Sunday, 30 April 2017

Hunter Watson: Possible Explanations Apr17; misleading statements by #DrDavidChristmas

by Email 29 April 2017: 

"In the attached paper I suggest that the Scottish Government might place too much weight on advice from experts when it considers the need to make significant changes to Scottish mental health and incapacity legislation. One acknowledged expert in the field of mental health is the consultant psychiatrist Dr David Christmas. I have no idea whether he ever advises the Government about mental health and incapacity matters. However, if he does then it is possible that some of the advice which he provides might be misleading. In the attached paper I explain why I am of this opinion. A copy of the paper has been sent to Dr Christmas so that he can comment if he is of the opinion that I have been misrepresenting any of the statements which I have attributed to him, statements which I seem to recall that he made at the CPG (Cross Party Group) meeting on mental health that was held on 26 April 2017.

Best wishes,
Hunter Watson"


Page dedicated to Papers and Articles by W Hunter Watson, Mental Health Human Rights Campaigner, retired Maths Lecturer, Aberdeen


May it be granted the older you are: Hole Ousia blog post


"On the 26th of April 2016 I attended the Cross Party Group on Mental Health and Older People, Age and Ageing, held at the Scottish Parliament. The following is an  account of my experience of this meeting and some reflections on conversations that have followed it.

At the end of this post are included two papers that were submitted ahead of the Cross Party meeting: a paper by me entitled “May it be granted the older you are” and a paper by Mr Hunter Watson entitled “Psychoactive Medications”.

I have been to quite a number of Scottish Parliamentary Committee meetings but this was the first Cross Party Meeting that I have attended. How welcome it was to see such a good turn out with a packed committee room. I am inclined to conclude that this indicates how important it is that we value our older generation. It was however unfortunate that other parliamentary business meant that various parliamentarians had to absent themselves.

I was  keen to attend this meeting for a number of reasons. Having an interest in the Scottish Government’s “Ten Year Vision” for Mental Health I had attended one of its consultation events in Edinburgh and had also submitted a written response. There were  574  written responses in total, which again seems most encouraging.

Given that opportunities for anyone to raise discussion, at parliamentary level, about the Scottish Government’s ‘Ten Year Vision’ may not come along very often, I felt it was important, as the only NHS psychiatrist for older adults at this Cross Party meeting, to do my best to put forward the experiences of my patients.

I was very impressed that the convener, Sandra White, MSP made sure that as many voices as possible were heard at the meeting. I wrote to thank her for this.

I was particularly struck by the compelling and worrying testimonies of Rosemary Carter and Dianna Manson whose experiences as older adults with mental health issues remind us starkly how important it is that policy makers consider very carefully the consequences of visions set for the years ahead.

Rosemary Carter highlighted her experience of how the dominance of cognitive assessments in my profession has reduced capacity to care for those who have non-cognitive mental ill health. As a professional working in this area I share her concern and am of the view that Rosemary is far from alone in her experience. When the Dementia Strategies and Targets were first introduced in Scotland from 2010 onwards, it was my concern about this potential for inverse care, and for increased stigma associated with ageing, that led me to advocate publicly for a timely approach to the diagnosis of dementia. I did so at a time when this approach had no support whatsoever from policy makers, healthcare or the Mental Welfare Commission.

I thought that Angela Dias of “Action in Mind” spoke with clarity and genuine concern about what she termed “institutional discrimination” relating to older adults with mental health issues living in Scotland today.

Mr Hunter Watson’s concerns about human rights for older adults do, in my opinion, need to be carefully considered.

The Principal Medical Officer for Scotland, Dr John Mitchell, acknowledged several times the evidence that those with chronic mental health disorders die 15-20 years earlier than those who do not. He stated at this meeting that this is a “huge finding, a universal finding, a huge inequity”. Academics are increasingly of the view that one of the potential reasons for such early death has been the prescribing of psychiatric medications. This is why I mentioned a number of times at the meeting the widely gathered evidence (PE1493, Sunshine Act for Scotland) that the pharmaceutical industry continues to have a significant role in the “education” of Scottish doctors in the prescribing of psychiatric medications.

