Srsly, I don’t wanna shat bricks

Saturday 6 November 2010, 2.54pm HKT


Previously … A lone daughter in a strange land and in trouble. It’s serious business. Today, details are trickling in. Srsly, to shat bricks I don’t want. I’m too brick-shattingly old for this.

It’s 3.59 am on a Saturday. It’s still raining from yesterday. Stop bloody raining on my parade. It’s my parade. Rain on yours for a change.

Yeah, it’s another tl;dr writeup. If you don’t want to read it, then my response to you is as given in the case of Arkell v. Pressdram (1971).

Things aren’t looking up for Q. It’s serious business.

Q’s mum sends me a copypasta version of a social worker’s email. I couldn’t reply because (guess what) no email address for the social worker.

FACT: Most people are totally retarded when it comes to forwarding email attachments.

If you’re literate and living in the Western world but can’t do email forwards or attachments in this day and age, you need to castrate yourself with a blunt plastic knife. Better still, use fine-edged, stainless-steel razorblades.

Copypasta

I forgive Q’s mum for copypasta. She’s totally freaked out knowing her daughter is in shits in another country. Her domestic email service is probably in some mutilated gobbledygook version of her native language. Witness Microsoft’s different language versions of their software for proof. Instead of a simple ‘yes’ or ‘no,’ Microshaft decided on its unilateral wisdom to use “uh-huh” and “nngh” that sound like a person having a coronary.

Which is roughly what I’m going through. After I finish shatting bricks.

The situation

Q’s being locked up in hospital for the next 28 days.

The way that social worker puts it in the email — well, read it for yourself below. I just had to quote it in full.

The mother said Q had been smashing things up in the house. Q was having some sort of breakdown. The police got called in. They took Q to hospital. The doctors there will carry out an “assessment” of Q to see if she has a medical condition.

I don’t know how the mother came by this information, but that isn’t really important now. We can’t confirm or deny any information because we couldn’t get in touch with anyone there.

Srsly, king-sized bricks aren’t strong enough to be shat.

The email

The social worker’s email:

Dear [mother]

I understand that you are the mother of Q. I need to inform you that Q has been admitted to hospital today because we are very concerned about her mental health [1]. She did not wish to come into hospital [2] and has therefore been detained under the Mental Health Act on Section 2 [3]. This means that she must remain in hospital for a maximum of 28 days for the Psychiatrists to complete their assessment of her [4]. She was quite distressed about coming to the ward but is much calmer now that she is here.[5]

The hospital is the Somewheretown Medical Centre and she is on ward SH1T. To contact them you should call [number] and extension [number].[6]

The address is [address], Somewheretown, SH1T 4OLE.

I am the duty social worker for today and will not be involved in her future care and treatment – I would therefore like to advise you to contact the Doctors and nurses on the above phone number as soon as possible.[7]

Best wishes

Jane Bloggs
Social Worker/AMHP
[Organisation and address]
[Organisation’s phone number][8]

Very kind of Jane Bloggs to inform Q’s mum.

Couple of red flags for me as a lawyer (which I am, but I’m not):

Broken assumptions

[1] You’re already making a basic assumption that Q’s got a mental disorder. (See below for an explanation.) Still, it must also be said that getting to the point right away is also doing the right thing.

[2] This is an ‘international’ situation. The mother is half way round the world and probably half way round the bend when she gets this email. It would have been better all round to give a little more detail as to how Q ended up being admitted to hospital. It’s like, was she strapped down yelling and kicking by men in white lab coats or gun-toting paramilitary commando-ninja-assassin-policemen to hospital? It really isn’t very hard to describe this in a few more words like this:

“It seems she was breaking things at home and someone called in the police, who feared she could harm herself and decided to escort her to hospital. She did not wish to come to hospital when the police brought her in, and she is now detained by doctors under the Mental Health Act 1983/2007 under Section 2.”

