Detained – a personal experience of detention under the Mental Health Act

by Megan S.

I was never able to accept why I had been sectioned or empathise with the nursing staff, who I viewed as enforcers of a grave injustice and tyranny, but I was always good at articulating my perspective, experience and grievances, good at creating awkward questions for the consultant and finding flaws and loopholes in his reasoning. 

However, with the benefit of hindsight I have come to understand that whilst capable of rhetorical manoeuvres, my detention under the Mental Health Act was a last resort means of harm reduction at a time I was taking huge risks and endangering myself. 

The consultant was Dr P, an expert witness who, whilst wanting the best for me, had a limited understanding of my experience of mental illness, constrained by his habit of contextualising my every move, thought and behaviour as an expression of irrationality. To him, it was self-evidently obvious that I was in a state of delirium that no one wants to be in. 

It was as if my mind were being forensically dissected and in so doing being eviscerated of personal context. He was the consultant, and he had total control over our short-term destiny, though in my case he determined my long-term destiny, as the section 3 he enacted lead to me being sectioned for two and a half years. 

At the centre of forced psychiatry is an inhuman desecration of civil and personal liberties, an experience which is, I believe, traumatic for all who unfortunately face such a fate. Psychology scholars, whose involvement in psychiatry is largely philosophical, theoretical and academic, as opposed to consultants arbitrating daily the terms and conditions of patient care, tend to agree that the way the mental health system works is, at best, suboptimal, at worst, patently abusive. I’ve read (as a form of opposition and protest as well as to learn) books by R.D.Laing, whom proponents of orthodoxy in psychiatry tar as “anti-medicine.” In all truth, he was actually a progressive force who expanded the validity of discourse on psychosis to be determined by the patients themselves, encouraging practitioners to treat their description of their experiences as an ontological truth.

The wealth of research, insight and perspective of the “anti-psychiatry” school is rendered impotent and redundant as a force for progression in mental health care, largely due to the fiercely conservative nature of the consultant species, who, as gatekeepers of the establishment, in my experience have an inbuilt reflex to protect and conserve their dominant role. There is an excellent, must read book, “Doctoring The Mind,” which explains how the perverse political economy of contemporary psychiatry co-opted by pharmaceutical companies – “big pharma” – directs research and development in such a way that most studies serve the agenda of the drug manufacturers, behind a thinly veiled pretence of scientific objectivity. 

Unfortunately the prevalent treatments are largely prevalent as a result of coercive persuasion by big pharma, rather than being the result of a compassionate and holistic appraisal of what’s best for the patient, up to date with developments in academic knowledge of psychiatry. According to the latest research it isn’t technically correct to adhere to a reductive biological deterministic, neo-Kraepelinian, model of analysing mental health. Contemporary research considers social stimuli as equally important as crude biology in understanding mental disease and it must be said we do not live in a society which serves the needs of the spirit.

You would hope someone invested with such power as consultants would be willing to reform their perspectives according to current research, but, in my experience, they grow comfortable with their authority, fearful of any force that could professionally kill them off. Admittedly there is scope for free will and moral agency of individual practitioners to move with the times. There are probably many cases of exemplary practitioners who have adapted to view their profession in a different light and who have withdrawn their participation in unethical medicine in righteous accordance with the hippocratic oath, but I’ve found the majority to be generally resistant to the idea that they are fallible. 

An important, perhaps the most important validating feature of the Mental Health Act, is the right to have your section assessed by a tribunal of independent experts non-aligned to the hospital, to whom patients and their key caregivers make a deputation. My experience of tribunals is that I didn’t have much luck. They were often kind and complementary, impressed by my articulacy and verbal communication but ultimately erred on the side of caution and deferred to the doctors because of a paternalism which made them want me to be protected from the harm I might wreak upon myself. 

Although I was unsuccessful, the tribunals were ultimately conducted lawfully and legitimately, but the deputation of one junior doctor was crassly unprofessional, completely factually inaccurate, with confabulations about my health not supported by my medical notes, at the same time committing offences against the sovereignty of the panel of the sort which, I believe, he ought be struck off for. A forensic analysis of his report revealed that, as well as making up a psychotic relapse contradicted by my medical notes, he also cited symptoms from five years earlier as a reason to continue my detention in the present. The most offensive manoeuvre he made was to threaten to immediately reassess me for a section if I won the tribunal, a basically illegal course of action diminishing the sovereignty and democracy of the tribunal process. 

Fortunately his incompetence was, quite easily, foiled by both my solicitor and the panel, one of whom tartly rebuked him by stating they were on the side of freedom. I got my upper hand and smug sense of satisfaction by demolishing arguments to keep me detained as logically flawed, an expression of the cartesian fallacy, an obvious piece of circular reasoning, they saying that because I had stopped taking meds before I would stop taking them again. Annoyingly this was interpreted and dismissed as a delusion of competence in reasoning by the quack. 

 

“One under duress of such authority is likely to respond to this system authoritarianism by not complying with treatment”

 

I was detained long beyond the period of medical necessity, the motives for which can be speculated, but ultimately was the result of technicalities about safe discharge. However my key worker made completely inadequate efforts to resolve the issue, leaving me in a situation which felt like arbitrary detention. At one point, at which I’d been stable for a long time, they said I had to be detained to be assessed for ADHD, a secondary behavioural disorder and not a primary psychological problem warranting hospital treatment. 

As part of my  two and a half years of detainment, I wound up in a private mental rehabilitation unit for more than 18 months, a situation I perceived to be one that no one was interested in helping me escape, and which had a profound effect on my trust in both people and the system;  it was a situation which changed my life for the worse. For example, being largely bed ridden for two years led me to become bed-shaped. As a result I found after discharge I was incapable of even minor exertion, to an extent I actively considered and actually needed a mobility scooter. 

Furthermore, long hospital stays for people with borderline disorder, one of my several conditions, lead to attachment to and dependency on care environments and, having been discharged into a live alone situation, I found myself lacking the kind of support system I had grown accustomed to. If you look at some of the books on asylums they will say the prospect of discharge for a long term patient sometimes leads them to sabotage their discharge to avoid detachment from an environment they have been attached to.

The possibilities of improving the experience of – and outcomes for – those beset by mental illness, despite the baleful current state of mental health practice and policy, are great and an opportunity begging to be seized. The difficulties are largely those borne of a failure to treat the mental health sector with parity of esteem relative to investment in the NHS, itself not funded at an optimal level. Most policy makers worth their salt agree there is much room for improvement in the way mental healthcare is funded and administered and that it is highly desirable to develop factual, accurate understanding of health conditions historically stigmatised and ridiculed. 

We know enough of the barbarity in the historical treatment of mental illness, some aspects of which the contemporary system has inherited, to justify full system reform. In regards to many features of the governance of mental healthcare, we are still at an early stage of development, as many nurses and system administrators fail to comprehend. One under duress of such authority is likely to respond to this system authoritarianism by not complying with treatment, where a more consensual approach would benefit us and elicit greater trust.

The defects in mental health administration are at once a question of crude economic investment and yet a question of ethics. As both NHS and private providers face exposure and criticism for subjecting patients to dehumanising treatment, a different approach is needed. A good place to begin is to nationalise the private mental health sector and bring it under democratic scrutiny. In the 21st century we ought to be doing better than 1950s models of psychiatric care.

 

“Megan S is an independent citizen journalist, postgraduate geopolitical analyst and passionate civil liberties and peace campaigner. Her academic background is in modern history and politics and whilst the tone of her writing is largely polemical, her work is still nonetheless informed by data, evidence and an academic perspective.”