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.