Clearly, I don’t recommend writing like that for the locals ‘over thar.’ But Q isn’t a local and it is more sensible to give as much information as possible at the outset because of the remote distance and language problems. Derp.

[3] Give the Act’s full name. No all of us are familiar with your shitty pseudo-americanized British laws that you have now ‘over thar.’

[4] Why not add in a rider just to calm people’s nerves down? Example:

“This does not necessarily mean Q has a mental disorder. It just means the law allows us to determine if Q is having some kind of medical or non-medical condition.”

[5] Is she calmer because she’s calmed down or because of any kind of medication or treatment given to her at this stage? You know, we’re not ‘over thar,’ where we could just hop onto a taxi and see how she’s doing. It takes a 12-hour flight just from my “Asia’s World City” (Hong Kong) to the UK. Q’s mum’s flight would take longer, plus the time to get the fucking visa and other paperwork just to buy the air ticket beforehand. Then it takes another couple of hours to travel from the destination airport to Somewheretown in a strange land with strange transport services using strange money. The hours all add up, boy.

[6] Mind if we ask for an email address? Seeing that we’re over here and Q’s with you splendid chaps ‘over thar,’ I do admit we’re asking a bit much, aren’t we? Ah, yes, there’s the niggling inconvenience of timezones, isn’t there? Oh, noes, we forgot! People can’t always ring in from Faraway Exotic Lands, can they? Uh-oh, automated voice systems! Oh, I nearly forgot, Faraway Exotic Lands with Funny-Looking Coloured People aren’t necessarily able to spik da Inglish lingo, sometimes not even Engrish. Hmm … what to do?

[7] You know, we’re not ‘over thar.’ Kindly give us one or two regular contact persons ‘over thar’ to handle communication with us since this case involves a foreign national. Good idea, no? *Snorg*

[8] For chris’sakes, gi’z’us your bleeding email address, wontcha? I know you’re only responsible for the day, and we won’t blame you for that. Just giv’us your supervisor’s name and email. Geez! You have a foreign national suffering from a breakdown and in custody on your hands! Hello!

[6], [7] and [8] are perfect ways to cause a fukkin’ mental breakdown in others and smash things in the house and get hauled into hospital to be assessed for mental health. *Facepalm*

Those are my concerns as a lawyer. You don’t want to know my concerns as a person. (A lawyer is defined as not being a person, by the way.)

Look, mate, I don’t blame Jane Bloggs the Social Worker for those red flags. It’s how things are done in a public health authority. It’s no different anywhere in the world.

But what I would like is for the public health authority ‘over thar’ to try a little bit harder in their free time to think about how procedures need to cover admissions involving foreign nationals. Jane Bloggs is just following procedures. The policymakers and administrators make procedures. Hello!

The law and Q’s life

This is the legalistic bit you can skip reading. You don’t have to be lawyer to appreciate this, though. But you’re pretty square to skip it because this is the part that hits paydirt. *Snorg*

STEP 1.

Mess up your mental-health law by clamping on various bits of other legislation to amend it, instead of making fresh provision to deal with the matter.

First off, note that lunacy, insanity and mental disorder are legal concepts. They are not medical concepts. Your lunatic aunt, your insane father and mother, your mentally disordered boyfriend or girlfriend are not suffering from a medical condition. They are suffering from a legal condition. You’re pretty insane to think differently.

FACT: Most mental-health laws around the world are a right abortion.

The Mental Health Act 1983 (“MHA 1983”) is the main piece of British legislation that deals with nationwide matters of mental health. The MHA 1983 was amended by the Mental Health Act 2007 (“MHA 2007”) and by the Mental Capacity Act 2005. The short form is to call it MHA 1983/2007.

The MHA 1983 consolidates the law relating to mentally disordered persons (Preamble). It covers the reception, care and treatment of mentally disordered patients, the management of their property and other related matters (s.1(1)).

The MHA 1983/2007 defines ‘mental disorder’ very loosely now when compared with previous definitions. Currently, mental disorder for the purposes of the Act is “any disorder or disability of mind” (s.1(2) MHA 2007).

