Worrisome Court Decision In Great Britain Following Suicide

The story was published in the UK in The Guardian, Hospital breached duty of care to psychiatric patient, supreme court rules.

An NHS trust breached its duty of care to a 20-year-old [actually 24-year-old] patient who killed herself while on home release from a psychiatric unit, the supreme court has ruled.

This, in my opinion, was a disappointing decision that can only mean the sectioning of more patients in hospitals across Great Britain.

Pennine Care NHS Trust, the supreme court found, breached its “operational obligation” to look after her under Article 2 of the European convention on human rights, which states that “everyone’s right to life shall be protected by law”.

Unfortunately protecting “everyone’s right to life” means interfering with everyone’s right to do whatever they will with that life; specifically, this Article 2 would interfere with a persons right to destroy his or her own life. This “protection” is likely to interfere with the rights of a great many people.

In allowing the family’s appeal against the trust, the supreme court said her parents were the “victims” under the terms of the convention and confirmed that they should receive damages of £2,500 in addition to an earlier settlement.

The good news is that it was not a very big penalty, and so there’s a limit to the extent of a disincentive for releases that it might represent; the bad news is that hospitals now are likely to be more disinclined to release voluntary patients. This disinclination will probably mean the sectioning of more patients who voluntarily admitted themselves into a hospital.

One doctor “noted that, if she attempted or demanded to leave, she should be assessed for detention under the Mental Health Act 1983”. But on 19 April 2005, she was allowed home after requesting leave. Her mother “expressed concern about Melanie [Rabone] coming home for the weekend, but Melanie was keen to do so. On 20 April 2005, Melanie, aged 24, hanged herself from a tree.”

The problem with decisions like this one is that many more patients who are not going to kill themselves are likely to end up paying the price of involuntary confinement for this one patient’s errant way. Hospitals are no better judges than anybody else as to who will, or who won’t, off themselves. Despite this article mentioning what it calls ‘civil liberty groups’ being involved in the arriving at this decision, over this “right to life” issue I imagine, the price that is paid is going to be paid in an overall loss of civil liberties for people, human beings, experiencing the mental health system in the United Kingdom.

2/20/12 Update: I’ve revised my opinion about this decision. I doubt it will make much difference in the long run. I’m keeping the post because of the discussion that ensues. As you will find if you read the comments below, involuntary inpatient treatment has nearly doubled in Great Britain over the last ten years. My premise is that if there was less involuntary treatment before, there is little need for more involuntary treatment after. More involuntary treatment, more sectioning, is indicative of less tolerance in society toward deviant behaviors. More fear in the general public of people experiencing difficulties is disturbing. Increased intolerance is not an improvement in my book.

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44 Responses

  1. I find your attitude here somewhat confusing. If I’ve understood correctly, you believe in and advocate the concept of radical accountability for one’s actions as well as the concept of absolute freedom (both of which I wholly agree with). But if you believe that no one has the right to interfere with one’s desire to commit suicide whatever emotional state that person’s may be in, as in the case you discuss here, why do you say that:

    “People, especially unfortunate people, need chances. They don’t just need second chances. They need third, fourth, and fifth chances as well. In any land of opportunity there should be an abundance of chances, that is, there should be more rather than fewer of these chances. Chance is opportunity. Good fortunes are what unfortunate people lack.”

    I mean if one has a total freedom over one’s behaviours and beliefs, ie., one is radically accountable, I can’t understand why ‘circumstances’ or ‘unfortunate destiny’ should prove to be any more limiting than the latter. Why should these people be given extra chances when they should try to sort themselves out and not rely on other people’s handouts. The ‘unfortunate’ don’t need extra chances, they need a bit more of a backbone and stronger a work ethic!

    • I’m not saying nobody has to right to interfere with one’s desire to commit suicide. If anybody really wants to commit suicide nothing is going to stop them from doing so. Anyone who desires (if that’s the right way to put it) to die, can find a way to do so. Botched suicides happen because the person really doesn’t desire death in the first place. I’m not saying people shouldn’t give other people a reason to live. I think the court was going further than it should have done by trying to make the hospital responsible for this girl’s death when she was able to deceive the hospital staff as to her real intentions. I think the British Supreme Court decision was a bad one because it is likely to result in hospitals being more reluctant to discharge patients due to a fear of litigation. I can’t, under any circumstance, applaud imprisonment trying to pass itself off as therapy.

      Man and woman make themselves what they are but within the context of other men and women. There is the pronoun I for what I as an individual can do alone, and that’s not so much. There is the pronoun we for what I can do with others, and that’s much more. One is limited by what the other makes of one in a social context, but social contexts are not beyond changing.

      Total freedom over one’s behaviors and beliefs within the context of a social vacuum isn’t much of a freedom. People need other people, that is, the one we have been speaking of exists within a social mileux. Our history has always been a history of conquests and usurpations. I think Pierre-Joseph Proudhon put it best when he said, “Property is theft.” Impoverished people, in other words, are not to blame for the problems in the world these days. They, in fact, are more innocent than certain other parties. We could always, if we wanted, do something about alleviating poverty in the world, but then the rich would call it stealing, wouldn’t they?

      Slavery was once the way of the world. I can’t say slaves had a fortunate existence. I don’t think you can blast slaves for not having a strong work ethic either. I’m glad slavery is on the outs now. A slave making much of his or her life would depend a great deal upon the good graces of others. Any slave would have more opportunities if given his or her freedom. Abraham Lincoln promised freed slaves 40 acres and a mule. Many former slaves have done pretty good to have gotten wherever they’ve gotten despite the government reneging on its promise.

      • I suppose I’m looking at the freedom question from a European, and in particular Scandinavian context, of a welfare state and workers rights. (I keep forgetting that most people in these internet circles are from the USA!)

        I live in a social democracy which has insured that every Norwegian national/legal resident has rights to free health provision, free education at primary, secondary and higher education levels (including university/college/polytechnic courses), a heavily subsidised childcare. Furthermore, workers rights are taken very seriously here as are the unions something which ensures that those legally employed have a right to a paid 25-day annual leave, maternity/paternity leave (at full wage for 8 months or at 80% of one’s wage for a full year), sick days, sick days for when one’s children are ill, etc. The benefit system is really good being especially supportive of single parents, those who face a real physical disability, etc. In short, the state here doesn’t leave you to rot. And to make sure that the system runs smoothly, we are all taxed to our eyeballs! (As we should be!)

