Friday, November 24, 2006

England: "They're getting away with murder"

There has been much public outcry in the aftermath of the headline-grabbing tragedy of John Barrett, a man with schizophrenia who killed a stranger in England.

A distraight father, Tim Salmon, talks poignantly in the Observer about stigma and the system and the impossibility of getting real help for his son in a cuture that values language and empowerment above all else - including medical intervenation. He writes that one mental health worker noted his son was "having issues" - a euphamism for his schizophrenia, and then discuses:

... the intractable and messy nature of an illness whose distinguishing feature is loss of reason. Not that you are allowed to say that, because it runs counter to the 'ethos of optimistic realism', probably promotes stigma and generally interferes with our modern desire to pretend that there are no inequalities or other unpalatable differences between people.

This extreme aversion on the part of the caring professions to calling things by their proper names is one of the most vexatious 'issues' I have encountered. The sick are no longer patients, but clients or service users and, by implication, considered capable of evaluating their own needs, entering into contractual relations with doctors and other agencies whose function is to deliver the chosen service or care package. If this seems a surprising way of approaching people who, when ill, are almost by definition 'not in their right minds', what are we to make of the recent 'best value' review of mental health services by Camden council in north London in which it proposes to give patients/clients direct payments from social services with which 'to organise and buy the services you need for yourself'? And this, when one of the most notorious symptoms of schizophrenia is an inability to understand your own situation.

Camilla Cavendish in today's Times is also up in arms about the culture of what we way seeming to matter more than the importance of what we actually do to help people.

[The] determination [of the mental health lobby] to stamp out stigma can lead them to rewrite reality. Illness has become health. Patients have become clients. Savage attacks on other people have become "untoward incidents".

Now last week’s devastating inquiry into the death of 50-year-old Denis Finnegan, murdered while cycling through Richmond Park by a paranoid schizophrenic, John Barrett, is being twisted by powerful groups who put patient "rights" above public protection.

A respected consultant psychiatrist neatly summed up his profession’s hostility to inquiries. "Being retrospective," he said, "they foster a simplistic notion of the preventability of homicides". Really? What last week’s inquiry showed was that Finnegan’s death was wholly preventable, caused by gross incompetence and arrogance — from the tribunal that discharged Barrett in the absence of his doctor, to the psychiatrist who gave him an hour's leave from hospital, to the nurses who
failed to warn the right people that he had not returned ....

The whole reaction has been surreal. On Friday the Royal College of Psychiatrists insisted that "all the professionals involved in this inquiry [must] be supported" and
announced that it is planning — a seminar. Shouldn’t someone be sacked? ...

The Mental Health Alliance, a group of 80 charities, is concerned only to emphasise that Finnegan’s death was "extremely rare". This is a familiar refrain from those who fear the public will shun schizophrenics. But it borders on falsehood. When I called the Department of Health this week, I discovered that between 55 and 63 people are killed every year by people who have recently been in contact with mental health services. At about 10 per cent of the total murder count, dare I say this is quite a lot? The charity SANE believes that at least one in three of those murders is preventable. Its analysis of 69 such inquiries finds that in half the cases, professionals had ignored warnings from family and friends. Some psychiatric patients refuse treatment. What is less well known is how many others are denied it, even when they or their relatives are crying out for it ....

There was a preference for "engaging" with patients, over "intervening". There is an understandable reluctance to act in loco parentis for adults who may at times be perfectly capable. But the jargon of "empowerment" creates nonsenses. It means a manic depressive choosing not to "engage" with social services, which then walk away. It means a schizophrenic choosing whether or not to take medication, even if he has a violent history. It means setting Barrett free to buy a packet of knives
and take a taxi to Richmond Park. In most cases, treating people who have lost
their reason as though they were rational beings leads to misery and neglect. In
a few cases it leads to death.

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