Compulsion outside hospital

J Thomas expresses worries about

COMPULSORY TREATMENT IN THE COMMUNITY


Let’s get one thing clear to start with: under the proposals for the new Mental Health Act, you will not be treated against your will in your own home; even our Government now states that treatment which is resisted must be carried out in a clinical setting – hospital, or a day-care centre, at least. But if, instead of having treatment forced on them, unwilling patients were advised that they would have to be detained in care until they changed their minds and accepted treatment voluntarily, what a difference it would make!

The danger, both to patients and the public, occurs when the use of compulsion leads people to resist being treated at all. If, like the Government, you do not understand this, then please read on.

Most people resisting treatment are likely to be suffering from paranoid schizophrenia. This illness came to me when I was 21, and kept me down for 20 years. The trouble with neuroleptic medication is that it can take time to work. The voices troubling the patient soon realise what is happening to them and do not wish to be silenced. They repeatedly scream their warnings to the patient: “They are going to weaken and possibly kill you with their treatments”. “They are blunting your mind”. “Soon you will be a harmless cabbage”. “You will end up like those you see in the next ward here, strapped up in wheelchairs with their tongues bobbing in and out of their mouths, completely gaga”.

With all this going on in the patient’s head, it is small wonder that many decide, as I did, to resist further treatment at all costs. An unending nightmare. As I remember so well, life while resisting treatment is a total unending nightmare. You fear most the psychiatrists responsible for your treatment. You see their fear of you in their eyes, particularly if they are smaller than you. If you are a strong, well-built six-footer like I was, you know they will always be prescribing maximum dosage for you, however reassuring you try to be to them. Next you fear most a gathering of 3 male nurses. Two of them are no problem – you can give them back more than you get, and they will have no hope of injecting you without breaking needles, but 3 is the worst number. Two hold your arms, the third slaps and punches you into submission. Four or five can pin you down to the floor for injection without too much damage to you, apart from the occasional retribution (for past injuries to them).

The result is that you end up full of hate and loathing for the hospital and all the asylum staff. And they do not have any respect for you. How can anyone have respect for a pathetic object who can legally be clobbered with mind-altering drugs against its terrified wishes and resistance?

So what do you, the paranoid patient, learn from all this? You learn first of all to lie. You lie about your voices. You say that, because of the medication, your voices have completely gone. When the voices come, you learn not to go rigid or silent, or change your expression – you learn not to stop talking or show them up in any way. If there is anyone near you, looking at you, you know you must never talk back – or even think back – when your voices come. You smile at the nurses, to effusively thank the doctors for making you better. You learn to be nice to, and encourage, the other wretched patients on the ward. On the run When they finally let you go, you happily promise to take your medication. Once you are out and on your way, you drop your pills down the lavatory.

If you are prescribed injections in the community, you have to leave home. As you are still in mortal fear of medication, you must hide away, sleep rough, and threaten to kill any member of your family, or anyone else who may betray your whereabouts and call the police to take you back to the hospital.

I can’t help feeling that our Government must know all this. They must have been told it many times before, and must realise the terrible security risk to the public that their idiotic policy creates. They must also realise that people such as I once was, know only too well when they are relapsing or going “high” and badly need care and help. But ex-patients know equally well that to return to the dreaded NHS hospital will mean minimum care and maximum forced treatment, so all the ex-patient can do is hide away and remain a serious lurking menace to many others.

That is, of course, except for the privileged few who can go to receive what they really need, care without compulsory treatment, at a cost of a mere £3,500 a week minimum, from any good private nursing home. Even on an MP’s salary, you can only afford a few weeks of private care!

A professor of psychiatry told me last year that he would much prefer not to have to rely on enforced treatment, but his NHS budget could not afford it. It is hard to believe that 65 years ago, care without treatment was available to all detained mental health patients, despite us then being a far poorer country.

Statistics obtained from this time for paranoid schizophrenia are also important. They show that one third used to recover completely from a breakdown, while another third recovered but relapsed later. One third never recovered from their last breakdown, whether it was their first, second or third. This meant that every patient had a 50% chance of making a full and lasting eventual recovery without the need for any medication. Happily, with modern medication your chance of recovery, provided you keep on medication, goes up today to over 80%.

My final full recovery, after 20 years, was due to a talking treatment called “time sharing”, given to me by another patient. It was also very much due to the fact that in my last hospital detention. I was, to my astonishment, not treated by compulsion at all! Things do get better sometimes!