won – by Katie Sutton (Monday 11th November)
• Thorpe Park and the great big lie – Kattie Sutton (Wednesday 13th November)

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South London and Maudsley on film: humanity and humour

Looking at a newspaper story about the murder of drummer Lee Rigby earlier in the year, Lloyd, who has a diagnosis of paranoid schizophrenia, said that hearing about schizophrenics in the news made him feel worse. He worried that he didn’t know his own mind and wondered if he himself could turn into a murderer too, since that’s what he read in the papers. Dealing with the symptoms of psychosis can be difficult enough in itself. Having to deal with society’s perceptions that people with your diagnosis are violent and unpredictable adds another level of difficulty.

Earlier today, I attended an advance screening of Channel 4’s new series on the realities of modern mental health care at the South London and Maudsley (SLaM) mental health trust.  In the screening room in the basement of Channel 4′s headquarters in Horseferry Road, a select audience sat in red plush seats watching one of four programmes in the series on modern mental health care. The series is entitled Bedlam and the name choice has caused controversy. To an extent it can be argued that, when a respected NHS trust calls a television series after a medieval asylum, it dilutes the strength of the case against Thorpe Park’s “mental patient scary fun” horror maze Asylum. But what of the series itself?

The episode previewed profiled the work of Speedwell community mental health team (CMHT) in Deptford, south London, over the course of a year. The four-part series, which starts at 9pm this Thursday, also covers the Anxiety Disorders Residential Unit, Lambeth Triage (the front line for emergency cases) and the older adults unit (over 65s).

Without giving too much away, we followed patients Tamara, Lloyd and Rosemary, all of whom experience psychosis. We saw them trying to cope with periods of illness, voices, delusional beliefs about bed bugs and with children being taken into foster care.  We saw them using prescription drugs as well as speed and alcohol to help manage their troubling symptoms. We saw them at times chaotic and disturbed, and at other times funny and happy.

We saw social worker Jim Thurkle doing his best to hunt down and help patients, a third of whom refuse to engage with him. We saw Dr Tom Werner doing his best to confirm the stereotype of the psychiatrist in the bow tie. We saw the fine line between enabling someone to live the life they choose and intervening in the interests of their own health and safety.

Not once did we see someone who could be considered a danger to anyone else. Not once did any of the patients present as anywhere remotely near the stereotype of the paranoid schizophrenic mad axe murderer. What we saw was patients struggling to manage their lives in difficult circumstances, and the professionals who tried to help them.

It was particularly interesting to see the work of a CMHT  which, along with GPs, carry out the bulk of psychiatric care in this country. As the booklet handed out at the advance screening says:

“The lion’s share of SLaM’s work takes place in a community setting, looking after more than 35,000 people with mental health issues. SLaM treats 8,000 psychosis patients a year; 6,000 of whom are based and treated in the community. We touch on different treatments available and see intense and moving interaction with social workers and mental health teams.”

As Pete Beard, the producer of the episode, who answered questions after the screening, said:

“We wanted to reflect the realities of this challenging work, following the actual narratives of people walking a tightrope with their mental health as it happened and the teams who act as a safety net. I feel that these realities are rarely reflected accurately in the media and as a result it is important to demystify the work performed as community teams, especially taboo subjects such as being sectioned”.

It was profoundly moving to see someone taken away from their own home, against their will, and detained with no legal authority other than the personal opinions of a social worker and doctors. No police arrest, no court process, no judge, no jury. Just a simple form signed, and you have no choice about even the simplest things like what you eat, where you sleep or what shampoo you use to wash your hair. And, on a more intrusive level, you have no right to refuse medication.

This extended scene cannot help but make you reflect on the balance of power between the state and the individual, and on what society deems to be acceptable norms of behaviour. This is especially so when you’re dealing with someone you don’t really know, as can be the case when a mental health team is called out to consider sectioning someone. Britain has a proud tradition of eccentricity, but that is not tolerated if you are deemed to be mentally ill. Simply being a nuisance to others but in no way dangerous to yourself or others can, ultimately, mean three people decide on your behalf that your quality of life will be improved by a compulsory stay in a locked psychiatric ward.

The sectioning sequence made me think about the boundaries or free will and autonomy and to what extent people’s peculiarities are tolerated. I have been on the receiving end of such a process, and it changed my life irrevocably. As Dr Baggaley said, when he’s taken part in sectionings he does wonder whether this was what he trained for. Although he sees it as difficult, he does see it as necessary.

Dr Baggaley described the person in question as a “revolving door patient” who would face repeated hospitalisations, some under section (compulsion), for the rest of their life. And yet this is someone who will – under the current welfare benefits system – also face repeated Work Capability Assessments. It is hard to see the point of such assessments in this case particularly since, as Dr Sarah Wollaston MP wrote today, WCA’s are not geared towards helping people with mental health problems find and retain employment.