Bloody’ell, that could apply to the Prime Minister for all we care! I mean, I know literally dozens of people with a ‘disability of mind,’ and they’re mostly bankers, lawyers, accountants and government regulators. My parents certainly were ‘mentally disabled’ considering the careers they chose (architecture and fashion design). Farkin’ell, I’m mentally disordered to be in the printing business in this age of PDF files and weblogs.

The previous definitions were in four broad terms: “mental disorder,” “severe mental impairment,” “mental impairment” and “psychopathic disorder” (s.1(2) MHA 1983).

Bear in mind the way MHA 1983/2007 defines the concept of mental disorder doesn’t necessarily match medical categories of mental illness/disorder as given in the hated, shoehorning ICD-10 or DSM-IV.

FACT: That definition may or may not be justifiable medically. Medical evidence of mental disorder as defined by that law is only evidence obtained by medical personnel in a medical facility.

MHA covers everyone in the UK, locals and foreigners alike. It helpfully has s.141 to deal with MPs (Members of Parliament) and the privileged political class in case they become stark raving lunatics, which they are by the way.

But you’re off scot-free and excluded if you’re an alcoholic, or druggie, or a promiscuous fucktiger, or a sexual deviant (s.1(3) MHA 1983 amended by s.3 MHA 2007).

(Wonder if the law covers a person with a vibrator in one ear who’s into deviant sex like tossing off to anime bukkake paedo-figures whilst smashing things around the house under the habitual influence of drugs and alcohol?)

So what makes a mental disorder under the law? Well, that’s left in the hands of the psychiatrists. Generally, their definition would cover schizophrenia, anorexia nervosa, major depression, bipolar disorder and similar illnesses, learning disability and personality disorders. I personally would include psychiatry, economics, law, linguistics, psychology and sociology, but that’s just me.

STEP 2.

They take you in because you’re a patient before you’re actually one.

The authority to detain Q in hospital is s.2 MHA 1983/2007. This is an assessment order and comes under MHA 1983 Part II “Compulsory Admission to Hospital and Guardianship.”

FACT: The detention and assessment order is not a court order. It is an in-house administrative order carried out by the very establishment trying to detain you.

A Section 2 order lasts up to 28 days and is non-renewable (s.2(4)). This means the health authority can compulsorily detain a person for 28 days but cannot reapply for another Section 2 order when the first one expires. Okay, that sounds reasonable and hopeful.

I quote the whole thing to you:

2. — (1) A patient may be admitted to a hospital and detained there for the period allowed by subsection (4) below in pursuance of an application (in this Act referred to as “an application for admission for assessment”) made in accordance with subsections (2) and (3) below.

(2) An application for admission for assessment may be made in respect of a patient on the grounds that—

(a) he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
(b) he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.

(3) An application for admission for assessment shall be founded on the written recommendations in the prescribed form of two registered medical practitioners, including in each case a statement that in the opinion of the practitioner the conditions set out in subsection (2) above are complied with.

(4) Subject to the provisions of section 29(4) below, a patient admitted to hospital in pursuance of an application for admission for assessment may be detained for a period not exceeding 28 days beginning with the day on which he is admitted, but shall not be detained after the expiration of that period unless before it has expired he has become liable to be detained by virtue of a subsequent application, order or direction under the following provisions of this Act.

(s.2 Mental Health Act 1983 as amended)

How’s it done, this Section 2 order?

A Section 2 order is instituted following an assessment under the MHA 1983/2007 by two doctors and an “AMHP” (Approved Mental Health Professional). (Funny how everyone’s a ‘professional’ nowadays, isn’t it?)

The law requires the two doctors must not be in the same service (to ensure independence). One of the doctors must be a Section 12 approved doctor and the other doctor optionally Section 12 approved (s.12 MHA 1983/2007). Usually, a psychiatrist will perform a joint assessment with a general practitioner (GP) (BrE) / family doctor (AmE).