        Yet despite such a “context” there is a visible minority who does nothing to change their situation, I mean the “unfortunate” people as you call them. (I was one of them until I realised that I was using emotional problems as an excuse and was milking the state in the process. Why should others pay for me to sit on my ass and do nothing just because some unpleasant things happened to me?) The number of such unfortunate people is growing yearly and I can’t see it has much to do with the context in this case. (And we’ve hardly felt the economic meltdown that’s hit the rest of the world.)

        In other words, even if you created a system that actually cares for its citizens, the “unfortunate” won’t simply disappear as if by magic. It seems that exactly the opposite is the case, at least here. The “unfortunate” have grown comfortable with the state picking up the bill and doing little to make themselves financially independent.

  2. Involuntary confinement is going to cost money, if it expands to hold more people.
    Do they have the money and space?
    Will the slow suicide methods of smoking , eating and drinking too much still be allowed?

    Why would a 20 or 24 year old want to die?
    At that age myself I wanted to die to escape.

    • She entered the hospital after slashing her wrists. I don’t know why she’d want to die. Why would she want to live? Maybe she felt she was missing something essiential in her life.

      I don’t think the hospital should be held accountable for suicides that take place beyond the walls of the hospital. She took her life, the hospital didn’t take her life. If she’d hung herself in the hospital that would be a different matter altogether, it would then have made sense for the hospital to be penalized. After this decision hospitals in Great Britain are likely to be much more hesitant about releasing voluntary patients for fear of litigation.

      Once again we’re left with this little dose of irony–When is voluntary treatment not voluntary? When that treatment takes place behind the locked doors of a mental hospital ward.

      • I have a problem with the idea of “beyond the walls of the hospital”.

        Because the psychiatrists have power they get to define the words, they get to call their drugs as medicine.

        If you have someones mind altered by alcohol and they do something stupid , you can blame the alcohol.

        If you have a junky who needs a fix of their drug, and they do something stupid to get the drug, or do something stupid in withdrawal for it, it is understood as a result of the physical dependency.

        No one ever blames the psychiatric meds/drugs, or the person that prescribed or forced them .

        Physical and mental conditioning from psychiatry lasts past the walls of the hospital.

  3. This incident is highly unlikely to cause more sectioning within the cash strapped NHS. What it may do is prompt closer attention to risk assessment, which would save lives.

    It is clear from the passages you have quoted that it was recommended that this young lady “be assessed for detention” in the event that “she attempted or demanded to leave”. This assessment did not take place and that constitutes negligence on the part of the trust. Staff also ignored her mother’s expression of concern.

    The pathetic sum of money awarded to her parents is an insult. It is unclear what other “settlement” they received. Regardless, it will do nothing to assuage their loss.

    I find your comments rather callous, MFV. The idea is to help people like Melanie, not to write them off and then blame them for potentially causing changes yet to be suggested or implemented that you interpret negatively because of your own experiences.

    I read the article and found that the decision is welcomed in Great Britain because it means that hospitals will be expected to take better care of patients who enter hospital voluntarily.

    Melanie had “been assessed as a moderate to high suicide risk who might need to be detained if she attempted to leave”, so I think that the court’s decision is just.

    There is always going to be a grey area in the decision making process but sometimes it is obvious. It is true that if someone wants to die that they will find a way, but that way should not be due to a failure to observe recommendations as we see here. Melanie would have had a chance of recovering had she been kept in for observation.

    Åse Ø. Perhaps it is the case that you needed to find “more of a backbone and stronger a work ethic” (sic) because you were “using emotional problems as an excuse”, however your experiences and realisations are not transferable to every individual encountering difficulties.

    It is possible that one might find a dependency culture arising in Norway because of the high standard of living afforded to all, and incentive is something that ought to be addressed before the lack of it becomes a problem. I do not know what other factors contribute so will not comment further other than to say that your fairly privileged way of life renders comparison invalid. “Milking the state” in Stockport is an altogether different and grim proposition.

    I cannot say what troubled young Melanie but from a purely geographical perspective, one might borrow a phrase from you, markps2; “to die to escape” becomes conspicuously understandable.

    • GM, voluntary is voluntary, it is not detainment. Detaining patients who enter the hospital on a voluntary basis is NOT taking better care of them. The Supreme Court it would seem wants more assessing to see if patients should be detained. This would mean the detaining of more patients for periods longer than they would be detained if not assessed. I imagine the section of the mental health act that they will be assessed for is the section that changes a patient’s status from voluntary to involuntary. No, callous or not, as you put it, I don’t see this decision as a good one.

      Ase, pardon my previous response, it was somewhat rambling when I could have been more to the point. You say, “there is a visible minority who does nothing to change their situation.” You talk about people “milking the system”. The key word here is “minority”. This is why people sit at the table with other people. One is never one alone, one is always one among many. There’s that social context I was talking about previously. Nobody ever succeeded alone, likewise nobody ever failed alone. Success and failure are group endeavors. The group you are speaking of impacts other groups. It is the people who are not “milking the system” as you put it, who must sit down with the people who are to come up with a solution. Your “do nothing” minority must have their own feelings, hopes, and aspirations that they can air. I seriously doubt it is a case of people with an intense desire to “do nothing”. I’m a big fan of this group negotiating with that group in order to come up with a situation that pleases everybody. If “do nothing” is living on ‘do something’s’ time, ‘do something’ has an issue to take up with him or her. “Unfortunate” and comfortable are words that don’t belong together. Perhaps if your “do nothings” were made less “comfortable” the situation would change.

      MarkPs2, certainly the hold of the psychiatric profession extends beyond the walls of the hospital. I don’t disagree with you there. On the other hand, there’s this song by Bruce Springstein, When I’m Out On The Street. It’s talking about getting off from work, but it might as well be talking about getting out of the hospital or stir. The lyrics go like this, “When I’m out on the street I walk the way I wanna walk. When I’m out on the street I talk the way I wanna talk.” I think there’s a place where the influence of the hospital ends. If I were to give that place a name perhaps I would call that place Resilience.

      • I suppose I should have made myself much clearer – not the first time that my verbosity got in the way of clarity! The visible minority I refer to, which I myself was a member of until recently and whose numbers are rising with every coming year, are those seen, or who see themselves, as “mentally ill” as well as addicts with a “mental health diagnosis”. I really don’t see why the society should be supporting those suffering from made-up illnesses. I mean the term mental illness has a much intelligibility as the idea of a married bachelor or an integer that is neither odd nor even. I’m personally ashamed that others had to pay for keep when what was holding me back from participating in society were my own character flaws. I of course support the idea that those with real disabilities and/or physical illnesses need support as well as those whose precarious status is a result of wider social/environmental causes, such as refugees.

