Thursday 16 April, Dr Alex Thomson: ‘Patients should not be coerced into treatment‘ Institute of Ideas:
“Those with mental-health issues deserve the same rights as everyone else. We must scrap the Mental Health Act 1983 (England), says Dr Alex Thomson.
Modern medical practice is based on the principle that we are all entitled to make fully informed decisions about our medical care. We are all free to agree or disagree with our doctors and accept or disregard their advice. We can choose how healthily we eat, whether or not to drink more than we should, and whether to smoke or take drugs. If we develop an illness and need medicines or surgery, then we can listen to the medical recommendations and perhaps choose between alternative options, but it’s up to us to choose whether or not to accept treatment and nobody can force us to do what we don’t want to.
Of course, if we become temporarily incapable of making decisions, for example through serious illness or injury, then decisions can be taken on our behalf using a framework set out in the Mental Capacity Act 2005. This basically means that if we lose the ability to understand, remember and weigh up the information needed to make a decision, or we are completely unable to communicate, then healthcare staff can decide what is in our best interests. This needs to be based on both the medical condition and an understanding of our personal preferences and circumstances.
However, there is one category of illness where decisions can be made for you even if you are capable of making them yourself. According to the Mental Health Act 1983, there is no requirement to test whether or not you are capable of making decisions. Forcible hospitalisation and treatment can be given if you appear to be mentally unwell and, in the eyes of the assessing doctors, your safety or others’ safety might be at risk. There are two reasons why this is a problem. Firstly, it continues to divide illnesses into ‘mental’ and ‘physical’ in a way that perpetuates stigma and prejudice without being medically useful. Secondly, it makes it easy to use shortcuts: why should an overstretched, understaffed mental health service spend the all the time that is needed to explain your condition, discuss treatment options and seek your views, when they can just forcibly give you treatment anyway?
Repealing the Mental Health Act 1983 would not mean that people with severe mental illness cannot be treated. Most people who are admitted to hospital under the Mental Health Act don’t have capacity to make decisions about their care and so the Mental Capacity Act would apply. However, the requirement to formally test and to take into account a person’s decision-making capacity would radically alter clinical practice. It would oblige healthcare staff to explain the treatments on offer and the reasoning behind their recommendations, since it is impossible to test whether somebody can understand, remember and weigh up the relevant information unless you actually communicate it to them. It would also oblige staff to listen to and consider the reasons behind patients’ decisions. This might just lead to mental health services based around dialogue, collaboration and mutual respect rather than force or the threat of force.
Dr Alex Thomson is a psychiatrist working in London. Follow him on Twitter: @AlexBThomson.”