In Q’s case, the joint assessment will probably be by two Section 12 doctors. It’s bound to be more convenient for the health authority to do that. Q is a foreigner in England and very unlikely to have a GP. You can easily see how highly likely these two Section 12 doctors are going to agree with each other’s findings.

If the two doctors agree that the person is suffering from a mental disorder (and agreement is highly likely when you have two Section 12 doctors working on the case) and thinks the person should be detained for his/her own safety and the safety of others, they fill out a medical recommendation form and give this to the AMHP.

If the AMHP also agrees that there is no workable choice but to detain, the AMHP completes an application form requesting the hospital managers to detain the person. The person will then be hauled off to hospital and the 28-day assessment period begins.

During the assessment period, the Section 2 order allows hospital staff to administer medication and/or treatment to the person against his/her will. The explanation is that observation of response to treatment serves part of the assessment process.

In other words, if I torture you to death, my observation of your death serves as my assessment of your ability to survive torture.

Beautiful, just fookkin’ beautiful.

STEP 3.

You are ordered to receive treatment, whether you like it or not.

Come Day 28 under the Section 2 assessment order and you are still considered by the medicos to be a danger to yourself and others. What next?

FACT: Once your in, you’re in for a long time. There are at least two or three other orders down the line to keep you in custody. And since the custody is beyond the initial assessment, treatment has to be given, even if you don’t want treatment. Your refusal to treatment can be overridden by hospital personnel by their non-recognition of your protests as refusals.

The Section 2 order is non-renewable. What seems reasonable on first sight rapidly descends into FUBAR. Because, now, a Section 3 order is laid on you.

Section 3 order is a treatment order (s.3 MHA 1083/2007). It is instituted in the same way as the Section 2 order. And like that, the Section 3 order is a compulsory detention order but with full-blown treatment added.

The only difference here is that the doctors doing up a Section 3 order (a) must be clear about the diagnosis and proposed treatment plan (but then they always are because they’re pros), and (b) be confident that “appropriate medical treatment is available for him” (s.3(2)(d) MHA 1983 as amended by s.4(2) MHA 2007). “Appropriate medical treatment” has a wide definition here and may be basic nursing care alone.

Detention

This Section 3 compulsory detention and treatment order is renewable, unlike a Section 2 order is not. The initial Section 3 order can be for up to six months. The second one lasts another six months. The third and future orders lasts up to one year each.

In the UK today, most treatments for mental disorder are given under Section 3 orders. These treatments usually include psychotropic medication injections (e.g. antipsychotics). It used to include electroconvulsive therapy (ECT, or “Doctor Shock”).

After three months of this detention and treatment, the Section 3 order has two possible ways to go. The first way is the person/patient has to consent to their treatment. If that doesn’t work out, the second way is for the hospital authority to get a second opinion from an independent doctor to confirm that the treatment being given is in the person’s best interest. (But of course it always is!)

A rider: Section 3 treatment doesn’t exactly exclude Dr Shock. The Responsible Clinician (RC, i.e. your case doctor) can authorise two ECTs in an emergency situation for Section 3 patients. ECT may not be given to a refusing patient who has the capacity to refuse it. For an incapacitated patient, ECT may only be given where it doesn’t conflict with any advance directive, a donor’s or deputy’s decision, or the decision of the Court of Protection (Mental Capacity Act 2005).

That’s just bollocks because who knows you’re refusing ECT or any other kind of ‘medication’? You are being compulsorily detained. You are on their home turf and it’s their ball game. They’re all hired by the same employer. They’ll just say, “We were not aware that he/she was expressing verbal protestations and indicating refusal to treatment because those patterns of expression are consistent with the outward characteristics of that type of mental disorder.”

This is a distinct possibility in Q’s case.

FACT: There has never been even one case that shows ECT works.

STEP 4.

We care about you, so we can hold you indefinitely.

Doctors and nurses have statutory detention powers against you while you are in hospital (s.5 MHA 1983).