  4. My objection, Ase, is to the Atomistic approach (self and family). I favor a more Holistic approach (neighbor and community). I feel we’re all in this together. If people cop out, it’s up to other people to straighten them out. Given the big economic meltdown the world experienced recently I’m less inclined to see it as a matter of individual “character flaws”. We’ve got this great gap, in this country anyway, between the rich and everybody else. We’ve also got a vanishing middle class. The rich may blame the poor, but the poor aren’t responsible for the problems faced by the rich, believe me. That gap needs closing. We could eliminate poverty if we wanted to do so. Treatment junkies are lost in their own illusions, nonetheless, we can’t let people sink and drown. If we do something about the drug, drug, drug paradigm so pronounced in the mental health treatment world today, people actually fully recover from their problems, and we also do something about this spread of imaginary disease. That’s how I view the matter.

  5. I completely agree with you that the poor aren’t responsible for the problems faced by the rich in the world today. (I mean just look what’s happening in Britain at the moment where the poor are being demonised and punished for the mistakes committed by those in the City. Shameless!) And I completely agree with neighbourhood-community approach to life: “dugnad” (a Norwegian term for voluntary work done together with other people) and a well-functioning welfare state are the two things I believe Norway has really got right.

    I fully understand that the comments I’ve made so far seem cruel and rather facetious but there is a more serious point I was trying to get at.

    Even a rich society, like Norway, which has at its disposal vast amounts of money to be spent on public goods, doesn’t have bottomless coffers. The resources at our disposal, though handsome, are nevertheless finite. And the fact they’re finite raises a serious, ethical question: should any money be allocated to those who are “mentally ill” whether in the form of state benefits or through provision of various (mental health) services?

    Since mental illnesses don’t exist, how can we defend the expenditure of public funds on “disabilities/illnesses” that are in fact nothing more than personal foibles/flaws such as lack of self-control, stoicism, etc., in other words, simply idiosyncratic behaviours. How can we justify spending public money in order to improve the lives of persons who are fully responsible for the such problems in the first place.

    For example, if Ola feels depressed and goes to his family doctor and says I’m depressed, and the doctor in turn signs him off work because both the doctor and Ola believe that Ola can’t work because he’s mentally ill, Ola, under current law, has the right to sick pay for up to 52 weeks. (After that period other kinds of benefits are available if he’s still ill.).Why should Ola get this money if there’s nothing wrong with him? If he had cancer or a broken leg it certainly makes sense that the state picks up the bill. But there’s nothing wrong with Ola!

    My point is that the money spent on those like Ola could be allocated elsewhere, for example to those parts of health services dealing with the care of elderly or physically disabled adults or somewhere else completely to services used by refugees and asylum seekers.

    • Or even better to help those ex-patients/survivor whose lives have been deleteriously affected by various kinds of psychiatric “treatments”. And there are thousands of such individuals, unfortunately, all over the world.

      • I get your point, I just think we’ve gotten a little off-topic. My post dealt with my fear that a court decision is going to make the situation more difficult for mental patients, or service users, in Great Britain. I think that we will find an occasion to get to the subject of people using the mental health system for freeloading in more detail at a later date, so stay connected.

  6. I’ve got no sympathy for the psychs as a matter of course. I hate their guts. It is statistically likely that I would have little sympathy for the parents apart from the normal human reaction I might fleetingly feel if I was to witness their ignorance based anguish.

    About Melanie Rabone I know virtually nothing except that she was being humiliated, threatened and assaulted by hospital staff.

    The tragedy is that she didn’t live long enough to work out that these people were total bastards.

    When you truly understand, when you know in your bones that no person, no animal, no thing is by default deserving of any respect at all, the desire to kill yourself for emotional reasons evaporates.

    • ‘Default respect’? It’s an interesting concept, Rod, and I like it. I don’t think you have to go to far from there before you get to the subject of hierarchical systems, and sufferers of ‘authoritarian personality disorder’. When it comes to ‘authoritarian personality disorder’, I think you will have to admit, a lot of psychiatrists have it bad.

    • Hi Rod!

      Would you kindly explain your last thought a bit more? I don’t think I understand it fully. Why should not wanting to kill yourself follow from the idea that “no thing is by default deserving of any respect at all”? Thanks.

      • Yo.

        I’m suggesting that a major source of emotional distress is magical thinking which of course includes religion. Religions tend to demand unconditional respect for the entity that they worship. Religious communities then tend to demand that respect be shown between all members of the community. They insist that a person imbue all people with a positive value.

        This is rubbish of course, but the idea is instilled early. Honor thy parents etc. It’s brainwashing. It’s so entrenched that even most non-religious and atheist people still speak as though it must be a fundamental truth.
        But effectively they become bigots. They become intolerant of lack of respect. (This makes them 2nd order bigots. I’m intolerant of 2nd order bigots. That makes me a 3rd order bigot which isn’t really a bigot at all. For one thing, there is no 4th order bigot. It doesn’t compute.)

        So privately, at fluctuating levels of conscious awareness, we know that it’s rubbish. But we are forbidden, or are constrained by guilt and fear and shame, from stating the bleeding obvious. Children grow up logically retarded, confused and inarticulate. I suspect that even a great many adults are unwilling to pursue certain thought experiments to any great depth, even in total solitary privacy.

        I have exactly zero respect for strangers in the street, people I glimpse in the media, people I have never seen or heard of and people who have not yet been born. Does that make me a prick? Not at all. I’m neutral.

        Ok, with all that you might still ask – What’s this got to do with suicide?

        People who kill themselves have been successfully bullied, blackmailed and extorted of a period of time by people who claim to be deserving of respect..

  7. My, my. The coldness you all view Melanie’s death with is chilling; nay, psychopathic. This is a young woman’s life we are talking about, not just the rules and regulations of Great Britain’s psychiatric system.

    It is because Melanie lacked “Resilience”, MFV, that she required help that passed beyond the walls of the hospital. Clearly its “influence” had ended or she would not have ended up swinging by her neck from a tree.

    The law will not change in Great Britain because the power to detain voluntary patients already exists. Detaining patients who enter hospital on a voluntary basis only happens when it can be shown that person is at risk. It could be shown clearly that Melanie was at risk therefore the trust was negligent. That is all.

    The Supreme Court deems that “the state holds a responsibility for those in its care to which there is a real and immediate risk of death” (sic).
    I think that sounds fair enough.

