Psychiatric ASBOS?

Due to some back room bungling at Mute, this article failed to make it online before the Mental Health Bill received royal assent last Thursday to become law. Here mental health activist and editor of Mad Pride: A Celebration of Mad Culture traces the history of this deeply unpopular bill, from the early '90s to the present day. As of 19 July 2007, psychiatric service users can expect to be forcibly medicated even when not institutionalised and importantly when deemed 'untreatable'. The expanded number of health professionals given the powers to section patients will undoubtedly also result in more people being incacerated - predictably amongst the most vulnerable and discriminated against groups

Imagine having to choose between these. On the one hand, hallucinations including voices, confusion, social withdrawal, suicidal thoughts, inability to look after oneself, and occasionally, getting on everyone's nerves. On the other, submitting to anti-psychotic drugs, with their debilitating side effects: weight gain, impotence, shaking, agitation, drowsiness and irreversible Parkinson’s Disease- type symptoms including "Tardive Dyskenesia" - involuntary, ostentatious and embarrassing tongue movements. Stuck between a rock and a hard place, most of Britain's psychiatric service users at least want the opportunity to make an informed decision.

But if the Department of Health has anything to do with it and its proposed Mental Health Bill is passed, thousands more patients - known by the jargon in the scene as "users" and who at present can only be force-fed drugs if "sectioned" (compulsorily detained in hospital) - will have this decision removed from them and left entirely in the hands of doctors. Community Treatment Orders (CTOs) would allow psychiatrists to compel users in their own homes to submit to treatment whether they like it or not, at threat of readmission to hospital, regardless of their current state of health.

This threat has its roots in a very small number of highly publicised, tragic incidents in the 1990s, where members of the public were attacked by people with mental health problems, not necessarily already diagnosed, who had fallen between gaps in services and who were "defaulting on medication." Chief among these was the 1995 murder of Jonathan Zito by the itinerant "schizophrenic" Christopher Clunis, now in Broadmoor, at Finsbury Park tube station, an incident which catalysed a wave of newspaper headlines and campaigns by maverick charities like SANE and the then newly formed Zito Trust, to restrict users' civil liberties and reinforce public distrust of the mentally frail.

Prior to this, the Royal College of Psychiatrists had been pushing for many years increased powers for doctors to compel treatment.

In 1998, then Health Secretary Frank Dobson unveiled in parliament a Mental Health Bill aimed at satisfying these campaigners by replacing the 1983 Mental Health Act with new legislation, broadening the definition of mental disorder and removing several exclusions such as alcoholism and eccentricity; introducing CTOs; and replacing the previous "treatability clause" with "appropriate treatment," in effect allowing doctors to incarcerate indefinitely those with the unscientific diagnosis of "personality disorders" - IN CASE they became dangerous in the future. Announcing the Bill, Dobson described patients as "nuisance neighbours" and dismissed as "weasel words" Liberal Democrat MP Simon Hughes' concerns that the proposals constituted a draconian attack on patients' civil liberties.

SANE were thrilled. Chief Executive Marjorie Wallace's subsequent Daily Mail column was headlined, simply, "Victory." Photocopies of this article were plastered all over the walls of the charity's Whitechapel offices. Others were less pleased.

Every credible mental health charity in Britain came out strongly against the Bill, as did bodies representing social workers, and hospital and community psychiatric nurses. MIND, Rethink, and dozens of other charities and professionals' groups formed the Mental Health Alliance, aimed at challenging the threats through negotiation and media work, on the following grounds. The Bill's exclusive focus on public safety and violence would exacerbate public fear and hostility towards patients. CTOs, nicknamed "psychiatric ASBOs," would risk scaring people away from services, making them still more likely to default on medication. Numbers of people likely to receive forced medication would increase, and real service delivery problems, and discrimination and inequalities within the system, would not be addressed. The dignity, respect and rights of service users would be further undermined.

The most angry responses came from patients themselves. Since the 1970s, groups such as Survivors Speak Out and the Campaign Against Psychiatric Oppression had sought to challenge the many systematic abuses inherent in traditional psychiatric treatment, and promote alternatives. However, too much energy was frittered away in divisive debates on whether "mental illness" really existed, and appropriate or otherwise use of medical terminology. Ironically, the Bill had the effect of galvanising and uniting what had become known as "the user movement" against a common enemy.

In March 1999, pressure group Reclaim Bedlam organised a march on patients' old enemies SANE protesting against this charity's support for CTOs. Dressed playfully in white coats and armed with drums, whistles, tridents ("because we're media devils") and a giant seven-foot long syringe, hundreds descended on SANE's headquarters with a barrage of angry noise. SANE didn't know what had hit them. Bravely, Wallace came out and confronted the gang of screaming lunatics, disingenuously claiming that she'd "always opposed CTOs." This failed to prevent the negative headlines and TV coverage severely damaging her credibility.

This direct action marked a sea change in the nature of opposition to the Bill. SANE, at least in public, were forced to reverse their position. The Royal College of Psychiatrists followed, suddenly mindful that increased powers of coercion would also engender increased responsibilities, with doctors further scapegoated in the event of the occasional and entirely unpredictable tragedy. The entire mental health profession was now united against the government's proposals.

The Department of Health, reluctant ot back down, spent the next few years conducting a series of consultations and working groups with charities, patients and statutory professionals. In a game of cat and mouse, the experts failed to alter the DoH's intentions, but at least managed to repeatedly delay their implementation.

The stand-off continues today. Having jettisoned the idea of completely replacing the 1983 Mental Health Act with a new Act, the plan now is to amend it to incorporate the key contentious proposals. Last November, a new Bill was published and entered the House of Lords, which returned it to the Commons watered down. The DoH is still determined to overturn the Lords' amendments.

Those sceptical about opposition to the Bill should consider these facts. Patients are statistically far more likely to be dangers to themselves than others: at least 6000 people in Britain commit suicide every year. Contrary to common perception, homicides by the mentally frail are extremely rare, and 'sane' people are just as likely to be violent. But when did you last see the newspaper headline "Normal Person Attacks Bloke With Machete"?

Those who genuinely care about mental health should listen to the expertise of the patients themselves. While most of us don't disrespect doctors, we demand basic rights and feel our medication should be worked out in negotiation with psychiatrists, not dictated to us. In the face of irrational public and media hostility, we believe that mental health is a valid civil rights struggle on a par with those of women, gays and minority ethnic communities. Which is why many of us are now proclaiming: MAD PRIDE!