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May 20 2023
Failure by the NHS to adhere to the United Nations Convention on the Rights of Persons with Disabilities

This article was written by an anonymous guest author

This post references:

UN Special Rapporteur on Torture

UN Convention on the Rights of People with Disabilities

UK Mental Health Act (1983)

We are at a pivotal crossroads on our path towards a fairer society, faced with a monumental issue that, while hidden, carries unsettling implications.

The UK’s National Health Service (NHS) has repeatedly been implicated in serious violations of human rights, as outlined by the United Nations conventions on the rights of disabled persons. This is not merely an affront to international law; it’s a harsh, terrifying reflection of the suffering inflicted on people with disabilities under the pretext of health care provision.

The UK Government’s ratification of the UN Convention in 2008 was a potent commitment to protect disabled people’s rights, obligating domestic legislation to align with its principles. However, as we traverse through 2023, it’s distressingly apparent that the NHS has systematically breached this social contract, casually discarding the rights of the disabled.

The NHS’s Mental Health Act 1983 blatantly contravenes the UN Convention, notably:

• Article 12, Equal Recognition Before the Law: This Act permits restriction of legal capacity based on mental health status, infringing upon personal autonomy and decision-making rights.

• Article 14, Liberty and Security of the Person: This Act shockingly allows involuntary detention and treatment of people with mental health conditions based on their disability, violating their right to liberty and security.

• Article 15, Freedom from Torture or Cruel, Inhuman, or Degrading Treatment or Punishment: This Act neglects to shield individuals from non-consensual treatments such as electroconvulsive therapy and psychosurgery, which could amount to torture or inhumane treatment.

These issues have persisted for years. In 2013, the UN Special Rapporteur on Torture called for an outright ban on these reprehensible practices.

Regrettably, the proposed Mental Health Act reforms lack the depth needed to align the NHS fully with the United Nations Convention. A fragmented approach is grossly insufficient in addressing these grave infractions.

The field of psychiatry has largely remained reticent on this matter, often keeping these concerns concealed. The victims, who are often society’s most vulnerable, have their stories systematically suppressed.

Alarmingly, our media has mostly remained mute, a tacit accomplice to these profound human rights violations. The much-needed transparency is missing, replaced by a stifling silence that only magnifies the problem.

We must break this silence with knowledge, empathy, and decisive action. Disseminate this information broadly. Challenge the apathy that perpetuates these horrors.

We must unite and place collective pressure on the NHS to uphold its duty to protect the rights of disabled persons. The time for change is now. Let us stand together and navigate our society towards a future where health care is genuinely fair, and human rights are unreservedly respected.

David Gray-Hammond 1 Comments
May 9 2023
How many Autistic people are in inpatient units in the UK?

When we consider the world of inpatient psychiatric care, we often think about types of neurodiversity like schizophrenia and bipolar. While it is true that these individuals represent a considerable number of admissions, there is a darker side to admission to hospital. Detainment and admission is not solely the realm of traditional psychiatric “conditions”; Autistic people are being locked away for months or even years.

This issue has become so prevalent that the government has had to commission inquiries and reports into the matter. Still, there are a disturbing number of Autistic people locked away in these institutions.

According to the National Autistic Society, as of January 2022 there were 1,185 Autistic people held within the inpatient psychiatric system. Of this, around 1 in 7 (165) were under 18 years of age. It’s not just Autistic adults being detained, it’s our children too. This represents a stark departure from the so-called schemes of “care in the community” that promised to empty asylums and create a community culture of caring for our most vulnerable.

Instead what has happened is the systematic incarceration of Autistic adults and young people for no other reason than not having the correct services in place to support them in their independence. This becomes even more concerning when you consider the current rate at which care home and inpatient units are experiencing scandals around the mistreatment and abuse of those they are supposed to care for.

Autistic people are being abused daily in these settings, despite evidence to suggest that inpatient units are inappropriate settings for Autistic people. What we are seeing is the systematic practice of locking away people because our society is unwilling and unable to give them meaningful support at home. To my mind this is against the Mental Capacity Act (2005), in particular principles 4 and 5 of the Code of Practice:

“An act done, or decision made, under this Act for or
on behalf of a person who lacks capacity must be done, or made, in his best interests”

Principle 4, Mental Capacity Act Code of Practice

“Before the act is done, or the decision is made,
regard must be had to whether the purpose for which it is
needed can be as effectively achieved in a way that is less
restrictive of the person’s rights and freedom of action.”