Doctors may include “approved clinicians” (ACs) who may or may not be registered medical practitioners, such as AMHPs, clinical psychos psychologists and the like (s.5(2) MHA 1983 as amended by s.9(2)(a) MHA 2007).

Section 5(2) MHA 1983/2007 is a doctor’s holding power. If you’re already admitted in hospital and want out, the Responsible Clinician or his deputy (meaning any hospital doctor) can detain you for up to 72 hours. During those 72 hours, these buggers will carry out a further assessment of you. That may result in your discharge, or continued detention under a Section 2 assessment order (28 days) or a Section 3 treatment order (six months to a year).

The nurses have s.5(4) MHA 1983/2007 as their holding power. Theirs last just six hours, but often converted into a 72-hour s.5(2) power by a doctor. Only a first- or second-level Mental Health Nurse (i.e. psychiatric nurse) can implement s.5(4) detention. The nurses’ holding power is applicable to the same group of s.5(2) detainee patients as said above.

In other words, if you want out, the nurses can hold you for six hours, then the doctor comes along and racks it up 72 hours, which then leads to probably another 28 days or even six months to a year. Whichever way they play it, it’s a long stretch for you to sit out.

Big Brother, oh brother

If you think Big Brother is just a fantasy in Orwell’s books, then I’ve got bad news for you. There is a government body called the Care Quality Commission that puts pressure on the medicos to do the right thing — the right thing for them, not necessarily for you. The CQC (which rhymes really funnily with a rude Cantonese phrase)♣ considers it very bad form for doctors to lapse on their s.5(2) duties. The CQC (ha-ha!) basically forces doctors to decide if a patient has to be given a Section 2 or Section 3 order whenever that patient wants out.

♣ It rhymes with “eat farkin’ shit” in Cantonese.

* * *

I should also like to tell those dumbarses friends and people in Hong Kong and generally anywhere in this toilet bowl Asia couple of sobering things:

  • An astounding 33% of Asian countries have nil mental-health laws.
  • Those Asian countries that do have mental-health laws have much harsher provisions than British laws.
  • Hong Kong’s mental health laws are similar to the UK’s, but the detention periods are three times longer.
  • In Hong Kong, a non-medical fuckwit like a JP (Justice of the Peace, a ceremonial honour) is able to issue a one-year-long detention order against a person with little or no cause. What a wonderful British legacy for our esteemed ex-British Crown Colony.
  • Singapore is much more efficient because they can simply ‘convert’ your mental disorder into ‘terrorism’ under the Internal Security Act 1985 Cap. 143 and beat the be-jesus out of you until your condition or morale (or both) improves. If you do improve, you’re already pretty psychopathic anyway, so you’ll be given a military position and sent off as part of Singapore’s UN contingent to Iraq or Afghanistan. Well, come to think of it, that’s not so bad. Singapore does pay its professional soldiers quite well.
  • India’s mental health law is basically a copypasta version of its criminal code and internal security laws all rolled into one like a japati. C’mon, it just doesn’t have enough resources to deal with its breeding disaster of a population, much less its cookies.
  • China is identical to India. Its huge breeding disaster of a population is enough to drain even diamond-studded resources. The crazies are simply farmed for their organs or processed into Soylent Green. Actually, that’s not a bad idea. After all, the Chinese are mostly vegetarians, so the meat isn’t going to be smelly.
  • Japan basically has no mentals. From the country that brought us ‘weird’ since 1952, that country is pretty disturbed as a whole when you consider how much rape manga and anime bukkake that kids read or watch in public places. It just doesn’t matter.

* * *

Kafka would have been chuffed to the bollocks reading this.

More’s the pity that Q has to go through this alone ‘over thar.’

*

Photo credits (all images pilfered and used without permission):

CopyPasta via iHunt

Broken Egg via Joy the Baker

Mental Health graphic via Mental Health India

Detention Cell via Colorlines

Big Brother Is Watching via EnglishClub.com

© The Naked Listener’s Weblog, 2010.

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