Tag Archives: OCD

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

19 Jun
Harry Enfield as Kevin the Teenager (PA)

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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Update smallThe 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:

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Employment and Support Allowance

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Emirates Air and depression

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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”:

Open quotesTWO 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) Close quotes

 

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Mental health nurse & patient tweet chat: what do newbies need to know?

11 Feb

Psychiatric Nurse - Garrison - Book cover

Update small..

The tweet chat took place on Thursday 20th February 2014 with We Nurses – catch up with the discussion by taking a look at the full transcript!

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I’m planning my first one hour tweet chat in a couple of weeks (date to be announced). (Check out my quick guide to tweet chats for more on what they are – this and other helpful links are below). Here’s what I have in mind, for an inpatient mental health nursing tweet chat:

  • Patients: Are you a patient who’s experienced inpatient mental health nursing? What would you like the newbies to know – the student nurses about to start a placement or the newly qualified mental health nurse. What things that nurses did – good or bad – made a difference to your experience on ward?
  • Students: Are you about to qualify as a mental health nurse? Are you a student nurse about to start your mental health placement?  What is the balance between fear and excitement? What would you like to know? What practical concerns do you have? What do you want help with to make your first days on ward a success?
  • Nurses: Are you a qualified mental health nurse? Are you a student nurse who has completed your mental health placement? What tips would you like to pass on to newbies about to qualify or about to undertake a placement? What are those little insider tips that really helped? What would you have liked to know when you were a newbie?

I’d like to be able to share some really useful tips to help new mental health nurses and nursing students make their best start on ward, because that benefits both staff and patients. Here are some example questions I’ve thought up that students might want to know the answer to:

“How can I prepare for my placement so I get the most from it?”

How can I put the knowledge I’ve learned at university into practice on the ward?”

“How can I settle in as quickly as possible so I fit in with my nursing team and ward life?”

“How can I switch off after a shift?”

“What should I do if I see another nurse doing treating a patient unkindly?”

Here are some examples of useful tips to pass on:

The Bic 4-colour pens are really useful for filling in your paperwork.”

“Remember to always respect the patient as an individual and see past the diagnosis.”

“Don’t make assumptions or have preconceived ideas based on what you’ve been told before. Remain open-minded and make your own judgments based on your own personal experiences.”

As I’m not a nurse and haven’t run a tweet chat before, I’ve invited @MHnursechat – associated with the awesome We Nurses website and tweet chats – to run a joint tweet chat with me. We’re going to be discussing how this will work and, hopefully, setting a date. Very exciting!

In preparation for the tweet chat, I’m asking you to please share your tips and questions. That will help set the agenda to be followed and the areas we’ll focus on in the tweet chat – so it covers the most burning questions and drills down to the most useful tips. It may be that there will be more than one tweet chat on this topic – perhaps one covering what nurses need to know in their first few days, and another for when they’ve been there a few weeks. We’ll see. A tweet chat needs to have enough of a focus to engage people without overwhelming them, but at the same time enough breadth so it doesn’t peter out prematurely! If there are other topics you think would be good for tweet chats then please let me know!

You can comment below or tweet me (please don’t try to pack more than one query or tip into each tweet ) @Sectioned_ (please remember the underscore). It’s helpful if you could say whether you’re offering your comment from your experience as a patient, nurse or student. Look forward to hearing from you!

Why a tweet chat? I’m often interested in discovering what other tweeps think about topics and then sharing those insights. So, quite a few times, I’ve tweeted questions then collated the responses into a Storify story which I’ve sometimes turned into a blog. (I was rather excited to learn that this is called “crowd sourcing” and “curating the chat”.) This time I thought I’d try making it a bit more organised & involve more people: I’m beginning to learn just how valuable Twitter is as a way to bring together groups of people to share views openly in a way they might not otherwise do. (I’m told this is called “disruption” – disrupting the natural order of things and mixing it up, like mental health peeps and staff learning together.) (Thanks to Victoria Betton for all the cool jargon!)

Why this topic? After all, I’m not a nurse. As a child, however, I remember being taken to one of the big long-stay psychiatric hospitals of the sort portrayed in the film One Flew Over the Cuckoo’s Nest. I remember the high ceilings, big windows and long corridors. Happily I wasn’t being booked in myself. I was visiting family friends who worked there as psychiatric nurses. Members of my family also worked on psychiatric wards and in nursing.  When I was sectioned a couple of years ago, my inpatient experience fell far short of the care I would hope all psychiatric nurses aim to deliver. You could say that everything that could go wrong did go wrong. But, as I’ve been around nurses my whole life, I know that the image and practice of mental health nursing has come a very long way since the fearsomely controlling figure portrayed by Nurse Ratched. For me, nurses are (or should be) an essential part of the team that helps get me well. So I’m all for sharing tips and best practice to help nurses be their best. I’m hoping this tweet chat will be one small way to do that.