    Åse, The poor are not being “demonised” in Great Britain, although they are suffering the brunt of the economic downturn. Nobody is under any illusion about who is to blame. There is a huge amount of discontent with “the City” and bankers have been forced by popular opinion to relinquish their bonuses.

    Furthermore, the fact that your illness was made up does not mean that “mental illnesses don’t exist” per se.

    Rod, by your own admission you know next to nothing about Melanie Rabone therefore cannot know that she was being subjected to ill treatment by “total bastards”. I think that we can see that she was not being monitored appropriately, and that is all we can say for sure.

    And I doubt that her parents are suffering from “ignorance based anguish”. Having lost their daughter in this horrific way their anguish is anything but ignorant. I am sure they would give anything for a few minutes of blissful ignorance about now. That you would feel no sympathy for them is your affair.

    Getting a person in pain to ponder philosophical issues may provoke a revelation or two but the fundamental behavioural patterns of that individual will be their “default” setting until they are strong enough to implement any new belief structure.

    A far as respect goes, we are all part of the whole that is greater than the sum of its parts.

    The problem with any mental health system is the same. You are always going to get a certain number of people who get carried away with having power over others. Independent monitoring and rotation of staff is the only way to discourage cliques.

    Mental health care in Great Britain is not focused upon incarceration. It is not perfect but it is evolving into a more humanitarian and patient centred guardianship.

    I think you miss the point by focusing upon the negative aspects of the decision. The positive elements – greater safety for patients and greater accountability demanded of those who care for them – must be considered too.

    Here she is:

    http://menmedia.co.uk/manchestereveningnews/news/health/s/1129568_hospital_cleared_over_suicide_

    Young, bright, beautiful, finished.

    • Hi GM. I was going to write (but then didn’t bother) “One thing I know for sure is that she was being…”

      I wrote that it was likely that I would have little sympathy for the parents. If I was to know the family I may well be very sympathetic. But then since the parents apparently continue to blame the hospital I suspect that I would indeed not have much sympathy for the parents.

      My use of the word “statistically” is to suggest, as is the case, that I have knowledge of the circumstances of a number of child suicides. Same kind of thing. Desperate parents, multiple admissions, multiple suicidal gestures/attempts, dies on leave or shortly after discharge.

      Desperation might invoke sympathy but these people aren’t thinking right. If they are people who never think right there can be no sympathy, only pity. Pity is the worst.

      As for the hospital staff the only fault is that they exist.

      As a parent I never felt any fear or guilt of having inculcated fear and guilt in my children. As we saw terrible things happening to people in the world; that was the time to teach philosophy. If one would threaten to commit suicide I would express sadness and regret and then brighten up and ask if I could have their Playstation.

      • From this article you link to, GM, maybe the consultant psychiatrist should have been held accountable rather than the hospital. It seems to me that the hospital is getting flack for a decision made by a psychiatrist. Now what does the hospital do, fire the psychiatrist? Threaten the psychiatrist with firing if he doesn’t hand over 2,500 pounds? Shrug?

        But he acknowledged the decision to allow Melanie home was wrong and that if she had tried to leave before Dr Meagher had seen her she would probably have been sectioned – meaning she lost some legal protection because of their mistake.

        Patients in Great Britain are voluntary until they are sectioned. I’m just worried about British authorities using “right to life” as an excuse to section more patients. I think that a fear of litigation on the part of hospitals is sure to lead to more sectioning.

        Nobody has said anything about a person’s right to die. If a person is granted freedom over one’s own body and decisions, it is a right that one has regardless of whether the government recognises it or not. I’m not saying this girl might not have missed the reasons to live she might have had. I’m just saying that the solution to a high suicide rate is to make life more liveable for everybody.

        My question is why aren’t her parents being sued for not having instilled in her a proper appreciation for the value of human life? She took her own life. If we’re going to play the blame game, there are so many people that interacted with this girl that haven’t been touched. In the end, it was she who took her own life. I’m not keen on allowing anybody the “mental illness” excuse.

  8. No need to fire him, he already left and is practising psychiatry elsewhere
    http://menmedia.co.uk/manchestereveningnews/news/s/218427_sex_case_doc_loses_appeal
    Presumably the same one

    • Wow! Same name, too. This is a problem going way back. Doctors sometimes feel compelled to have affairs with clients, sometimes in the name of treatment. Clients often feel raped. I don’t know the resolution to this one. Laws against such matters are made to be broken. Imagine, if you would, standing in the way of true love. (I’m only kidding.) Human beings exist on a different plane, TWA, or AirFrance, or etc.

      I would wager that practicing a little bit of self-restraint makes much more sense.

  9. Shrug is about right, MFV. Doctors are rarely held to account for foolhardy decisions that cost lives.

    Rod, you undermine your own argument when you condemn the parents for blaming the hospital. They are blaming the doctor/the hospital/the trust. They comprise the same entity, more or less, and British law is set up so that legal responsibility lies with the hospital or trust. Doctors are ridiculously well protected with regard to any decision that can be justified as medical. Doctors run hospitals, administrators act as their public relations representatives, doctors are heavily represented on governing boards, and on it goes. If there is “one thing I know for sure”, it is that they are all in it together.

    Pity is compassion; the word has been twisted through sarcastic use to mean something stained with contempt.

    It is unhappily the case that people who really want to take their own lives will. The lack of effective help for people who feel that suicide is the only option is an indicator that there is something truly missing from the treatment modalities currently advocated.

    I agree that “to make life more liveable for everybody” is a solution overlooked, MFV. Fear of being a burden or of losing control over one’s own life and affairs can force people to act to take back mastery of their own existence.

    I do question Melanie’s background and what role her parents played, but these things are indeterminable to us. I also question why nobody was watching her for the duration of her release.

    By the way, I do not consider Melanie taking her own life as her “errant way” – it is not as if she got caught spraying graffiti on the school gates. She entered into a desperate act to escape her situation and she made sure she did a good job of it.

    Mental illness is not an “excuse”; it can be a reason. It exists as surely as does the common cold. Its lack of visual pointers is what condemns its true sufferers to be experimented upon by doctors like the Jews were experimented upon by the Nazis. And yes, those who do not suffer from mental illness are often trapped in the net.

    I understand your concerns but I do agree with the ruling, which states that a voluntary patient has the same right to have their life protected as does a patient who has been sectioned. I believe that the law on human rights has been appropriately administered in this case. What has not happened here is an increase in a hospital’s rights to detain a patient.

