18 April 2007

The Mental Health Bill

Sometimes it is worth thinking about the possible motivation underlying certain dubious developments. Try a cynical hypothesis — it probably makes no less sense than any other.

Consider. If you are the sort of person who:

  • loves the state, and believes in the subordination of the individual to the collective on moral grounds (there are plenty who fit that description);
  • thinks that we need to find a way to legitimise an increase in state authoritarianism;
  • believes the ends justify the means;

  • and you're involved in the psychiatric system, you might indulge in the following.

    1) Have a bias in favour of incarcerating the pathetic and the vulnerable, while
    2) selectively allowing the truly dangerous to be released and roam free, in order to
    3) generate the impression that mental patients who were allowed their liberty generally became a menace, so that you would
    4) provide ammunition to those who want to be able to lock up, and/or forcibly drug, anyone suspected of being "mentally ill".

    You might also help to massage and spin the relevant statistics to maximise the impression that:
    • a large number of murders were caused by people who could be labelled as "mentally ill", and that
    • the culprits were people who had been on medication of some kind, but who had decided to discontinue it.

    * * * * *

    As often is the case with a policy change which is felt to be desirable by some section of the political/technocratic elite for ideological reasons, we are given 'data' in a form which is clearly designed to elicit our agreement to what is proposed.

    Thus Philip Johnston writes in Monday's Telegraph that, according to the Health Department

    in the eight years of argument over the Bill, there have been 400 homicides committed by mentally ill people in England and Wales. In many cases the deaths could have been averted through better compliance with medication. Almost a third of the killings were committed by people judged by mental health staff not to be a risk to the public just a few days earlier.
    But to properly appraise this scare statistic, and similar ones being trotted out by the why-oh-why brigade (see e.g. Melanie Phillips), we would need more information about the individuals concerned. Had they previously committed crimes? At what stage were they diagnosed as "mentally ill"? In the case of those who had been receiving medication, has the possibility been considered that the cause for their committing murder wasn't that they were psychotic to begin with, but rather that they had been turned into out-of-control zombies by the drugs they were taking?

    One of the online commenters responds to Johnston,

    Having had extremely arrogant mental health professionals insist that what was very obviously post-traumatic stress disorder was actually a personality disorder, I am extremely concerned about allowing people who may or may not have their own agenda make the final decision about who is or is not a danger to whom. ... Many clinicians rely on psychological and behavioural models based on their own prejudices and stereotypes. Anyone who disagrees is labelled "scary", "treatment resistant" or "personality disordered" ...
    Do we really want to trust these kinds of "professional" to decide who should be locked up or forcibly medicated?

    "Care in the community" may or may not have been a misplaced policy, although if anything was wrong with it, it may have had more to do with the application than with the theory. It's all rather reminiscent of child protection, and the way we seem to get, simultaneously, plenty of both (a) families unjustly broken up on little or no evidence, yet (b) "helping families stay together" in cases where it is pretty damn obvious there has been abuse, thus actually promoting further abuse. (Which is then used to justify even more state intervention into family life.)

    Associated reading: Mediocracy: Inversions and Deceptions in an Egalitarian Culture, p.112.