Thursday, 7 April 2011

When Detained Patients Appeal Part IV: How To Get Off Your Section

Despite the title of this post, I’m not completely gamekeeper turned poacher – as an AMHP I do take the view that some people with severe mental disorder need to be detained under the Mental Health Act for assessment and/or treatment. However, if you are a detained patient who does not want to remain in hospital, here are some hints and tips that might make your stay a little shorter.

1. Appeal against your detention
When you are detained under a section of the MHA, it is the duty of the AMHP who detained you, and of the hospital staff, to inform you of your rights to appeal. Staff have a duty to help you if you want to appeal. Your case will then be heard by an independent Tribunal which is part of the judicial system. Around 15% of appeals to Tribunals are successful.

A formal appeal to a Tribunal will also concentrate the mind of the psychiatrist. If you are making a good recovery, they may well decide to discharge you from detention prior to the actual date of the appeal.

2. Get a solicitor
Patients detained under the MHA have the right to free legal aid regardless of their incomes. There are solicitors with special training who will take on this work. The hospital staff will put you in touch with an approved solicitor. Although a patient can use almost anyone to help them present their case in a Tribunal, your chances will be improved by having a qualified legal representative.

3. Allow the solicitor to present your case
Although Tribunals make an effort to appear as informal as possible, it is nevertheless essentially a court of law. The chairman of the Tribunal, whose status is equivalent to a judge, will not appreciate the patient making constant interruptions or challenging the testimonies of the psychiatrist or AMHP. The patient can ask their solicitor to point out inaccuracies or discrepancies in written and verbal reports. The solicitor will frequently pick up on these issues without prompting. Don’t make the mistake that Norman did (When Detained Patients Appeal Part II, 16th March 2011).

4. Be wary of opportunities to speak to the Tribunal
I’ve seen many cases appear to go well in the Tribunal right up until the moment when the patient is asked by the medical member or the chairman to tell them more about how they are or if they have anything they wish to say to the Tribunal. Many a paranoid or psychotic patient has then gone into great detail about their delusions or hallucinations, thereby proving that they have a mental illness “of a nature or degree which warrants detention in hospital” for assessment or treatment, and which would then make it very difficult for the Tribunal to discharge them. Don’t make the mistake that Denise did (Just Another Day, 3rd September 2009).

I remember one Tribunal I attended. The patient had sat there quietly throughout, allowing his solicitor to question the psychiatrist and his care coordinator. It had been going quite well for him. The solicitor had certainly made the psychiatrist look uncomfortable at times. The medical member then said to him: “Is there anything you would like to tell us?”

“Yes,” he replied. “I don’t need any medication or anything like that. I’d be perfectly all right if it wasn’t for these voices. They never leave me alone. They’re always going on at me to do bad things. I think it’s my psychiatrist, he projects them into my head from a transmitter on his desk. I had a brain implant inserted into my head many years ago which has made me half robot and half human. The implant picks up the signals and I then hear them. Those voices, they drive me mad, I tell you.”

He did not get off his section.

5. Do not threaten or assault the psychiatrist or other staff
This does not look good in a report to the Tribunal. It will also tend to stay with you in every future risk assessment.

6. Take the prescribed medication
Psychiatrists do as a rule want their patients to get better. Nowadays there is intense pressure on hospital beds, and psychiatrists do not generally want patients to remain in hospital longer than absolutely necessary. There is a wide range of psychotropic medication that can actually help people with depression, psychosis or mania with their symptoms. Cooperating with the inpatient treatment plan and with plans for your aftercare after discharge will definitely make your stay shorter.

If you are detained under Sec.3 (for treatment) you will inevitably be subject to Sec.117 of the MHA. This refers to the duty of the NHS and the local authority to provide aftercare. The cost of any aftercare provided (including residential or nursing care, as well as provision of community support services) will have to be met by the local authority or the local NHS Trust.

19 comments:

  1. Your comment "Cooperating with the inpatient treatment plan and with plans for your aftercare after discharge will definately make your stay shorter" has really annoyrd me. Why should you have to succomb to what the 'professionals' say. They don't even know how most of the drugs they prescribe actually work. If you don't want to be their guinea pig and in a lottery as to which medication will maybe work for you then why should you. Just because you may question their treatment doesn't make you mentally ill and unworthy of being released. Your comment smacks of a certain amount of bribery. Conform or you will be detained.