    Litigation is less of a concern in Great Britain, where compensation is limited and the law is heavily biased in favour of doctors. Whether there is any change in the numbers of patients detained, appropriately or inappropriately, remains to be seen.

    Rod, I think your Playstation approach is a healthy response to a healthy child being dramatic. If a child then retreated quietly, however, later leaving their Playstation neatly outside their bedroom door, I believe concerned parents would be prompted to investigate. If they were then met by a grinning child sitting on their bed yelling “Psyche!” I think most would then gladly kill their children themselves – but in a good way.

    All I mean is that we do not know. Children keep things inside, like rape and assault and bullying. It sounds like you have encouraged your children to be able to approach you and to not take themselves too seriously; these are powerful things. Children should never be made to feel guilty or fearful.

    Well, Meagher is quite the sleazebag, indeed – he looks like one too. It is hard not to speculate upon whether he had more sinister reasons for his refusal to detain Melanie.

    The name of this hospital seemed familiar to me when I first read it and I later realised why. Meagher was not the only employee insufficiently vetted by the recruitment team. http://www.telegraph.co.uk/news/uknews/crime/8996257/Male-nurse-arrested-in-Stepping-Hill-hospital-poisoning-investigation.html

  10. “Psych!” even.

    • Yo GM. Yeah.

      I can’t be fagged reading the articles again to check who’s blaming who. But as I said, knowing next to nothing, I would say that it is likely that the parents could ultimately be blamed. People have voted into power governments who will accept responsibility and build psych hospitals.

      Umm… pity. I think it’s deeper, darker, sadder than compassion. It’s able to contain more meaning. It can mean – I surrender with regret. I have nothing left. There is nothing left to be done.

  11. You blame the parents for blaming the hospital, Rod. Given your opinion on psychiatrists, I make the case that the terms are interchangeable to the layperson and in law in many instances.

    I do not think governments accept responsibility for much of anything. Tax payers fund the NHS in Great Britain and responsibility for patients is passed between doctors and executives who operate in much the same way as politicians.

    As for the parents, of course I wonder.

    The true meaning of pity is interchangeable with that of compassion. Your explanation, however, helps me to understand your earlier comments; I think that it is definitely one of those words that means different things to different people.

    To me it is best expressed as a look from one to another that means, “I feel quite sorry for you but I am so glad I am not you because you are screwed.” Similar, when I think about it.

  12. Oh, come now, Rod. There can always be another kind of bigot. Only a “3rd order bigot” would think all bigotry endeth with him..

    • I disagree with you here, GM. Some graffiti artists do a good job, too, although how desparate they are might be a matter for dispute.

      By the way, I do not consider Melanie taking her own life as her “errant way” – it is not as if she got caught spraying graffiti on the school gates. She entered into a desperate act to escape her situation and she made sure she did a good job of it.

      This young woman was 24 years of age, and that makes about 54 years of squandered life had she lived to the average age in the general population at death. We could hope that a few more years might have made a little bit of a difference, but there is no certainty in this kind speculation. Most people struggle, most people suffer, and most people don’t commit suicide. There is something extremely selfish in this act of self-destruction. There is also something very inconsiderate about this sort of an act. One is inconsiderate towards one’s friends, if one has any, and towards one’s relatives. I’m not saying that we have the intimate details, for instance, we don’t know whether a father or an uncle might have been raping this girl. Other women have been incest victims, too, if such were the case–we don’t know–but they don’t necessarily off themselves as a rule.

      As a person who was instructed to admit himself into the hospital voluntarily, who did so, and who was then court committed, I stand by my previous statements. The only thing voluntary about voluntary mental health treatment is the spelling, and that spelling is not even a mistake, it is an out and out deception. Let me put this into a plain speech…I think, in numerical terms, that this decision is likely to mean many more detainments than lives saved. I think there are other and more effective measures that can be taken to prevent suicide.

  13. I think that you understand my comments are not specifically about graffiti. What they are about is entering into an “errant” act. I believe we are heading towards a semantic debate here rather than one of belief. “Erring” means “deviating from an accepted standard”, so to use the word in this context just makes you sound rather right-wing Establishment and judgemental.

    I suppose it rankles for the same reason the term “to commit suicide” does. It is still considered a crime in some countries and a unsuccessful suicide attempt can mean a prison sentence. Great. Just what you need to cheer you up and make you feel like life is worth living.

    Others consider it a crime against the Christian version of God and believe it to be the destruction of “His” property. I do not. I believe we have an animal right to domain over our own selves.

    Suicide tears a hole in the fabric of the Universe of those left behind, however; especially that of children. It is a self-absorbed act that leaves those who love the person blaming themselves and searching for an answer that can never be found.

    But people who take their own lives often consider doing so to be an act of bravery or a matter of honour; of altruism even. They get to a point where they think their loved ones and the world will be better off without them. Some can be convinced otherwise and others never can.

    Escape is a strong motivator. Feelings of fear, guilt, shame, abandonment and loneliness can trigger the decision to seek permanent relief. Crippling anxiety causes sleepless nights, which cause hallucinations, fatigue, and more anxiety. Medication for all of the above can simultaneously carry the risk of causing all of the above. People end up not knowing which way to turn. Some turn to the wrong person, and that can be fatal.

    I think that young people are affected in ways we are new to. Social networking, living through machines and the general onslaught of information take their toll. It is all too much for people to keep up with, so feelings of inadequacy are inevitable.

    But it is elderly men who are more likely than any other group to take their own lives, as they feel control over their lives and their vitality slipping away. It is perhaps like the old stag taking to the forest when he feels it is time.

    Less wealthy cultures have different attitudes towards death because of the strain on resources of the elderly or infirm. In affluent western societies, the goal of medical practices is to fix people when they are broken. They do not take into account that a person might have had enough of their life for whatever reason, as is their right. Perhaps if we were not so obsessed with the “accepted standard”, we might find it easier to accept a loved one’s choice; hard as it might be. We tend to think that because we have all this equipment, all these drugs, and all this scientific knowledge that we can and should keep people alive. When these things fail, people are left feeling as if everything would have been all right if that next breakthrough was not still around the corner.

    We can treat each other with greater compassion and encourage communication and community, but even in the most Utopian of societies it is likely that people will still exercise their fundamental human right to die. And yes, that is a human right too.

    I do not have all the answers, MFV, if but a few, but I think we should be reluctant to make sweeping statements about the experiences of someone who thinks their death is better than their life. The real reason is likely to be the one they never share.