Principle 5, Mental Capacity Act Code of Practice

Given that inpatient treatment does not improve outcomes for purely being Autistic, there is a significant and unresolved risk of abuse, and the overt removal of a person’s freedom, I would argue that both principles 4 and 5 have been failed. One might argue that the Mental Health Act (1983) should take precedence which allows for the detention of people who are at risk to themselves or others.

First I would bring your attention to this section of the Code of Practice:

“The MCA should be central to the approach professionals take to patients who lack
capacity in all health and care settings (including psychiatric and general hospitals).
The starting point should always be that the MCA should be applied wherever
possible to individuals who lack capacity and are detained under the Act.”

Section 13.11, Mental Health Act Code of Practice

We have to consider what is being classed as risk, and whether the deprivation of a person’s liberty is necessary. I posit that in most cases, Autistic people remain in inpatient settings because services have no resources to appropriately address their dysregulation in the community.

An Autistic person’s freedom should not be decided by government funding.

To boot, the prinicples of the act itself state that professionals should use the:

“Least restrictive option and maximising independence”

SWLSTG NHS Trust

In what world is indefinite detention in an institution the least restrictive option? Since when does detention be decided by community resources? This is a dangerous precedent to set, it opens up the entire neurodivergent community to facing detention.

When we consider the Royal College of Psychiatrists disturbing statistic that Autistic people are nine times more likely to die by suicide, and combine that with the fact that according to The Nuffield Trust there were 1,357 suicdes in 2019 amongst people who had been in contact with mental health services. Something is going very wrong, and I suspect that, in part, it is the number of Autistic people being detained wrongfully under The Mental Health Act.

It is clear that this situation is out of control. Autistic people should be supported to freely live their lives, not spend years locked in seclusion rooms suffering chemical and physical restraint as a daily practice. Sadly, until such time that our government supplies appropriate funding and resources to services, we are going to continue to witness the systemic mistreatment and killing of Autistic people.

We are Autistic, not monsters to be hidden away from society.

Make sure you check out the CAMHS crisis resource page.

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David Gray-Hammond 1 Comments
Aug 25 2022
The Mental Health Act (1983) explained

The mental health act of 1983 (updated 2007) is legislation in England and Wales that puts into law the individuals rights regarding mental health treatment. In particular, it talks about the individuals rights with regard to inpatient treatment. This is an issue of significance to the Autistic community.

Patients in an inpatient setting can be either formal (detained under the mental health act) or informal (they are inpatients volutarily). For the purposes of this article, we will look at the sections that can be used to detain an individual against their will, and what their rights are with regards to their use.

Section 136

This pertains to the removal of an individual from a public space, to a place of safety, for assessment. This is carried out by police. Under this section you can be held for assessment for up to 36 hours.

Section 135

This section allows police to enter a private place (not public) to detain you for assessment. To do this, they must have permission from magistrate. Again, you can be detained for up to 36 hours.

Section 2

Under this section, you can be detained for up to 28 days in a psychiatric facility for assessment and treatment. People held under this section can be treated against their will. It is unusual for a section 2 to be renewed.

Section 3

This section can be renewed.

Initially you can be detained for 6 months, it can then be renewed for a further 6 months. After this period subsequent renewals allow for 12 months of detainment. This section should only be used for yourself and others safety, and where treatment cannot be provided as an outpatient.

Section 5(2) “Doctors Holding Power”

This section allows a doctor or other approved clinician to detain you for up to 72 hours. This section requires a report to be made to the hospital manager. You are most likely to come across this as a voluntary patient.

Section 5(4) “Nurses Holding Power”

This regards detainment by a specially qualified nurse. You can be held for up to 6 hours, or until a doctor or clinician with the power to detain you arrives, whichever is earlier.

Section 117 aftercare

This section describes the legal duty to provide aftercare for those discharged under sections 3, 37, 45A, 47, and 48. this also applies if you are under a Community Treatment Order (CTO).

Community Treatment Orders

This is similar to being “on licence” from incarceration. A CTO allows you to be treated in the community under certain conditions. If you break the conditions of your CTO, you can be recalled to hospital.

This is not exhaustive, the mental health act contains a great many sections, but these are the ones you are most likely to encounter standardly.

Remember

If detained under section, you are legally entitled to an Independent Mental Health Advocate (IMHA) and a Second Opinion Approved Doctor (SOAD). You also have the right to go to tribunal and ask that your section be ended.

David Gray-Hammond 0 Comments
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