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  2. I'm sorry if I offended you. But that is the reality, rightly or wrongly. I know "professionals" are not fallible. I also know that medication for mental illness is not an exact science, and that there can be side effects for some that are unacceptable. However, most of the mental health professionals I know really do try hard to help their patients keep mentally well and out of hospital, and on the minimum medication necessary to achieve that. And if someone has been mentally stable for long enough, and is able to lead a fulfilled life, good professionals will work on reducing or even stopping medication.
    This is a complex and difficult area about which even professionals will not necessarily agree. What I do know from many years experience is that people with severe mental illness can be helped with the right treatment (which does include a lot more than just medication).
    What is frustrating is seeing someone recover and be discharged from hospital free of symptoms, only to relapse because they do not recognise the part that medication and the support of the community mental health team had played in that.
    I know that this is an issue that will always be contentious. Remember, this blog is just the view of one of those professionals.

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  3. I'm not so much offended as just putting across someone who is on the other side of the fence's view. It almost becomes a game. Either play it or suffer the consequence. I'm not saying that medication doesn't bring relief, however, i question when one's intellect and knowledge of oneself is pushed aside to be compliant to the 'professionals' opinion, which in my experience is what happens.

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  4. Dear Masked AMHP,
    Just stumbled across your excellent Blog, I will certainly keep reading. I am a Mental Health Solicitor and have just started my own blog at http://tammygroves.vpweb.co.uk/blog, perhaps our paths will cross one day!

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  5. Where is my comment? Pharmacuticals and Psychiatry in Cahoots. Disappointed that I could be sanctioned for expressing the views of the Critical Psychiatry Network.

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  6. I'm sorry, but I don't know what comment you are referring to. I only ever remove comments if they are demonstrably Spam, ie containing links to irrelevant websites, or advertising products.

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  7. I am in hospital under 37 without restrictions and I don't have mental health problems and I don't have learning difficulties I have mild autism and I have leave to get a chance to write this and I hate where I am I want to be discharged I am in hospital for nothing and they wonder why I keep getting angry and frustrated with certain people I am living with. I I don't take medication I do psychology sessions which are rather pointless as I could request it in the community and I don't want to be where I am any more I want to report my story to the paper soon people realise I shouldn't be there and I could get thousands of pounds for this as I am not crazy I don't self harm it's not the money I want it's my freedom and my horse career I want. I was attacked in the community by a bloke when my ex bf was also being beaten up by drug addict and end up in prison for no reason and then they dump me in hospital till my court date which got thrown out of court which I don't find is funny I am more mainstream capable then most of the patients they are constantly drugged up on prn form of tablet and very unwell and it's spose to be a low secure hospital it is a horrid place and they make me smoke 5 a day when is my choice and that includes when I go out every 3 hours means 1 fag only I want some one to help me asap I want to be discharged and I am basically making money for this snobby doctor who speaks old fashioned way which she is very dry with her sense of humour so yes I am making money as I am in hospital when someone out there is very unwell needs that bed when I should be discharged and in a support commendation with the right help with decent staff support without treating me like I have no rights and choices and I am more clever then the staff that act like they have mental issues please help me thank you xxx jordan

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    Replies
    1. You can't appeal to a tribunal against sec.37, but you can appeal to the hospital managers.

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    2. Can you move to another country to get off section?

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    3. If you manage to leave the UK while detained under Sec.2 or 3, you cannot be returned once the term of the section has run out.

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  8. Hi, I need some help for my 19year old lad. His case is very unusual and don't know who to turn to for help. He is suffering total indignation and dehumanisation at the hands of a psychiatric nurse who is supported by his superiors. The more I complain the more they drug him up. The medication dose has been so high that he is like a zombie and know they have sectioned him off and they are changing from different hospitals because older seriously ill patients are harming him. Please help me this morning alone he was punched in the head and survived a stabbing. Most of the nurses believe he is vunrable and should not be in the ward but say they are just workers.my son cries all night and says he will go mad if he stays a day longer. Someone help me.

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    1. As your son has been subject to the Mental Health Act, he would be entitled to an Independent Mental Health Advocate. An IMHA can advocate on behalf of your son. The hospital should also have a Patient Advice and Liaison worker (PALS) who can assist patients to complain about their treatment, etc.