One of the things which struck me in this episode was the amount of humour. Despite their difficult circumstances and troubling symptoms, the patients followed could come across as affable, amenable and warm-hearted. Ripples of laughter would regularly rumble across the audience, and not just because viewers were looking for a little light relief in what was, after all, a serious topic. As with any other fly-on-the-wall documentary, the colourful charaters in this episode were full of humour. The seriousness of the subject matter made the flashes of levity even more welcome.

Overall, this preview episode was intimate, insightful and profound. It showed human beings in all our difficulties, complexities and ambiguities. It showed the realities of trying to combat the stigma around mental illness with humanity and humour. It showed that danger and fear are the least of the concerns of the CMHT.

On a final note, I will end with a criticism that was raised by audience members with personal experience of mental health services: namely that the episode was somewhat naive and unrealistic. Audience members had received far worse experiences of mental health care, or had been able to deliver a far worse service due to cutbacks. It was acknowledged by the film makers that Speedwell CMHT had a ring-fenced budget, so had not been under the same constraints and workload other CMHT’s they’d liaised with had.

It was also highlighted that a lot of the difficulties patients needed help with were practical, and that these needs were not being met. The patients were unable to deal with these matters themselves and therefore they were stuck in difficult circumstances. Examples were the bedbugs which did actually exist in Tamara’s flat. It was not a delusional belief (though its extent may have been) and dealing with that practical problem may have lessened her delusional symptoms. This and her use of amphetamines may also have been the way she managed the immense sorrow of losing her children. Lloyd appeared to be using alcohol to numb his pain.

With a series planned over two years and filmed over twelve months, much footage will have ended up on the cutting room floor. It’s a shame, however, that the close relationship between medical help and social support, and the parts played by talking therapies and thereapeutic activities, were overlooked completely in this preview episode.

Nor was the 9% reduction in inpatient beds in the past 2 years mentioned.  Nor were the terrible cuts to community mental health services mentioned.

On the other hand, as Madeliene Long, SLaM chair said:

“Despite it affecting so many people, mental illness is still poorly understood. The stigma and discrimination that people face can make their mental health even worse and can prevent them from seeking help. So it’s really important that we do everything we can to raise awareness, challenge stereotypes and promote the facts about mental health. I’m really pleased that we have been able to work with Channel 4 and The Garden Productions on such an ambitious project which sets out to do exactly that.”

As executive producer Amy Flanagan said,

“Many of these patients had lived long lives with no history of mental illness. It could happen to our parents, to us.”

And, if it does happen to us or someone we know, programmes such as these will mean it feels a little less alien and a little more a part of everyday life.

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Media coverage:

• Channel 4 – press release about Bedlam
  • Anxiety (Episode 1/4) – 9pm Thursday 31st October – “It’s a condition every one of us experiences from time to time, but imagine if one day you woke up and found your anxiety had spiralled completely out of control.”
  • Crisis (Episode 2/4) – 9pm Thursday 7th November – “At Lambeth Hospital in south London, the Trust has pioneered the use of short-stay emergency wards for patients in crisis. It’s effectively run like A&E but for those with mental illness.”
  • Psychosis (Episode 3/4) – 9pm Thursday 14th November – “In this episode we explore the world of the mentally ill who live in the community.”
  • Breakdown (Episode 4/4) – 9pm Thursday 21st November – “In the final episode of Bedlam, cameras gain access to a psychiatric ward for over 65s at the South London and Maudsley (SLaM).”

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South London & Maudsley NHS Trust:

• SLaM’s site on the TV series – Bedlam
• On twitter: @MaudsleyNHS
• Website: SLaM
• SLaM and C4 make groundbreaking documentary series on mental health (22nd August) (initial press release)
• Bedlam – Our new TV series (2nd October)
• Bedlam – The story behind the name of our C4 series ( 3rd October)
• Bedlam – Our new Channel 4 TV series SLaM e-news edition (14th October

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People involved:

• Dan Charlton – Head off communications & media at SLaM (twitter @Dan_Charlton1)
• Dr Tom Werner (twitter @TellDrTom) – psychiatrist & CBT therapist – website

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Blogosphere

• Can stigma be challenged by evoking stigmatising stereotypes? From the Maudsley to Bedlam (2nd October) – My initial blog, with links to lots of other matieral

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Related coverage:

• Guardian newspaper – People with mental illness need help to get back to work – but coercion is wrong (28th October) – By Dr Sarah Wollaston MP
• Guardian newspaper – Why mental health bed cuts make me ashamed to work for the NHS (October 2013) – By Dr Alex Langford (who also attended last night’s private screening)

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Confiscating patient phones on psychiatric wards

My photograph of an Olympic Park telephone box, July 2012

Some thoughts on the confiscation of patients’ phones on psychiatric wards, prompted by the fact someone found my blog yesterday by searching the term, “If you are in a psychiatric ward do they confiscate cell phones or computers”.

