Parity of esteem: Mental Health Treatment = Physical Health Treatment?


Theresa May said in May 2018 that “tackling the injustice of mental illness” is one of her “absolute priorities” as Prime Minister. Her government has promised to treat mental health as seriously as physical health, and claims it is spending a record amount on mental health services. However despite this promised increase mental health services in the UK continue to be at crisis point with frequent news stories highlighting critical failures that are putting lives at risk. However it is not the disparity of this woeful lack of funding that most upsets me; it's the way patients are treated that causes me most distress.


Mental Health Detentions 2016/17
Here in the U.K. we have a law called the Mental Health Act 1983. Huge numbers of people get caught up in it every year, especially those of us with autoimmune encephalitis which now accounts for at least 9% of psychotic illness. The Mental Health Act allows a doctor to forcibly detain a person in a hospital or other secure facility under a process called sectioning. The doctor can then administer drugs against the patients wishes.

We also have a law called the Mental Capacity Act 2005 which allows someone with sufficient insight and cognitive ability to have a say in how they will be treated, in other words you are deemed to have the ability to make your own decisions, however the mental health act can override it. What this means is that if someone has mental capacity but are deemed to have a mental health problem that may potentially put themselves or someone else at risk, they can be locked in a hospital (or initially a police cell), sometimes for months or years, however they can still be held fully liable for their actions such as debts incurred while in the grips of mania and psychosis as they are said to have mental capacity. And of course it's a doctor who gets to make this decision, someone who may not necessarily have the time or, in a highly risk averse and litigious society, the appropriate motivation to act in the best interests of the patient that gets to decide between someone keeping their freedom and having a say in their treatment or not.

This is terribly unfair, as it means someone with cancer can agree to or refuse any treatment, yet someone with encephalitis that presents as mental illness can have treatment forced upon them, even if they have full mental capacity. This means they can be detained, forcibly drugged and have many of their basic human rights removed by their doctor regardless of the patients or patients families wishes. There’s an excellent thought piece in this weeks Lancet that describes the disparity in our laws. 

I was never held under a section order of the Mental Health Act, however my doctor made it very clear that in his opinion I met the criteria for sectioning. If I hadn't voluntarily admitted myself to hospital and stayed there I would most certainly have been detained which would have removed any possibility of me refusing treatment, but even though I was in hospital voluntarily my freedom was still taken as I was forbidden to leave and if I had left I would have been returned to hospital and sectioned. 

Of course I was very unwell, however my mental capacity was not questioned - I was fully liable for any and all of my actions, yet despite not causing myself or anyone else any harm, my doctor could very easily signed a piece of paper and had me held in hospital for months and forcibly drugged me. Of course there are people who do pose a very real risk, often to themselves, after all suicide is a leading killer in the UK, and the treatment I received in the psychiatric hospital was mostly quite good, however in the face of emerging evidence that our lifestyles are behind many cases of mental illness, and that gluten is a confirmed cause of psychosis, shouldn't we we offering people a different, more thoughtful and dignified treatment rather than just locking them away and drugging them? But then, there's no money in curing patients is there!

The thought of being placed in psychiatric care is something that still terrifies me today, particularly if I get exposed to gluten as there is a very real likelihood I will become psychotic, and if this happens my treatment needs to be a strict Autoimmune Protocol diet and to stay at home and recover, being locked in a hospital, drugged and fed crap food is not going to help.

The Nightingale Psychiatric Hospital in London where I spent 6 months of my life
Photo © Michael Hall 2019

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