Present: No list was passed round at this meeting so there is no record of who attended this meeting.

Apologies: Mark Bertram, Peter Campbell, Peter Linnett

Dave Harper offered to chair the meeting but welcomes volunteers to chair other meetings. As decided last week, Dave said the main part of the meeting would be devoted to discussing the proposed new mental health act which is currently at the stage of a white paper. Mike Crawford and Rufus May were invited to make short presentations on their views of compulsory treatment which forms a large element of the proposals.

• Anne Cooke drew attention to the Mental Health Alliance Week of Action which started on April 2^nd. There is information on the MIND website. We may want to join in with this.
• Duncan has setting up a website of the group at www.criticalmentalhealth.co.uk

Mike Crawford presented his understanding of the proposed legislation under the new mental health act. He said a key issue was what the proposals were in relation to compulsory treatment and whether it would be likely to increase or decrease how compulsion is used. One question was why was the 1983 MH act being changed?

He did not find any convincing well-thought out rationale to this. Rather, the legislation seemed to have been drafted on the back of a couple of speeches by Frank Dobson (Minister of Health) around the time of some sensational media coverage of incidents of harm to self and others involving individuals with a history of use of mental health services. Frank Dobson had stated in a speech that ‘care in the community has failed’ and stated that the ‘law must be changed’ and that ‘non-compliance with agreed treatment is not an option’.

The new legislation allows compulsory medication to be given outside of hospital settings (eg in clinics or CMHTs). Mike said he thought that another aim of the legislation was to decrease bed use in hospitals since this is very expensive for the government. He said that the current requirement that a person is admitted to hospital for compulsory treatment puts a ceiling on the numbers of people that can be treated in this way.

He commented that the increasingly defensive attitude towards treating people who have mental health problems seems to be leading to a tendency to increase the use of coercion. Comments and questions were invited.

One person commented that there was a letter in the Observer the other day arguing that people should be given the choice of having compulsory treatment at home or admission to hospital for sanctuary which need not involve treatment. He said his personal view was against compulsory treatments of any kind. He was in favour of having hospitals as places of ‘asylum’ or ‘sanctuary’ not ‘treatment’.

Rufus May gave the next presentation. He mentioned two people he had spoken to recently in his role of psychologist in a CMHT. Both wanted to come off their medication – one because of weight-gain the other because he doesn’t feel it is doing him any good. Rufus felt he wanted to be able to find a way of negotiating a gradual coming off the medication with them which wouldn’t be possible if there was a sense of ‘compulsion’ around.

Rufus said he thinks we have enough compulsion. What is needed is to build up a culture of negotiation and collaboration. He pointed out that many outcome studies of recovery from mental health problems stress the importance of a good, trusting relationship. This is seriously endangered when there is the threat of compulsion.

He talked about a recent study in a hospital in Bradford where instead of the nurses work being taken up with having people on different levels of ‘observation’, the nurses were told to interact in a therapeutic way instead. Violent incidents reduced considerably, as did the number of people seen to be needing observation, absconding reduced and ‘staff absconding’ (time taken in sickness).

Rufus said he believed that by not engaging with someone as a person but as someone who needs to be controlled, we prevent recovery. He said if people are treated irresponsibly, they behave irresponsibly.

A member of the group made the point that although the media present sensational articles which often demonise people with mental health problems, they could also be used the other way around. For example, what about deaths in psychiatric hospitals caused by control and restraint Louis Appelby (the Mental Health Czar) is looking into this as part of his enquiry -- discussed in a recent Health Services Journal Article. Perhaps enough is not being made of using the media in this way. If the legislation is passed as it is, perhaps we need to be vigilant for cases where compulsion in the community has fatal consequences and make sure these are publicized.

Another person present said the problem was there was no voice for people who have come out of mental health services. Women now have a voice, gay people have a voice of political legitimacy which is recognised, ‘Reclaim the streets’ have a voice but survivors of the mental health system do not. She said ‘We are not given the status of experts on our own experiences, we are ‘victims’ ’.

Someone else noted that the media need to emphasise the ‘normality’ of people with mental health problems – ‘we are normal people who have had certain life experiences…’ The statistic 1 in 4 (people who experience mental health problems) should be used.

Diana Rose pointed out that David Brindle (editor of Guardian ‘Society’ pages) now published good stuff on mental health and this is the result of months of hard work by a mental health group, winning him over.

Someone else from the floor said that ‘capacity’ could be used to decide whether someone should have a compulsory treatment or not. It should be up to society to decide what constitutes treatable behaviour. Instead, the government has decided to leave it to doctors to decide on diagnosis and treatment. The responsibility is not left with society but is handed over to certain ‘professionals’ to make these decisions.

Someone pointed out that who is ‘banged up’ has changed with society’s view of what is acceptable eg women being put in asylums for being unmarried mothers decades ago.

Another person noted that in-patient treatment was so awful that she would rather be on compulsory medication at home if it was time-limited and could prevent admission. Someone else suggested that before compulsory drug treatment is considered as an option health services should have a duty to show they have tried other kinds of treatment, such as psychological treatments. It was pointed out that in the white paper ‘treatment’ is used to mean ‘drug treatment’ as if that is the only kind of treatment available. People are labelled ‘treatment-resistant’ when only drug treatments have been tried – no psychosocial interventions. 98% of people never get offered anything but medication. The message the public get is that every other avenue has been tried and medication is the last resort. There is plenty of evidence that prescribing is irrational and often people are over-medicated.

One person said that there was a place for just sanctuary where people would just treat you like a human being and not make any interventions at all. People would get better quicker that way. Someone quoted a statistic about more people with schizophrenia getting better if it was left to take its natural course, than if it is ‘treated’.

Another person commented that the key to change was in either raising managers’ anxiety about things or promising to alleviate their existing anxiety. One thing they are anxious about is spending lost of money on beds in the private sector. Would be good to suggest an alternative to this.

What to do ? Do we join the Mental Health Act Alliance’s action ? They have said they are not against community treatment orders per se (this is NSF’s view). Some people present are against compulsory treatment of any kind. Some are against the new legislation. Others think compulsory treatment in the community may be preferable to compulsory treatment in hospital, if the legislation is drafted carefully (eg to be allowed only if other options for treatment than medical have been tried).

May be we should campaign for places of ‘asylum’. At the moment they do exist but are badly funded because they are not medically run.

Do we: 1. Make a statement strongly against the new legislation, even if we think it is still likely to go through ?

2. Try to suggest some amendments in a damage-limitation exercise ?

1. debate about the name of the group: important for publicity of the group that the name is clear and says something about what we are about
2. ground-rules: eg to have a break half way through to allow for more informal discussions/cigarette break
3. to think further about a statement on the new mental health act

1. To think further about how the media works and how to ‘action’ it.

£10.98 was left over from 17 January meeting which was put towards the £30 cost of the room at this meeting. £26.78 was raised tonight. After payment for the room we were left with £7.76 which will again be put towards the hire cost for the meeting on 25 April.