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  9. Hello,

    My son has been detained for two years on a Section 3. As he is now eighteen, he has to be moved on to adult services.
    He is in Northampton and I live in Kent. I would like him to be able to access the community and maybe return home.
    The Doctor will not take him off section and will give no reason as to why. He has not been given any chance to prove his his safe outside and they are going to be sending him to another locked hospital.
    What can I do to get him off section and back home?

    Thanks.

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  10. hi
    our son has recently been detained under section 2. this is the second time in 4 years.
    last time he appealed his section and was released from hospital. in our opionion too early he refused to take any meds in fact he threw them away on the way home.it took over 9 monthe be foer he came back to any kind of normality.he would do thing totally out of character talk nonsense allday and he ended up living in the local woods for a time.
    his new tribunal is due this Monday coming what rights as parents do we have regarding the tribunal and are police reports and incidents taken into account with regards to his mental state leading up to his sectioning. can all of this information be taken into account as we as parents are concerned he will be released prematurely. surely the people that know him should have a say at a tribunal along with the indepenant solicitor and the clinician who has never met him (only after a week of treatment)please can you get back to me asap with any help
    .thank you in advance
    Gary

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    1. There are three reports submitted to the Tribunal: the Medical report from the psychiatrist, an inpatient nursing report, and a social circumstances report. the social circumstances report is written by someone from the community, usually a social worker. When compiling that report, they are supposed to consult with the nearest relative and anyone else relevant, and take into account their views and wishes. A relative can attend a tribunal as long as the patient does not object.

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  11. Can anyone tell me if there are any support groups for nearest relatives, my daughter has been on section 3 for nearly 4 years, during that time I've muddled through as her nearest relative the best I can with little or no support, to the best of my ability I've advised her to be compliant with meds and treatment, looked after her finances and tried to give her as much support as possible, which isn't easy when she's in Northampton and I live on the 140miles away on the south coast. Recently on the request of my daughter I applied to the hospital to discharge her. She seems to have been lost in the system, with no one really fighting her corner, she was only just 18 when sectioned and was told it would only be for a few months when they sent her miles away from home, she's almost 22 now. During that time my wife and I have been told very little of our daughters mental health, her prognosis or treatment and relations with the hospital she is now detained in have always been somewhat strained. The ward she's held on has what we consider a fairly draconian regime, where levels are key, hard earned and easily taken away. We feel she's been exposed to all sorts of things she should never have had to witness. Seems the majority of the women in her unit are there as an alternative to prison, she is bullied and has been attacked on numerous occasions, which would be perhaps easier to accept if our daughter was a criminal but she isn't and has no criminal convictions. And despite expressing our concerns fears and feelings nothing has ever changed. Two years ago I tried to apply some pressure on the hospital through correspondence and meetings to get our daughter moved somewhere closer to home, at which time she was told she was top of the list for a bed, but by me making waves staff made her life so difficult she became unwell again and another 2 years has passed. A year ago worryingly my wife was diagnosed with vascular dementia, we toyed the with of not telling our daughter in case it caused her to relapse, but we had to as we felt she had a right to know. Despite our worry it has actually had a very positive affect on her, she hasn't self harmed and her schizophrenia is totally in remission, on the ward she has earned her top level and kept it since. In her last CPA she was really praised but left feeling hopeless as there is still no end in sight, the RC offered her a place in a ward on the same site in Northampton where she would have to stay a minimum of another year. I hope this offers some insight into what bought me to make the application for discharge. Inevitably the RC barred my application and I am now waiting upon my invite to the managers review meeting that is now being arranged. Reason I ask about support groups for nearest relatives, we were asked for the name of our solicitor if we were to have representation at the managers review, I tried to get a solicitor but none were interested, I was told I'd never win!

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  12. Sadly, if you have a bad CPN you are going to fucked up in this system. Change the cpn or the team to one which is more community inclusive. These lazy cpn's get paid for writing reports that lock up young people. Don't be afraid to change the cpn many times until you find one that shares your values.

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  13. Hi, My friend has his tribunal this week and I am hoping he gets out. In your opinion, what are the most important point that can influence the panel to discharge him. I understand the 3 reports play a vital part in deciding but apart from that - what should be said to the panel to help his discharge.

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    1. It's important that your friend allows his legal representative to represent him, and not to interrupt when other people are speaking. Take notes if he disagrees with what it being said.
      Your friend needs to agree to a community treatment plan, which will probably involve medication. Recognition that he has a mental disorder will also help.

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