File under “Whose Interests Are You Really Trying To Protect?”
With the Mental Health Bill for England and Wales going through Committee stage in the House of Commons, the BMA is concerned that the proposed legislation will harm patients with mental health disorders.
Currently two doctors [at least one must be a consultant psychiatrist] have to agree before anyone is detained under the Mental Health Act but the Government is proposing to change this and widen professional roles within this field.
Under the new Bill, it is proposed that doctors, psychologists, nurses, occupational therapists and social workers could receive training that would enable them to have overall charge and be the responsible clinician for a patient who is sectioned. This could mean that for some patients there could be the possibility of no medical input at all.
The Chairman of the BMA psychiatry committee, Dr JS Bamrah, said today:
“Psychiatrists have undergone in-depth and intensive medical training so that they can provide the best, up-to-date health care to patients suffering from mental health disorders. As the delivery of mental health services is multi-disciplinary, there should be recognition of the professional roles involved but the Government’s proposals go too far.”
“A decision to detain a patient is a very serious one and it would be irresponsible to by-pass clinicians when detention decisions are being made. We strongly urge the Government to think again and ensure that psychiatrists are fully engaged in caring for these very vulnerable patients. It is well documented that psychiatric patients often suffer from a range of medical problems so it is vital that the clinician responsible for their overall care is also able to deal effectively with a range of health issues.”
The reality is that this is scaremongering and professional protectionism of the worst kind. First, as a psychologist I don’t have a medical degree. I don’t have the legal right to prescribe medication or to recommend or perform medical procedures, and I don’t believe psychologists should be given that authority, despite what some of my colleagues in Canada and the US may say to the contrary. But I don’t need a medical degree to provide an accurate mental health diagnosis (indeed, many of the members of the committees who have worked on various versions of the Diagnostic and Statistical Manuals [DSMs] which define the criteria for those diagnoses have been psychologists or other professionals without medical degrees). And I don’t need a medical degree to be competent to determine imminent danger to self or others at least as well as a psychiatrist.
Second, the statement that someone could be hospitalized as an involuntary patient without involving and physician or psychiatrist at all is ludicrous, not the least because a physician of some type would need to be involved to prescribe any psychotropic medications, and it’s difficult to believe that someone meeting the criteria for involuntary detention under the mental health act would not require some sort of medication as part of that hospitalization.
And third, involuntary detention is always limited in scope and always requires review by mental health practitioners beyond the admitting practitioner, physician or otherwise. In Canada, that means the case must be reviewed after 72 hours to ensure that the patient still meets all of the criteria for involuntary detention.
I find it hard to believe that the protest of the BMA has anything really to do with the welfare of the patients who may be affected by the proposed new legislation. Frankly, I think it has far more to do with fears on the part of the BMA that the traditional sanctified hierarchical position of their member psychiatrists might be eroded should the legislation pass – and that, of course, might translate into some loss of income for the profession at the same time as it improves service to mental health consumers and their families.
UPDATE: A Bogus Poll
Today, this report from the Royal College of Psychiatrists attempts to claim that the British public is opposed to the new legislation:
“The public do not support proposed laws that would make it easier to detain and treat people with mental health problems against their wishes, according to a YouGov poll published today.
The poll, commissioned by the Royal College of Psychiatrists, showed that 72% of those surveyed do not think that people with mental health problems should be forced to have ‘treatment’ from which they cannot benefit. And 68% do not believe that hospitals should be used to detain people with mental health problems if they cannot benefit from treatment and have committed no crime.”
What’s wrong with this survey?
The UK psychiatrists are asking questions in a way almost guaranteed to elicit a negative reaction. And they are doing so without providing respondents with the information needed to make an informed decision.
This is almost a replica of how civil rights activists have opposed the implementation of “Kendra’s Law” in the US. Those states that have approved such legislation to date have not seen the predicted mass involuntary detentions – again, this is scare-mongering at its most blatant.
The goal is not and never has been to hospitalize individuals who do not need to be hospitalized. The goal is to facilitate the involuntary treatment of individuals who are a clear and imminent danger to self or others and who lack the capacity to make informed decisions regarding their own welfare. And in the case of the UK legislation, the proposal is to allow mental health professionals other than psychiatrists the authority to make such decisions within existing legal and ethical restrictions on involuntary hospitalization.
And THAT is the real reason for their vigorous opposition to this bill.
mental health legislation, mental health treatment, politics of health care