  14. Cultural differences are a factor in your concerns because you look at the decision from a US perspective only. The use of greater force to control a situation is endemic and this approach to patients is incredibly damaging. You were effectively imprisoned in a stealth attack and any trust you may have had was destroyed. I do not know if you have shared your story here or anywhere else; if you have, I would be interested to understand more.

    It is different in Great Britain, although that is not to say that dangers do not exist within its mental health service; far from it. Outdated ideals and attitudes prevail in many instances, however the general push is towards greater understanding and improved care. Yes, the system is littered with egomaniacal doctors and power crazed nurses, but you are just as likely to come up against that in general medicine as you are in mental health. The sheer brutality of the US system is not mirrored in Great Britain, but there is a long way to go before the NHS is able to provide a nationwide service of equal standards.

    Voluntary mental health patients are free to leave and do so if they wish. The sectioning of such a person would have to be justified in strong terms and it is, more often than not, exercised in relation to patients who are considered to be at risk of serious self harm. And anyway, most facilities lack security measures that prove to be much of a challenge to determined escapees, with inpatients even scaling walls or fences to nip down to the pub.

    Pick up MoneyWeek if you get the chance and see page 18 for “The redefinition of mental health” as you might want to comment on it. DSM-5 is being challenged because of the APA’s links to big pharma.
    Here is the open letter and petition link for all those who are interested and/or wish to sign.

    http://www.ipetitions.com/petition/dsm5/

    The present edition is clearly lacking but it is good to see people are mindful of stopping the new one getting even more out of hand.

    MFV, I honestly believe that demand for profits and the self-justification of medical staff are the great drivers behind the negative aspects of mental health care.

    Melanie’s history and her high level of monitoring whilst in hospital lead anyone with an ounce of sense to see that someone should have been keeping an eye on her. And why should she shoulder the blame for the decision or any ramifications? Save it for the loathsome doctor who waved her off trailing her noose behind her.

    • I tend to think of suicide as a bad decision not even elderly men should make. My view is that when you’ve lived that long you might as well see that little thing called life through to the end. A heck of a lot of people may not have a heck of a lot to live for, but that gives them even less reason to die. Often when one does come to that decision, it’s because one can’t see past the end of one’s own nose. There are other people in the world, and let me tell you, life for them ain’t no piece of cake either.

      Let me indulge my passion for entymology. This is from Merriam-Webster’s definition of Errant.

      Origin of ERRANT

      Middle English erraunt, from Anglo-French errant, present participle of errer to err & errer to travel, from Late Latin iterare, from Latin iter road, journey — more at ITINERANT
      First Known Use: 14th century

      I was thinking of Errant as a derivative of Err. I’m not right wing, but I wouldn’t encourage suicide. I think of living one’s life as the more self-less path to take than the taking of one’s life is. Who is free, if all are not free? I think one could find a legitimate argument for suicide, too. I feel that suicide is one way of turning one’s back of the struggles, and the solution to those struggles, all of us have. We are all in this world together. This fact is something the suicide has a great deal of difficulty seeing.

      People have the right to commit suicide. Who’s to prevent them? They just don’t have the right to get caught at suicide, or to fail at suicide. Failing at suicide will automatically get you a psychiatric label. For those little indescretions we lock them up, and “treat” them, in order to convince them that life is worth living I imagine. Perhaps it is, perhaps it isn’t. If a person desires suicide, they can have it, and nobody is going to stop them.

      I may not have enough knowledge of the mental health system in Great Britain, GM, but I know how the system works in the USA, and I imagine there are parellels. I could be wrong about some things, too, though.

      Regarding the DSM, there is also a petition to boycott the DSM. Many of us think a challenge kind of lame. You’ve got all this criticism of the DSM-5 revisions. The DSM-5 gets published anyway. So much for the criticism. Want more of a bad thing? Later its likely to be the DSM-6. False epidemic after false epidemic, they’re are better ways to treat people than to label and drug them, and that’s about all you are going to get out of the DSM.

  15. In England, apparently, about one third of detained patients every year enter hospital on a voluntary basis and are then detained at a later stage. I don’t know whether that is a lot or little, compared to, for example, the USA. In 2009/10 there were about 46,000 detentions of which about 16,000 were detentions of informal patients. All in diagrammatic form on page 20 of this report
    http://www.cqc.org.uk/sites/default/files/media/documents/cqc_monitoring_the_use_of_the_mental_health_act_in_200910_main_report_tagged.pdf
    The diagram also shows that the total number of detentions have about doubled over the past 20 years.

    • Thank you for linking us to this report on the use of the Mental Health Act in Great Britain, Monday Morning. This kind of decision might lead to a slight bump in what it calls Changes in informal admission. It looks like it wouldn’t really even amount to too much of a change there though. Detaining 1/3 of your voluntary admissions has got to be kind of high I would think. Even more distressing are the figures in Figure 1, the diagram on the previous page, page 19, of the report. In this diagram we see that detaining people under the Mental Health Act has practically doubled in 10 years time, and that this use of involuntary detention, and the forced treatment attendant, continues to rise.

      The use of the Mental Health Act to detain psychiatric patients is increasing. In 2009/10, the year covered by this report, the Act was used more than ever before to admit patients to hospital under compulsion, or to detain informal patients who would otherwise have discharged themselves (figure 1).

      The chart (figure 1) shows a rise from 21,897 detentions in 1987/88 to 45,755 detentions in 2009/10.

      • Actually the figure of 1/3 refers to the proportion of detentions where the person started out as a voluntary patient.
        As a proportion of voluntary admissions it is more like 1/10 – about one in ten people admitted on a voluntary basis will be sectioned. But still a significant number.

      • Thank you for your post, Monday Morning; I had been looking for those figures.

        MFV, to say that “This kind of decision might lead to a slight bump in what it calls Changes in informal admission. It looks like it wouldn’t really even amount to too much of a change there though.” is very different from imagining that “the price that is paid is going to be paid in an overall loss of civil liberties for people, human beings, experiencing the mental health system in the United Kingdom”, as you first stated.

        I think your former statement in this instance is closer to the truth; as I have propounded.

        Were you to re-visit Monday Morning’s link, you would see that the number of voluntary patients sectioned in Great Britain has dropped during the last ten years.

        I would suggest reading the foreward by Jo Williams, Chair of the Care Quality Commission, in which she voices the same kinds of concerns as we do here.

        I believe that the difficulty lies not with the stipulations but with their implementation.

