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COMPULSORY PSYCHIATRIC TREATMENT

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COMPULSORY PSYCHIATRIC TREATMENT RISKY BUSINESS Mary O Hagan * WHAT IS COMPULSION? Mental health legislation establishes the circumstances in which a person with ... – PowerPoint PPT presentation

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Title: COMPULSORY PSYCHIATRIC TREATMENT


1
COMPULSORY PSYCHIATRIC TREATMENT RISKY
BUSINESS Mary OHagan
2
WHAT IS COMPULSION?
  • Mental health legislation establishes the
    circumstances in which a person with mental
    disorder, who hasnt committed a crime, can be
    detained or treated without their consent.
  • The criteria include
  • Mental disorder
  • Danger to self or others
  • Incapacity to refuse treatment

3
WHAT IS RISK?
  • Possibility of harm, loss or danger
  • Factor involving uncertain danger, hazard
  • Risk is located in the future

4
APPROACHES TO RISK
  • Cause of danger
  • The gods
  • Fate
  • Nature
  • Response to danger
  • Supplication
  • Acceptance
  • Control

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6
RISK AND MAD PEOPLE
  • INTRAPERSONAL RISK
  • Harm to self
  • Internalised stigma and hopelessness
  • People in contact with mental health services 20
    times more likely to kill themselves than general
    population.

7
RISK AND MAD PEOPLE
  • INTERPERSONAL RISK
  • Mad as perpetrators
  • Weak statistical correlation between madness and
    violence. Other factors are stronger such as age,
    history of violence, gender and substance abuse.
  • Mad as victims
  • Much more likely to be victims than perpetrators.

8
RISK AND MAD PEOPLE
  • ENVIRONMENTAL RISK
  • As causes of madness
  • Trauma, deprivation, social inequality, loss
  • As consequences of madness
  • Trauma, deprivation, social inequality, loss
  • Social stigma and discrimination
  • Unsafe, unhelpful, coercive services

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10
APPROACHES TO RISK AND MADNESS
  • WIDER COMMUNITY
  • An unsustainable consensus
  • Mad people a risk to others
  • They cannot take responsibility for their actions
  • The community has ceded responsibility to
    services
  • Services entirely responsible for controlling
    risk
  • Mental health leaders collude with this consensus
  • The scene is set for the wide acceptance of
    compulsion

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12
APPROACHES TO RISK AND MADNESS
  • MENTAL HEALTH SYSTEM
  • A contestable dominant paradigm
  • Compulsion supported by belief in biological
    pathology that destroys autonomy and needs
    correction with treatment.
  • Poor powers of prediction
  • Serious violence by mad people too rare to
    predict well
  • Debatable if compulsion reduces suicide rate
  • A narrow conception of risk
  • System driven by risk to institutional
    professional reputation
  • Little regard for risks to consumers

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14
COMPULSION - RISKS TO CONSUMERS
  • DISCRIMINATORY CRITERIA IN MENTAL HEALTH ACTS
  • Danger to others
  • Preventive detention can happen despite no crime
    (only with mad)
  • Danger to self
  • Compulsion can happen despite competence (only
    with mad)
  • Competence
  • The criteria for non-voluntary treatment should
    focus on the mentally ill persons capacity to
    understand that he or she is ill and the benefits
    that might result from treatment. Ryan et al

15
COMPULSION - RISKS TO CONSUMERS
  • INHUMANE TREATMENT
  • Hospitals
  • Experienced as unsafe and uncaring
  • Seclusion, restraints, forced injections
  • Experienced as re-traumatising and as punishment

16
COMPULSION - RISKS TO CONSUMERS
  • CORRUPT REVIEW PROCESSES
  • Review Tribunals processes
  • Intimidating and humiliating
  • Review Tribunal decisions
  • One in 20 applicants get off order in NZ
  • Language to justify decisions does not appear in
    Act in NZ

17
COMPULSION - RISKS TO CONSUMERS
  • QUESTIONABLE TO HARMFUL OUTCOMES
  • Medications can be life-depleting and
    life-shortening
  • Compulsion re-traumatises and corrupts
    therapeutic trust
  • Undermines autonomy and creates overdependence
  • Compulsion lowers social status and increases
    stigma
  • Compulsory community treatment results in no
    significant difference in service user, social
    functioning or quality of life compared with
    standard care. Kisely et al. Cochrane Review

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19
THE RISKS TO REFORM
  • RECOVERY POLICY
  • National policies in all English speaking
    countries founded on recovery, but no reduction
    in compulsory treatment.
  • Compulsory treatment not compatible with
    recovery
  • Self-determination and personal resourcefulness
  • Collaborative relationships (shared risk,
    positive risk)
  • Choice of services
  • Equal participation in society

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21
ALTERNATIVES TO COMPULSION
  • Stop colluding with discriminatory community
    consensus
  • Recovery focus - crisis prevention focus the
    life I want
  • Advance directives
  • More and better crisis options
  • Robust systemic and individual advocacy
  • Compulsory responsiveness orders
  • Separate healing function from control function

22
AN END TO MENTAL HEALTH LAWS
  • Treatment and detention without consent rare and
    brief
  • Emergency interventions have the comparable
    threshold as physical medicine
  • Rethink assumptions about human responsibility
    for crimes
  • Humane recovery oriented criminal justice system

23
THE ROAD TO HELL...GOOD INTENTIONS
  • Of all the tyrannies a tyranny sincerely
    exercised for the good of its victims may be the
    most oppressive...for those who torment us for
    our own good will torment us without end for they
    do so with the approval of their own
    conscience... CS Lewis

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