I thought the presentation by Dr David Christmas was most interesting and share his concern that there is an imbalance in research studies across the age ranges. I raised a number of questions with Dr Christmas because he works as a “super-specialist” and so deals with a very select group of patients.

At the Cross Party meeting Dr Christmas stated that “depression is under-recognised across all age groups” and that “maintenance treatment has a good risk-benefit ratio.” He did so without acknowledging that these statements cannot be made with absolute certainty.

I have attended a wide range of GMC-required Continuing Medical Education (CME) and so over the years have found that I have attended a number of educational talks given by Dr David Christmas. He always carefully talks through his declarations of interest which for at least the last five years do not  include any financial interests other than his employment with NHS Tayside as the Clinical lead of the Advanced Intervention Service.

Dr Christmas is a member of the Psychopharmacology Committee of the Royal College of Psychiatrists. The Chair of this most influential committee (in terms of the prescribing of psychiatric drugs) is Professor Allan Young, a “key opinion leader”. Professor Allan Young declares his extensive financial interests as follows: “Paid lectures and Advisory Boards for all major pharmaceutical companies with drugs used in affective and related disorders” . A similar key opinion leader, Professor Stephen Stahl, gave a keynote talk at the British Association of Psychopharmacology in 2015. As he is American, and they have a Sunshine Act, it is possible to establish Professor Stahl’s earnings from promoting psychiatric drugs. When last looked at, this was, more than $3.5 million dollars. In the absence of a similar Sunshine Act in the UK we cannot establish the scale of payments made in the UK.

Dr Christmas has given educational lectures alongside Dr Hamish McAllister-Williams who is also a member of the Psychopharmacology Committee of the Royal College of Psychiatrists (RCPsych), and who was appointed in 2012 as Director of Education for the British Association of Psychopharmacogy (BAP).

Dr McAllister-Williams declares a wide range of financial interests with the Pharmaceutical Industry. Dr McAllister Williams is “a major contributor” to the RCPsych and BAP Continuing Professional Development programme.

It was with this knowledge, of the influential position that Dr Christmas has in terms of the education of UK psychiatrists, that after the Cross Party Meeting I wrote to ask Dr Christmas to ask if he might support a Sunshine Act for Scotland?  At the meeting Dr Christmas took time to carefully address other biases (which I share his concern about) but did not do the same for the financial biases that may affect the advice given by key opinion leaders. The same potential exists for research itself.

In my correspondence with Dr Christmas I  reminded him that I prescribe both antidepressants and antipsychotics but explain to patients that the best evidence we have is generally based on short-term studies and that all interventions (including psychological interventions) can have both benefits and harms.

I have  confirmed with Dr Christmas that I share his determination to seek science that is as objective as possible and that this means that I realise that biases do indeed come in all forms and not just financial. I simply argue that science should be based on transparency or it ceases to be science. My view is that it is not necessarily a bad thing if doctors are paid for their time and expertise working outwith the NHS. For example, working for NICE, or giving expert views to court. However, when a doctor has a financial “conflict of interest”, this can affect the treatment decisions they make, or recommend. These conflicts cannot be entirely avoided, and in many cases they are entirely reasonable. However, it is important that information is available on which companies have paid a doctor, so that colleagues and patients can decide for themselves what they think. For example, there is longstanding evidence that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients.

I have also discussed with Dr Christmas the view that proportionality of understanding should come in words as well as numbers and  that the quantitative and qualitative require ‘parity of esteem’.

In summary, I thought the Cross party meeting on Mental Health, Ageing and Older People was an excellent opportunity for a range of voices to share their thoughts and experiences. Such involvement is to be commended and I hope that both my profession and policy makers of all sorts may agree. ..."

Dr Peter J. Gordon
(writing in my own time)"

Read complete blog post 

Friday, 14 April 2017

Mental Welfare Commission Adult Acute themed visit report April2017; #HunterWatson response

talk to the hand: MWC
Mental Welfare Commission for Scotland's Adult Acute themed visit report April 2017

"We protect and promote the human rights of people with mental health problems, learning disabilities, dementia and related conditions" p1

My response: No you don't.  There are no human rights guaranteed when a psychiatric inpatient in Scotland.  I can testify to this.