        The same ‘office politics’ mentality exists in whatever situation you place people in, and mental health is no exclusion. At one end you have well paid individuals evaluating and determining what is best for people detained by law, and at the other end you have people who are simply ‘doing a job’; interpreting and implementing these instructions in a way that suits them. In the same frame as you would place dishonest building contractors, mendacious mechanics, and so forth, you have mental health staff who are not particularly interested in the welfare of patients. Their focus may be on where they are going tonight/went last night, who is sleeping with who, how they are going to get through their shift without half a bottle of vodka, etc.

        I note from the link that the more secure the facility, the more likely abuse is to take place. I find this to be true across the board and to be an issue that needs addressing with alacrity.

        I concur with your comments regarding the DSM-5. It is often the case that mild objection gives people the impression that they have taken action, whereas the truth of the matter is that, whilst there may be slight concessions buffed to a sheen by public relations staff, the objectionable goes right ahead with nary a hitch. By that time the mild protestors have run out of steam but congratulate themselves on the fact that they “did something”.

        As you know, I have particular concerns about the targeting of children by drug companies. They are not in a position to defend themselves, and parents who are not able to parent well are likely to seek a reason for their child’s behaviour that they are not to blame for. I view the drug companies as child abusers in this scenario, enabled by knowing or unwitting parents.

      • Oops. Thanks for the correction, Monday Morning. About 1/3 of the patients tend are voluntary, and 1/10 of those end up sectioned. Although this is a figure that I doubt will change all that much (my initial fear) given the figures on the diagram, I am very disturbed by the extent to which involuntary treatment is increasing. As is always the case with all supposed “last resorts”, once you let the “last resort” in, it tends to be used less and less as a “last resort”.

  16. It is the worst of bereavements when someone you love takes their own life. If those who are considering this could be taken on a Christmas Carol journey to the future to see the devastation wreaked upon the lives and sanity of their loved ones, I hope they would see how much they are loved and how much hurt they would cause if they carried it through.

    I do not advocate taking your own life, MFV. Far from it. But I do try to understand it.

    I agree with some of your points and not with others, as is usually the case. In respect of some:

    Your views and ideas of shoulds and should nots are as irrelevant as mine to the people out there contemplating taking their own lives right now unless they happen to be reading this. I hope that if anyone is, they stop and reach out to someone and tell them their thoughts.

    You say that elderly men “might as well” see life through to the end. Some might say that they have lived long enough with their independence to want to go before they lose it to double incontinence and condescension.

    Not being able to see outside of yourself is one way of looking at it; another is that people look outside of themselves and see a world that does not need them anymore.

    If someone feels that they are a strain upon resources they might reason that everyone else would be better off without them. How often have you seen a movie where a wounded character stays behind to hold off the bad guys/aliens/zombies/opposing army/catastrophic event with everyone knowing that to do so means certain death? We applaud the heroic suicide when we are presented with it as one. The self-sacrificial suicide of the individual, wounded or not, is something we tend to respect. Our military could not exist if this were not the case.

    Not having a lot to live for does not mean a person has “less reason to die” as you describe. If someone does not have a lot to live for, and they do not feel that they can start over, then dying is likely to make more sense to them.

    It is hard for people to see that “we are all in this world together” when the local thugs have just smashed their windows and terrorised them outside their own front door. There are a lot of factors that bear upon a person’s decision to take their own life, and the treatment they are subjected to by their fellow man is at the top of the list.

    You say that there are solutions to the struggles “all of us have”. This is not the case for everyone. But it is true that people can get to the point where they cannot see solutions even when they do exist; or they find the alternatives untenable.

    On “Errant”:

    I had no idea you were so interested in insects(!) You mean etymology, of course; a shared interest.

    I do not believe that you were expressing your concerns about Melanie’s interest in travel when you were condemning her for the decision taken after her death that you felt might bring about an increase in detainment of voluntary patients within the British mental health system.

    You were using the word “errant” as an extension of “err”, you say, so you meant that she was “mistaken or incorrect”, which is fair enough. I do not find it the best word to use in the context of suicide because of its variations, which include “to do wrong” and “to sin”. I have it from “Middle English via Old French ‘errer’ from Latin ‘errare’ – stray: related to Gothic ‘airzei’ – error, ‘airzjan’ – lead astray”.

    “Errant” steps off in a different way because as well as “erring”, it means “deviating from an accepted standard”. Further, its literary or archaic meaning is “travelling in search of adventure” as in ‘knight errant’. This second meaning is derived from “Old French ‘errer’, ultimately via Late Latin ‘itinerare’ from ‘iter’ – journey”.

    All references are from The Oxford English Dictionary or The Concise Oxford Dictionary.

    I think we are less free than the average insect, but that is another debate.

    • Excuse the (sp), GM. I disagree about our freedom in relation to the average insect. I think insects lead much more precarious existences than the human species as a rule, due in no small part to the influence of secular humanism. Both are spectacularly successful species, but as an indication of this precariousness of life where insects are concerned, I’d point to pest control. The closest we’ve gotten to secular insectism is the science of entomology I suppose.

      On the other hand, errant way was not a spelling mistake on my part. Realize that to be mistaken is to stray from the path of the truth. As for what you call the second, literary or archaic, meaning, I would suggest that they aren’t that far apart. Cervantes’ Don Quixote, a satire, tackles the subject of ‘knight errantry’, from which we also get the word quixotical. A word that may not seem so relevant here, except in so far as illusion leads to disillusionment–the final chapter of Don Quixote. In Paul Bunyon’s Pilgrim’s Progress, for example, travel could be said to be metaphorical, and some people don’t always, as in Melanie’s case, make it out of their “Slough of Despond”. I’m sure you’ve heard the expression, “to err is human”. If errant ways are plural, suicide is singular; usually it is singular anyway. The pity is that her passage was so final. Pilgrim’s Progress is a moral tract, and morality can get us out of any “Slough of Despond” we encounter.

  17. Freedom is not defined by how precarious or not one’s existence is. But if it were, it would be fair to say that a high proportion of people live precarious existences. Looking at human existence through western eyes clouds our view, as there are plenty of places in the world where secular humanism is extremely thin on the ground. And we can hardly claim to be exemplary examples of its philosophy at work given our military strategies and the human casualties we cause.

    Regardless of pest control, insects are free from the moment they are born until the moment they die. There are notable exceptions, such as ants, who enslave one another. We regard them as the insects most like ourselves.

