Friday, 11 October 2013

"patients without capacity don't require advocacy" - let's give the workers iPads

I remember a consultant forensic psychiatrist telling me in 2012 that "patients without capacity don't require advocacy" as if it was a fact.  Fortunately I knew the truth of the matter.  That independent advocacy was a legal right for anyone detained under the Mental Health Act.

I made him aware that I knew the MH Act and anyway the person we were discussing had capacity.  Probably too much capacity and that's why they wanted to restrain, seclude and forcibly treat him.  Without an advocate present.  However this patient insisted on an advocate being present for they knew the MH Act also, far better than I.  The psychiatrist wasn't happy at not getting his way.

But in this locked ward the MH Act wasn't adhered to and they took every opportunity to deny the basic human rights of patients.  Locked in a seclusion room with no toilet or water to drink.  No pens to write with.  Nurses rolling their own cigarettes in the ward.  They expected carers to obey and reacted badly when a carer resisted.  

The patient resisted the ignorance and inhumane treatment until he was overpowered and forced to comply.  He fell over, losing balance because of the psychiatric drug, and nurses accused him of being silly.  The carer told the nurses it was side effects of the drug.  

This carer then had to instruct the nurses in this locked ward about basic communication skills, how not to invade a visitor's personal space.  They had obviously got too used to forcing patients to comply that they had lost awareness of what was appropriate behaviour when dealing with carers and family members.  In fact the senior charge nurse said that they didn't get many visitors.  I'm not surprised.

This carer wasn't allowed in the front door at visiting time but was sent round the back, in the dark wintry nights, icy beneath feet, to knock on a door and not be heard, then had to hammer on it.  Until someone came.  It put this carer off visiting at night.  She didn't want to break a leg.  Again.  Now they have a doorbell and window in the back door.  

Don't know about the practice though.  Joinery improvement work is far easier than changing attitudes and behaviour.  That will require ongoing monitoring and evaluation.  Asking patients and carers about their treatment.  Listening to the customers of the service.  Really listening.

At a recent meeting in this psychiatric institution to do with "involvement" of people with lived experience, the senior manager mentioned getting iPads for workers, as if this would improve their communication skills.  I was incredulous.  Thought the guy was joking.  Maybe he was.  Or losing his marbles.

Then another carer told their story.  Of poor psychiatric treatment, neglect, lack of communication and information.  Difficult to listen to.  Confidentiality was mentioned.  Then breached by the worker in relation to my situation.  

We heard that in Fife there are no dementia statistics.  How could this be?  Don't know.  But they have to be gathered.  Maybe the iPads will help?

Welcome to my world! 


  1. Chrys, I really admire your writing.

    The fact that someone is standing up for patients rights. Any right. Basic rights - a luxury as a former in-patient I was not afforded - seeing that you come from Cupar I assume that you refer to Ward 4?

    Yes, sadly, I remember walking out of that place more screwed up than when I came in. What really annoyed me was that once you were detained under the MH act, whatever you say, no matter how silly or sane, can be palmed off as ramblings of a mentally unstable chappy. - and that mentality was what removed my basic human rights.

    However, I am not saying that I did not need treatment because I can quite honestly say I did, but the most progress has been made through working with the third sector on a less intrusive basis.

    1. Thanks for commenting Raymond.

      Yes I refer to Ward 4 at Stratheden Hospital, now also called the IPCU. And I agree that the Mental Health Act in this ward didn't protect basic human rights. It actually gave more power to the professionals to deny the rights of patients. And they have got away with it for years.


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