I’ll work the twitter conversation up into a proper blog post when I have time, and then publicise it. In the meantime, it’s here as a repository for some thoughts of mine and thought-provoking responses of others.

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• Storify story of my twitter conversations on this topic, including patients & mental health staff
• An earlier blog post – Psychiatric wards and social media

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Mental capacity, mental illness and pregnancy – Miss B and the “bipolar abortion” case

Some thoughts (here, here & here) on the recent case of Miss B, a woman in  her 30s with a diagnosis of bipolar disorder who was sectioned to prevent her from exercising her reproductive health choices. She had to go to court and reveal the most personal details of her psychiatric and gynaecological health, as well as her sexual history, in order to be able to do so. In the end, just a few days before the legal time limit for abortion, the judge in the case came down very clearly on the side of mental capacity.

It’s all set out in the tweets (including conversations with a psychiatrist and a Mental Capacity Act trainer, as well as a woman of reproductive age with a bipolar diagnosis). I may put it into written form but here it is for now. It’s something that I and a lot of women of reproductive age feel strongly about.

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My Storify stories:

• Mental capacity, mental illness & pregnancy – part 1 (twitter discussion of the case) (21st May)
• Mental capacity,mental illness & pregnancy – part 2 (conversation with consultant psychiatrist Judith Lewis) (29th May)
• Mental capacity, mental illness & pregnancy – part 3 (conversation with Mental Capacity Act trainer Matt Graham) (30th May)

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Legal links:

• The Court of Protection judgment in Re SB (A patient; capacity to consent to termination)  [2013] EWHC 1417 (COP) 21 May 2013 – the judge’s comments in full (21st May)
• Mental Capacity Act 2005
• UK Human Rights blog – Bipolar patient has capacity to decide to terminate pregnancy (24th May)

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Commentary:

• The Fementalists blog – The bipolar and abortion case (22nd May)
• Purple Persuasion blog (Charlotte Walker) – The Court of Protection, motherhood and mental health (29th May)

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Media:

• BBC news – Bipolar disorder woman in legal battle over abortion (21st May)
• BBC Radio 4 – All in the Mind – “Could what seems like a very unusual case have implications for anyone with a mental health problem when it comes to what they can and can’t decide for themselves?” (12th June)
• BMJ (British Medical Journal) – Woman with bipolar disorder can abort her baby, judge rules (24th May)
• Daily Mail – Bipolar patient who is 23 weeks pregnant CAN have an abortion as she is capable of making the decision herself, rules High Court judge (22nd May)
• Huffington Post – Pregnant Woman With Bipolar Disorder ‘Begs Court To Allow Her To Have An Abortion After Ceasing Medication’ (21st May)
• Independent newspaper – Bipolar woman wins High Court battle for right to have abortion (21st May)
• Telegraph newspaper – Woman with severe mental disorder given right to have abortion by judge (21st May)

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Monitoring the Mental Health Act: the CQC’s annual report

Today, the Care Quality Commission (CQC) published its annual review for 2011/2012 of its monitoring of the Mental Health Act. The Mental Health Act covers powers to detain people against their will in psychiatric hospitals, to treat people compulsorily outside hospital and the treatment of people on psychiatric wards voluntarily. CQC inspectors visit hospitals and other venues where the Mental Health Act applies in order to produce these annual reports.

The report covers such areas as:

• What is the Mental Health Act and how is it used?
• Are care plans focused on individual needs?
• Are patients involved their care?
• Are patients given the opportunity to give consent?
• Is there a culture of control over patients?

Below are some useful web links from the CQC, mental health charities, the social care sector & the media, together with my Storify of tweets throughout the day using the hashtag #MHAreport, as a helpful one-stop-shop today. If you have any helpful links to add, please tweet me or comment below.

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• My Storify story of tweets using the hashtag #MHAreport (last updated 5:30pm)

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From the Care Quality Commission:

• The Care Quality Commission’s annual report for 2011/2012 on its monitoring of the Mental Health Act
• The CQC’s 12-page summary of its report
• The CQC’s easy to read version of its report
• View key findings in the CQC’s infographic version of its report, for visual learners
• Link to large print version of the CQC report
• Link to audio version of the CQC report
• For comparison, a link to the 2010/11 summary report
• “What can a Mental Health Act commissioner do for you?” – Find out about the role of a CQC commissioner in this piece by Steven Richards
• “An inspector calls” – piece for mental health charity Mind by CQC inspector Edith on what inspections involve

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Comment from mental health charities:

• Comment from Marjorie Wallace, chief executive of mental health charity Sane, on the treatment of mental health patients in response to the CQC’s report
• “Our risk averse mental health system is wasting money and harming recovery“ – Paul Jenkins (chief executive of charity Rethink Mental Illness) writing in the Independent newspaper yesterday
• Response from mental health charity Mind to the CQC’s report
• “The Mental Health Act should only be used as a last resort and with extreme care” – Paul Farmer, chief executive of the mental health charity Mind, in the Huffington Post

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Comment from the social care sector:

• “Action needed on Mental Health Act report as patients and social workers suffer” – Andy Nicholl at social care website Community Care, published today
• “Severe pressure’ on AMHPs amid job cuts, rising workload and bed shortages“- Andy Nicholl at social care website Community Care, published today
• “Often “good practice” in Mental Health Act detentions is no more than basic human rights” – Andy Nicholl at social care website Community Care, published today

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In the press:

• “CQC mental health report finds ‘containment over care’: some mental health services have “allowed cultures to develop where control and containment are prioritised over care”, a report says” – BBC news
• “Some mentally ill patients may be unlawfully detained due to errors in medical records” – Daily Mail newspaper
• “Mental health patients being ‘detained in all but name‘: The Care Quality Commission finds mental health patients denied information, and staff inadequately trained” – Guardian newspaper
• “CQC criticises mental health provision” – GP magazine Pulse
• “Mental hospitals ‘treat patients like prisoners‘” – Independent newspaper

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On radio:

• Radio 5 Live radio call in: overcrowding on mental health wards puts patients at risk of abuse & neglect, with Victoria Derbyshire (30 January)
• BBC Radio Norfolk: Chris Goreham at breakfast radio phone-in. Staff are the treatment in mental health services yet 20% cuts planned in Norfolk & Suffolk (from 7 mins 30) (28 January)
• BBC London: Drivetime with Eddie Nestor. The CQC’s report found overcrowding & containment was prioritised over care (from 16mins) (30 January)

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Ward newbies: what advice would you give to a patient on a psychiatric ward for the first time?

My stay on a psychiatric ward was a bit of a shocker. No one explained what was happening, why it was happening or what to expect. It seemed there were 1,000 unwritten rules for patients to abide by – or, if they were written down somewhere, they were not communicated to patients. And, as a result, we never knew what was expected or what we’d done wrong.

If only I had had someone to explain how things worked, my stay would have been much more therapeutic. If only staff had communicated with me rather than turning up mob-handed to wordlessly pin me down and inject me with unnamed drugs then disappear. If only staff had taken simple steps like telling me when mealtimes were, rather than waiting for me to spot the trolley being wheeled away from the dining area then saying I was too late to eat. Again. If only I’d been given the ward Welcome Pack on day 1. Rather than day 8.

I know there is great psychiatric inpatient care out there and, even where there isn’t, there are hints and tips that will help inpatients get a more positive experience of their stay on ward.

So, what would your advice be to someone staying on a psychiatric ward for the first time?

• Are you a patient on ward now? What questions do you have? What advice so far has been helpful to you? Perhaps you wonder why your phone charger has been taken. Or why there’s someone watching you and making notes on a clipboard several times an hour. Or how to get hold of tampons and a toothbrush.
• Have you been an inpatient on a mental health ward before? What would you have liked to know when you first arrived? What tips would you like to have been told? What advice do you have for someone who’s being treated on a psychiatric ward for the first time?
• Are you a member of staff – a health care assistant, nurse, occupational therapist, cleaner, doctor, advocate? What advice would you give to patients on their first stay on a psychiatric ward that would help them understand the experience and get the most from it?
• Are you an AMHP or police officer who takes people to psychiatric wards or places of safety? What would you like patients to know?

As TheSchizoPodcaster (@UKschizophrenic) tweeted last night:

“No one has explained anything yet. […] Do staff watch you all the time when you are sectioned? It is normal for this to happen? I don’t like it at all! Makes me angry!”

Student mental  health nurse Kathryn Finch (@Kat_Finch) tweeted back:

“It’s just to monitor how you are and if there’s improvement or not in how you are. They’re looking after you, try to stay calm. You’ll be on obs for at least the first 24 hours. It all depends on how you’re presenting and the risks they feel are there.”

Hopefully that advice was reassuring and useful. Please let me know – either in the comments below or on Twitter – so we can share the best tips for patients on psychiatric wards for the first time.

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• My Storify story of tips received by Twitter so far … hopefully more to add!
• The Code of Practice to the Mental Health Act – guidance to staff on their powers and duties, which can give patients an idea of what to expect
• The Nice Guidelines on Service User Experience in Adult Mental Health – this is the experience NHS care providers are supposed to provide
• The Wardipedia website’s tips on welcoming new patients

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