    Insects never have to worry about paying the mortgage or the rent, they pay no taxes, they are free to roam wherever they wish, they are not expected to dress a certain way or worship or avoid speeding.

    Did you ever look out of the window when you were incarcerated and see the insects? Did you ever wish you were as free as they were?

    Entomology often involves killing the insect for study or for display so it is far from being a form of cross-species secular insectism.

    I could have chosen any wild animal: Bat, shark, dolphin, gazelle, crocodile, rhinoceros, and so on. We could have a philosophical debate about the freedom of each one in relation to us and each other. I chose insects because we so often think of their lives as disposable, yet they enjoy more freedom than we do. In terms of our eco-system, they are arguably more important than we are. They make up two thirds of all species and there are those amongst them who can withstand the onslaught of the worst weapons we have invented to destroy each other. I daresay we might succeed in terminating ourselves one day, but not the insects.

    Briefly, regarding the DSM-5 petitions, I have had a re-think following a closer look at both presentations. Although I agree that there is much more to be done regarding that which is already considered legitimate, I think it is a good thing that the individuals who challenge the new labels are paying attention and are involved.

    And so to “errant” again..

    I think we are going to have to agree to disagree on this one or else I am going to end up in the “Slough of Despond” myself!

    I just think another word would have served the sentence better unless you meant to blame Melanie in a rather fundamentalist manner. Straying “from the path of truth” is the definition of err in biblical terms, so that leans even further towards the religious right. You were quite cross with her at the time so the ‘sinning against the Establishment’, inference was inevitable.

    Sinning is the theme in the Pilgrim’s Progress reference you make:

    ‘This miry Slough is such a place as cannot be mended; it is the descent whither the scum and filth that attends conviction for sin doth continually run, and therefore is it called the Slough of Despond: for still as the sinner is awakened about his lost condition, there ariseth in his soul many fears, and doubts, and discouraging apprehensions, which all of them get together, and settle in this place; and this is the reason of the badness of this ground.’

    Not a great holiday destination then.

    Do you mean to call Melanie a sinner?

    As an aside on Don Quixote, I daresay that Alonso Quixano would be locked up these days and treated for being delusional and dangerous. I think it is sad that his adventures went the way they did in the end; sanity is not always the best option. It would seem that, for some, life isn’t either.

    I am not sure that morality is what gets us out of our individual Sloughs of Despond, MFV, and nor do I think that we can we impose our own senses of morality upon Melanie. I doubt that the ethical consequences of her behaviour were primary factors in her decision; made, if it were, from such a doleful place. It is sad for us that Melanie took her own life; for her it may have been blessed relief. The treatment she received was ultimately ineffective and that, to me, makes Melanie’s death a mental illness fatality. The treatment was flawed.

    It is journey’s end for Melanie, or journey’s start, depending upon your beliefs. I wish her peace.

    • Entomologists may dissect insects in the interests of science, but they don’t generally opt for specicide. I’d say they’re interest is governed by a type of love, and this love would forbid wholesale destruction of habitat. If insect species have any friends, one of those friends would be the entomologist.

      I don’t think we will ever have a cure, let alone an effective treatment, for the suicidal impulse. Feeling bad isn’t an illness. Psychiatry calls it an illness, but psychiatry is full of shit. Morality or wisdom, G.M., there are better things to do with one’s life than end it.

  18. Like everyone else, entomologists can go either way. Some entomologists are as you describe, others are involved in attempting specicide; see mosquitos.

    I found this:

    http://www.entomology.edu.au/index.html?page=159175&pid=62443

    No bees were hurt in the course of this research..

    I thought about Thanatos after my last post and I have just had a bit of a read of Freud’s ‘death drive’ theory. I am no fan of Freudian thinking as a rule, but thought about what would be appropriate if his theory was accurate. From what I have read, I think the best treatment for someone feeling suicidal might be to encourage them to express themselves aggressively in order to turn the death drive outwards again.

    There may be no cure. There may be no reason for a cure. If people do not want to carry on living, then they do not have to.

    Feeling bad is subjective. How bad is bad? Screaming in pain is a long way from feeling glum. I think that screaming in pain needs treatment.

    Yes, there are better things to do with life than end it.

    • Poor mosquitoes! (I’m not joking, but my sympathy for the malaria bug is a little more circumspect.)

      As I’ve indicated previously, Freud’s death wish (Thanatos) seems to overcome life instinct (Eros) more often than it is deflected with an act of murder–survival instinct trumping the death wish. I would imagine this fact diminishes the importance of much pseudo-scientific presumption, even that of Sigmund Freud.

      A couple of notes about the Quality Care Commission report we referred to earlier. Although the overall patient population has decreased substantially, the involuntary patient population has nearly doubled in the last decade. The involuntary detention of voluntary patients has declined. The forensic population is rising, but this rise is not yet alarming. What is alarming is this doubling of involuntary patients, coupled with the fact that the UK just recently introduced Community Treatment Orders. These Community Treatment Orders are a form of involuntary outpatient treatment for people exiting the hospital in Great Britain much like conditional discharges from hospitals in the USA. They haven’t been used very much as of yet, but I imagine this usage can only increase with the passage of time. 98 % of these Community Treatment Order involve treatment with psychiatric drugs, and that is a statistic I don’t expect to decline any time soon. If the institution is dwindling, the institution without walls is expanding, and this a disturbing trend, not just in Great Britain, but in other parts of the world as well.

      • G.M. Forest, the site didn’t pick up your last comment for some last comment for some reason, but I’m copying it below.

        If we could murder without consequence, it would be a more viable option.

        That said, I was thinking of something more along the lines of a ball game.

        Take a look at the figures again and see how the Section 136 admissions have increased. It is difficult to calculate exact figures because numbers are presented differently from the overall totals, however it appears to be the case that the increase in involuntary admissions over the last few years is due to the use of this facility.

        The CQC report talks about the need to define the parameters of the use of Section 136 efficiently and the need for services to have better communication with one another.

        The Chair of the CQC, Jo Williams, talks about the misuse of CTOs in her foreword. Here she voices her concerns again:

        http://www.guardian.co.uk/society/joepublic/2010/oct/27/community-treatment-orders-mental-health

        All in all, I would say that the CQC is aware of the problems and is addressing them. Given recent developments although, how effective this will be remains to be seen:

        http://www.guardian.co.uk/social-care-network/2012/feb/24/leading-cqc-mission-impossible?INTCMP=SRCH

  19. Many thanks, MFV. It did show up on my computer but with a note attached; I think there might be a couple more.

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