Scottish Sunday Express 5Oct14: Patient locked in cell, no toilet, food, water

Here are a couple of my tweets from yesterday, after reading up to p23 of MWC report then giving up:


Response from Hunter Watson, Mental Health Human Rights Campaigner, 14 April 2017, in Email to MSPs and Others:

"The MWC report makes interesting reading. Among the points to which attention should be paid are the following:

1. The report notes that exercise is to be encouraged since it can benefit both mental and physical health. Yet in some care homes for older people exercise is discouraged. Residents who wish to walk about are deemed to be restless and are liable to be given some form of chemical restraint, often an antipsychotic drug. The administration of this drug to an elderly resident with dementia increases the risk that the resident will die prematurely and so breaches that resident's absolute right to life.

2.  The MWC report fails to acknowledge that some experts believe that compelling involuntary mental health patients to continue taking antipsychotic drugs increases the risk that they will die prematurely whether or not they have dementia.

3.  The MWC report appears to assume that mental health patients who are detained under the provisions of the 2003/2015 Act do not have the right to refuse medication even though they might have the capacity to make a treatment decision. The MWC report, regrettably, ignores the provisions of the Convention on the Rights of Persons with Disabilities, especially to Article 12 of that binding international human rights treaty which has been ratified by the UK. A study of Article 12, which guarantees equal recognition before the law, should make it clear that people with mental health problems have the same right to refuse treatment as people with physical health problems.

4.  The MWC report gives the false impression that mental health patients will receive a fair hearing if they appeal to the mental health tribunal. Two matters should be noted in connection with this apparent assumption:
  (a) Forced treatment normally begins before an appeal can be made to the Tribunal.
  (b) Mental health tribunals are not impartial since their findings are based almost exclusively on the evidence provided by the responsible medical officer. Hence mental health tribunals do not provide the fair hearing required by Article 6 of the European Convention on Human Rights.

5. The MWC report correctly notes that all people have an absolute right not to be subjected to inhuman or degrading treatment. It is to be regretted, therefore, that the MWC did not investigate whether any of the mental health patients that came within the scope of its survey had been subject to such treatment. When carrying out this investigation it should have taken account of the ruling of the European Court of Human Rights in the 2012 case of Gorobet v Moldova (para 52): forced treatment which had not been shown to be a medical necessity could amount at least to degrading treatment within the meaning of Article 3 of the Convention. I personally am aware of treatment which belongs in this prohibited category and have written about it in some my papers.

     The MWC is to be commended for carrying out several worthwhile investigations. But its findings would be even more worthwhile if it paid greater heed to human rights issues and to the reality of the dreadful experiences of some involuntary mental health patients. It is to be hoped that the Scottish Government can be persuaded to do this."


'Staff shortages blamed for leaving mental health patients in fear': Helen McArdle, Herald Scotland 13 April 2017:


"A review of 47 mental health wards across Scotland found that one in five patients feel unsafe during the night on hospital "due to reduced staffing levels", with one patient telling inspectors they had "put a chair against my door because of the violence and the shortage of staff". Another patient complained that the atmosphere could be "quite frightening" due to patients with drug and alcohol problems, swearing and talking past midnight on mobile phones. 

The report, published today [Thu] by the Mental Welfare Commission for Scotland, said safety was a "significant issue" for women in particular, with 28 on mixed wards saying they had felt unsafe compared to only two men. Only four of the 47 wards visited were single sex. ...."

"Scottish Labour Inequalities spokeswoman Monica Lennon MSP said: "No one should be made to feel unsafe or be subjected to sexual remarks, especially not vulnerable patients in our hospitals."


More of my tweets this morning:

Saturday, 8 April 2017

my comment #CriticalPsychiatry 7Apr17 RD Laing "experiment in unstructured living"

An experiment in unstructured living for people with mental health problems: Critical Psychiatry blog post 7 April 2017, Dr Duncan Double, and my comment:

