It has recently come to our attention that British law and culture still focuses on those with mental health problems as being “public protection” issues, with patients remaining the subject of fear and derision in a way those with physical ailments would be all too ready to complain about.
We are well aware that many troops returning front the front line face enormous difficulties dealing with Post Traumatic Stress Disorder, and that about a third of victims of sexual violence will also develop similar symptoms. One might expect that in the 21st century major advancements in medical care and treatment of those with PTSD would mean that care providers are in a position to offer specialist care and treatment for this terrifying and debilitating condition. Not so. It took a long time for war veterans with what was once known as “shell shock” to be acknowledged as deeply traumatised and need in support, treatment and understanding. Only someone who lives with the condition, or is close to someone grappling with it, knows of the poison it spreads whilst it remains untreated.
When the Joint Committee on the Draft Mental Health Bill in 2004 explored the history of treatment for mental illnesses, some recurring themes emerged. They recorded,
“Mental health legislation has at least three centuries of history behind it. Many of the issues which the current Government and this Joint Committee have had to address would be familiar to our predecessors since at least the beginning of the 19th century. At the heart of these is the question of how we as a society balance the care and the control of people suffering mental distress or disorder. It is an issue which raises fundamental questions about personal autonomy and liberty, the role of the state and the extent of its powers and responsibilities, public attitudes towards people who are mentally-ill, developments in medical and behavioural sciences, the clinical judgment of medical practitioners and other professionals and complex questions of medical science, ethics and belief.
The history of legislation in the United Kingdom authorising detention of people with mental disorders reaches back to the Vagrancy Act 1744, which allowed unregulated confinement of the “furiously and dangerously mad”. Legislation in the 18th and early 19th centuries progressed from pure confinement to an emerging concern about the abuse of the mentally disordered in asylums. By the beginning of the 19th century people with mental illness were beginning to be seen as a separate group, whose needs were not met in workhouses or Houses of Correction. The County Asylums Act of 1808 provided for asylums to be built in “airy and healthy” locations, to which patients who were too “dangerous to be at large” were admitted. The emerging emphasis on the protection of “lunatics” against abuse led to a requirement in the 1828 Madhouses Act for all asylums and private hospitals to have a medical officer. Patients who recovered were to be discharged by the visiting justices. In 1845, the Lunatics Act marked another significant shift with the creation of a national system of inspection of standards in the form of the Lunacy Commission.”
We know anecdotally, that being presented with the prospect of being “sectioned” holds a great deal of fear for those either with or without a condition in need of treatment, as it raises the spectre of being treated and detained like a criminal, and the loss of one’s autonomy and liberty simply for an (often treatable) illness. The recent national Mental Health Awareness Campaign, Time to Change wouldn’t exist but for the need to keep raising awareness and challenging prejudices against those with mental illnesses.
But whereas most of the powers under the Mental Health Act are strongly balanced in favour of using informal admission (i.e voluntary hospitalisation) for those in need of help and treatment, the police retain archaic powers to detain people in a police station for up to 72 hours on a spurious assessment of the targeted person’s condition. If you’ve never heard of section 136 Mental Health Act 1983, look it up, it might strike terror in to the hearts of any right thinking person with even the most generous view of the police’s understanding of mental health issues. Under section 136, a police officer can detain someone s/he believes appears to be suffering from mental illness in a public place and remove them to a place of safety. Despite many constabularies’ protocols and longstanding opinion that a police station ought no longer to be regarded as an appropriate place of safety for the mentally ill, the local nick is where a lot of people are routinely taken, often exacerbating their condition and criminalising their illness. There’s no better way to remind a distressed person of the state’s attitude to their mental condition than locking them up in a police cell for hours or days without charge. Hence, the similarities to 18th century Vagrancy Acts that allowed “lunatics” to be incarerated can’t be underestimated. The disproportionate use of this section against the black community has also raised serious concerns about its misuse.
If we are to embrace the improved understanding of mental health in the 21st century, we perhaps need to stop obsessing about the cases of dangerous and ill persons as a reason to criminalise a whole host of people, who like, the PTSD sufferers, are ordinary people made ill by extrordinary and traumatising events they have experienced. Being locked up by a police officer is probably the worst thing that can happen to someone in those circumstances.
