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POPPY’S smile wit and frequent and funny use of expletives was something that her friends loved about her. A close friend said: “Poppy was beautiful inside and out and she often advocated for others in need.”
Despite that, it took a long time for Poppy to trust people, but one day she felt she needed to talk and even though she still wasn’t sure about her mental health team, she decided to sit down with her mental health social worker and a psychiatric nurse.
Over the next hour she disclosed that as a young child she had been abused and described in violent and graphic detail what she would like to do to her abuser if they ever crossed paths, though made it clear that in real life she would be too frightened to do anything at all.
Talking about this time in her life led to her mood tumbling down and, as a result, she made a serious attempt on her life. When she woke up in hospital and realised she had been unsuccessful, she escaped from the hospital and on a railway track made another attempt on her life.
The police charged her with “a breach of the peace” and “trespass.” During the trial “expert evidence” disclosed the details of what Poppy said to her social worker and psychiatric nurse regarding her violent thoughts about her abuser. Poppy was sent to prison for six months.
Suicide was decriminalised in 1961, so why are psychiatrists and other mental health staff supporting the police and prosecution so service-users like Poppy can be imprisoned, or threatened with legal action for being suicidal or showing suicidal intent?
The ethical responsibilities of those who work in mental health prioritises what is in the best interests for a patient. For example, a clinical psychologist has to “promote and protect the interests of service-users and their carers.” A psychiatric nurse has to “prioritise people.” A psychiatrist has to “make care of their patient their first concern.”
It might be hard to focus on patient-first priorities with such constraints in the sector and lack of bed availability. Yet with the use of Criminal Behaviour Orders (CBOs) Community Protection Notices (CPNs) as well as other legal recourses, it would appear patients become targets to blame. Rather than the spotlight on the need for more resources — threats and punishment get heaped upon those patients who, in asking for help, get depicted as attention-seeking, or as high-intensity callers.
These cuts to services and the subsequent action towards patients worried retired consultant psychiatrist Linda Gask, who said: “Crisis services should have sufficient time to provide compassionate care for those who attend. They should never be concerned with ‘controlling’ a vulnerable person’s behaviour.”
Prosecutions often involve such cases when suicidal intent is shown in a public place, such as a motorway bridge or railway track, where in some instances roads have to be diverted or trains stalled.
The cost financially of such action seems to be linked as to whether legal action is carried out, but other factors are involved, such as the diagnosis the individual has been given.
Many of those charged have the contentious label of borderline personality disorder (BPD), that is also called emotionally unstable personality disorder (EUPD).
Consultant psychiatrist Samei Huda said there were several problems with the BPD label. He argues the label is misleading, as it does not appear to be a disorder of personality: 90 per cent of cases seem to be linked to trauma, so “complex trauma” a better term. For the other 10 per cent “mood instability” seems more appropriate.
BPD has so much stigma attached to it that healthcare professionals deal negatively with such patients resulting in poor care.
If healthcare and other emergency staff don’t fully understand the arguments around this label, are they more likely to charge those with the disorder, assuming they don’t have an illness?
For Jade, this was a factor in her case. After being discharged from a psychiatric hospital, where she had been sectioned, Jade found herself struggling and unable to cope.
One day she found herself on a motorway bridge, her whole body shaking as she climbed over the ledge. In her only attempt to reach out for help she sent a text to mental health service Shout.
When the police found Jade, she was handcuffed and taken to the station: “I was told an officer would contact my child and adolescent mental services (CAMHS). When he returned, I knew immediately something was wrong.
“He arrested me and charged me with ‘wasting police time’ — I knew there and then something had been said to him by the CAMHS. I was put in a cell for eight hours then interviewed by angry officers who said I was attention-seeking and not ill.”
Jade said: “It made me feel like reaching out for support only got you in trouble, that the services who say, ring us for support before you breakdown, are actually lying and tricking you. Being arrested for being suicidal and then having to spend month and months under investigation was such a distressing time. I’m still dealing with the trauma associated with it.”