"unstructured living": not a good idea in my experience of psychosis and having to survive psychiatric treatment in 1978, 1984 and 2002. It required planned action firstly in resisting coercive drug treatment to which I was forced to conform on each occasion. Then, when strong enough, tapering the antipsychotics and taking charge of my own mental health. I couldn't have done this without structure and the support of family. You might describe it as being like a campaign or strategy. An end goal with steps to achieve it. Recovery the aim.
Courier article 7July15
I experienced another psychosis in 2015, a physical and mental health breakdown after years of campaigning for justice following my youngest son's abusive treatment in Stratheden psychiatric Hospital, Fife. Despite winning an Ombudsman case and apology from NHS Fife I didn't feel that justice had been done. Scottish Government awarded £4.4million to the Fife health board following my whistleblowing about the locked seclusion abuses, to build a new Intensive Psychiatric Care Unit, which is now up and running, about half a mile up the road from where we live. The bus we take into Cupar goes by the new unit, stopping to let psychiatric patients on. 

My altered mind state or reactive psychosis in the summer of 2015 did not require psychiatric inpatient treatment. Rather I was supported by family and virtually via Email with clinical friends, a doctor and psychotherapist. Both of these men listened to my ramblings non-judgementally, with mutual sharings and humour, a life saver. Social networking was a useful outlet. Plus I took Lorazepam on two separate nights to get my sleep pattern back on track, removing any stimuli like TV and books from the bedroom. Not sleeping through the day even if tired. I took up various activities again, to relax, including knitting, sewing, swimming, fitness, eventually cycling which I hadn't really done before, seriously. Now I have 3 bikes.
at Drayton Park 19Jul16, Shirley on left, Hannah on right
Regarding the Philadelphia Association Community Houses in London, I tried to visit them in July 2016, via Dr Bruce Scott who I know, in preparation for my PhD research into Safe haven crisis Houses, starting this September at the University of Edinburgh, Clinical Psychology department. However this wasn't possible. I did manage to arrange a visit to the Drayton Park Women's Crisis House, Camden and Islington NHS Foundation Trust, meeting with Shirley McNicholas who developed this resource over 21 years ago and is still the Manager. This was a positive experience, seeing the facility and learning about the organisation. I've also visited the Leeds Survivor Led Crisis Service, back in 2011, and hope to revisit during my research, which will be to evidence good practice, a mixed methods approach, qualitative and quantitative, hearing stories and gathering information about management and leadership styles, budgets etc. Focused research and a larger scoping or mapping exercise.
I want to see alternative (to psychiatric inpatient treatment) respite crisis support for people experiencing psychosis in Scotland. Choices of therapy, not just medication/drugs. And support in tapering psychiatric meds by psychiatrists, psychologists and peer workers, people with lived experience of coming off prescription drugs and making a full recovery. As I did and others have done. Our testimonies should be an important part of the mix, at the table during clinical meetings, alongside diagnoses and drug prescribing. Rather than on the periphery in blog posts and tweets, or in case studies and "vignettes".
Thanks for listening."

8 April 2017 at 10:44          

Wednesday, 5 April 2017

#Windhorse & Basic Attendance Workshop London 3May17 - Anne Marie DiGiacomo Colorado USA

Windhorse and Basic Attendance – A One Day Introduction with Anne Marie DiGiacomo; Wednesday 3 May 2017: 9:30 am - 5:00 pm; organised by Open Dialogue UK  

St Barnabas Dalston, Lower Hall, Shacklewell Row, London E8 2EA

"The ground of the Windhorse approach is one of viewing a person from the perspective of their history of sanity. This involves bringing awareness to a person’s basic sanity and health as opposed to focusing on the notion of pathology. It is from this experience of noticing one’s history of sanity and our natural tendency to be drawn to the intrinsic wholeness and health of a person that the practice of basic attendance springs.

The view of basic attendance suggests that rather than doing something we could simply slow down and begin to appreciate and understand the world of the person we are with. We can allow ourselves to see the world through their eyes. This kind of approach involves being fully with someone, listening to them and appreciating the wholeness and integrity of that person and their environment. Any activity or actions comes out of that naturally."


"the awakening of compassion was a quantum leap": recovery from psychosis

'The Seduction of Madness' by Dr Edward M Podvoll, 1991 Ed, Random Century Ltd, page 47

awakening of compassion

13 February 2016: Staying Well After Psychosis: Contents trajectory; fear of relapse; professional belief system #Podvoll

24 February 2016: "whatever recovery he achieved depended on his memories of these truths" Podvoll 1990