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web links 5

  • Guide to tweet chats – all you need to know to join in your first tweet chat or get more from them
  • Mental health jargon buster and acronym buster – please send yours in! We’ll try to avoid jargon during the tweet chat itself, but if the jargon’s in the jargon buster, I can just tweet a copy of that by way of explanation

For the nurses and student nurses amongst you, here’s some nurse-focussed content:

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

30 Jan

Care Quality Commission logo

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.CQC infographic

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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From the Care Quality Commission:

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Comment from mental health charities:Rethink mental illness logo

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Comment from the social care sector:Community Care logo

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In the press:

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On radio:BBC Radio 5 Live logo

  • 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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What does mental illness look like? Panorama & the Great Disability Scam

29 Jan

Panorama - The Great Disability Scam

Last night, BBC One’s Panorama presented a half hour documentary on the government’s Work Programme. This was introduced 18 months ago to help people who’ve been out of work for a long time get back into employment. The focus of the documentary was on how this programme was working for those with disabilities – the “hard to place” candidates. It exposed a culture of paid-by-results private providers cherry picking the easiest to help, parking those considered hard to help and insulting attitudes towards clients who who some staff labelled as LTBs – Lazy Thieving Bastards.

When I watched the programme earlier today, I was shocked by the interview with Mark Gould, diagnosed with anxiety and depression and out of work for several years.Panorama - The Great Disability Scam 3 The interviewer, Samantha Poling (pictured left) appeared to goad him into demonstrating behaviour that would make him “look like” he was mentally ill. It’s not an easy segment of the programme to watch.

That sparked a series of tweets, which I’ve collated here (links below), on the subject of what mental illness looks like, how it is perceived by the public and what that means in terms of access to welfare benefits when you’re unable to work – both in terms of the public’s perception of those who don’t “look” ill, and how Atos conducts Work Capability Assessments of people signed off by their own doctors as currently unfit to work. Panorama - The Great Disability Scam 2

I then commented on the fact that what you look like also forms a component of a psychiatric assessment. The Mental State (or Status) Examination includes observations such as whether you have a bizarre hairstyle or unnatural hair colour. I’ve written and tweeted on this before, in the blog post “You can’t dye your hair red”. I look at the contents of the MSE in more detail in these tweets.

It was interesting that the final segment of Panorama ended with an extended shot of a man in a wheelchair making his way slowly up a sloping street. That, it seems, is how people view disability.

Hope you find my tweets interesting. The best part, of course, is the responses of others. All the links are below.

If you have any comments on the post or the programme, please feel free to add them below. I’ll include new tweets that come in by updating the Storify story.

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

25 Jan

Welcome to the ward

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?First day

  • 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?

First day 2As 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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web links 5

  • 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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The new Mental Health Bill and criminal records checks (a “career death sentence”)

9 Sep

The new Mental Health (Discrimination) Bill gets its second reading in the House of Commons on 14th September. This means it moves closer to becoming law. The Bill seeks to remove some important areas of discrimination, to make it clear that people with mental health problems (past or present) may play a full part in public life – such as being an MP, school governor or serving on a jury.

In my view, the Bill misses one vital issue: criminal records checks. A tweet which gets a lot of retweets whenever it goes out is this:

“Mental illness is not a crime. Mental health history information has no place in criminal records checks. Full stop.”

People can see the obvious injustice in putting those whose only “crime” is to have had a mental health problem into the criminal records system.

This has had a direct impact on me and my ability to put last year’s events behind me and get back into the jobs market. I had a completely  clean criminal record and had never even come close to being arrested.

Then, last year, police came to my home and took me to my local psychiatric hospital where I was sectioned. It wasn’t until earlier this year that I learned – through Twitter – that this meant I could no longer say, “I’ve never been arrested”: the power used by the police – s136 – is an arrest, which would be kept on police records.

And, because the police had taken me to hospital, the hospital would have notified the police of the subsequent section 2, which would also be kept on police records.

I then found out that, if I wanted to volunteer at my local school or sports club, the enhanced criminal records check the head teacher or club leader would request would show up the arrest, and that I’d been sectioned under the Mental Health Act. This private health information is not something I want to broadcast to people in the area where I’ve lived for 2 decades nor people I’d be working for.

The good news is that I found out before applying to my local school or sports club, because then the cat would have been out of the bag.

Good news for others is that it’s only where there’s been some form of contact with police that mental health history information can appear on a criminal records check. The police don’t know if you’ve visited your GP for anti-depressants or seen a counsellor. They won’t even know if you’ve been sectioned, so long as there’s been no contact with police.

More good news is that it’s only where you want to work with children or vulnerable adults – and hence need what’s called an enhanced CRB check – that such information can be disclosed. A standard CRB check just has criminal convictions.

However, for me, keeping my health information private, as is my right, means I’ve not been able to use my time and talents to volunteer at my local school or sports club. Which is a shame. For me and for them.

That’s why I was heartened to hear this very issue raised in the recent House of Commons mental health debate. And why I hope there might still be time to get this issue included in the proposed Bill.

Read the Storify story in the link below to find out more.

[The new Mental Health Bill & criminal records checks]

The new Mental Health Bill & criminal records checks – tweets