Of course, there are times when mental health professionals need the involvement of the police. If there is an immediate risk to the life of an individual with mental health problems, or the life of someone else and this person is refusing emergency treatment, the police might be called to assist in order to place the patient on a section 136 of the Mental Health Act, or section 297 in Scotland.
If a mental health service doesn’t have a 24/7 urgent response, it will sometimes ask patients to call police, however, this can also happen even when a 24/7 response service is in place.
Suzy who has OCD, was advised by the 24/7 urgent response team to ring the police after being refused a mental health assessment at the hospital and a bed at the crisis house. Within minutes of putting the phone down she was arrested by police who appeared at her door.
“I was charged with breach of the peace and wasting police time, even though there was nobody else in danger and no disruption to the police.”
While they “investigated” she was placed on bail. Conditions of the bail included that she could be remanded in custody if she didn’t go to the hospital when the police requested her to do so.
This terrified Suzy: “I knew someone who lived in my area who was remanded in prison because the court felt she was a such a high risk, yet the local mental health services had declined to help,” Suzy said. “She spent two weeks in prison and killed herself not long after she got out.”
The deciding factor as to whether to prosecute was a claim that on the night she was arrested, Suzy had made 24 calls to the police. This was patently untrue.
“As soon as my solicitor found this statement from the acting inspector, he was able to disprove it, but by this time it was too late as the prosecution was underway.”
During the seven months while she was on bail, Suzy was deteriorating mentally and physically. Her GP wrote to the court saying he thought she might die if the prosecution continued. Meanwhile her solicitor had asked her psychiatrist and psychologist to give statements.
They both refused and one even told the solicitor that “prison might be good for Suzy.” The legal formalities ended when after seven months the prosecution deserted the case by presenting “no evidence.” The psychological trauma from that time continues to this day.
Using the legal system in this way, in an age when mental health resources are scarce with many unable to get help is a subject that Professor in Discursive Constructions, Dariusz Galasinski argues is due to the political nature of medicine.
“As a society, we give that power to medics and tolerate it when it is wielded because we consider it in our interest — they take care of our health and wellbeing. In other words, we give that power to medics because we assume they will have our backs.
“When the notion of ‘getting a grip’ is placed in the context of scarcer and scarcer resources, the need to tell people to be in control of themselves becomes more acute. ‘Wasting police time’ becomes shorthand for absence of mental health resources.
“In suicide you cannot ‘get a grip.’ Your life takes to the edge of experience and as stand on the precipice, you need help. And that help should come from medicine, from the system of mental health — because they are supposed to have our backs.
“When mental healthcare professionals join the state to punish you for finding yourself at the precipice of life, they no longer are committed to the priorities we, as a society, give them.”
This “punishment” is what Poppy had to endure. When she left prison after her six-month sentence, her family and friends said how different she was — her manner subdued and often anxious “the spark had gone out.”
Over time, Poppy’s mental health deteriorated further. The abuse she had suffered in her early life morphed together with the terror connected with her imprisonment. One day, while she was a psychiatric inpatient and meant to be on a one-to-one supervision, this weight culminated in her taking her own life.
There are no justifiable ethical or clinical benefits from threatening or proceeding with legal measures against services-users. Instead, a “patient-first” focus should be on bolstering the under-resourced mental health sector so that such patients can get the help they need.
When life is difficult, Samaritans are here — day or night, 365 days a year. You can call them for free on 116 123, email them at email@example.com, or visit samaritans.org to find your nearest branch.
Dariusz Galasinski is a professor in Discursive Constructions. His latest book is Discursive Constructions of the Suicidal Process.
Linda Gask is Emerita professor of Primary Care Psychiatry at the University of Manchester. Her latest book is Finding True North.
Samei Huda is a consultant psychiatrist. His latest book is the Medical Model in Mental Health.
Ruth F Hunt is a freelance journalist and author of The Single Feather.
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