The Power imbalance within Mental Health

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A random comment recently about mental health professionals and my views towards them has led me to think about my reaction towards those mental health professionals I have come into contact with over the years. When I first accessed mental health services as a young adolescent I viewed the staff I met as an out-patient as being somewhat important and aloof, but today after years in the system my attitudes have changed.

As an adult I have accessed both in-patient and out patient services, crisis intervention and assertive outreach alongside psychology services. My views are based upon my encounters with the professionals I have met along the way and whilst some have been friendly and accessible, others have utilised authority and control. It is this control that I think has led to my changing views, I no longer see medical professionals as just aloof but often depending on the individual as uncaring, unhelpful, interfering, misunderstanding, judging and most all controlling. I know I am sadly not alone in my views and that causes me some concern, when after all the reality is that  these very same people are deemed to be there to help someone like me with mental health issues.

Why has my attitude changed so much, from being the compliant patient to the person who probably now is seen as a bit of a pain in the backside, as I will exercise my rights to raise concerns, expect a certain level of service and insist on being treated as an equal. Yes that’s right an EQUAL.

I think the reason is quite simple, the power imbalances I have encountered along my journey have led me to no longer be so willing to just roll over and take being treated like a third class citizen, one without rights, views or opinions.

It is only within Mental Health that you will encounter healthcare professionals with the power to take away another human being’s liberty, to decide what they do, when they do it, how they do or even where they reside. The Mental Health Act gives this group of health staff more powers than most and it means that people like me can be treated with force, against their will and in a manner that at times is down right degrading.

During my first admission I was an informal patient, and yet deeply distressed I left the ward, my intent was to commit harm to myself, I realise that the healthcare staff had a duty to look after me, but did that have to involve chasing after me in a vehicle across the hospital grounds and onto a neighbouring hospital site as if I were a fox being hunted. Did they really have to restrain me with force, when I would have accepted that I needed to return back to the ward. Did I really need to be forced to take medication against my wishes and then placed on a Section  4,  put on 1-1 obs, and treated in a totally degrading manner. I was watched going to the bathroom, the staff who sat observing me; many of whom were random strangers to me, didn’t engage nor did they make any attempt to understand why I had wanted to leave or the pain I was feeling.

medication blog

Over time and a number of admissions these experiences got even worse and I have endured being held in a locked room, never mind a locked ward. I have faced being injected with medication, held face down and restrained so forcibly that I was left with bruises. I have had every ounce of dignity stripped away as the power imbalance that exists  has allowed them to deny me not only my freedom but the right to make even simple decisions. I am left feeling as if at times during my encounters with healthcare staff all rights to humane treatment were taken away.

When I was a sectioned patient and placed on my one and only Section 2, I was placed in a high dependency unit for short periods on more than one occasion, I was often nursed by male staff more like bouncers, who seemed to be deployed from the male ward to deal with the so called ‘problem’ female. I wasn’t allowed the right to even a hot cup of tea, no only a tepid one , yet I have no record of being aggressive towards any staff so cannot to this day comprehend why. I wasn’t going to throw it at them that’s for sure.  I wasn’t allowed access to many of my things, I was held in a small area of confinement and treated as if I was just a trouble maker, again there wasn’t any kind of what I would call treatment, no one seemed to do anything except ply me with medication.

When I was held on a Section 3 the power imbalance allowed these same staff the right to determine where I would reside, and the type of unit that would be. They sent me miles from home to a private facility which last year failed its care quality commission inspection, there the treatment got even worse and I wasn’t allowed the right to even walk alongside the very people who were tasked with my care. My therapy sessions were through a series of locked doors and I couldn’t leave a session even if I wanted too. They could control whether I was allowed in my room unaccompanied, what times of the day I could access my bed, they forcible restrained me, refused me access to fluids and phone calls home. They had control over my possessions, even my toiletries and they determined whether I could use a bathroom with any ounce of dignity at all.  They tried as best they could to prevent me from studying in the unit, because it meant that a tutor from the Open University would have to visit once in a while. It took a lot of pressure to be allowed to study, which  is something that is still regarded as a basic right afforded to many  prisoners, just it seems not mental health patients. They also observed all of my family visits, searched every object I was given and denied me access to many things my family brought me. these weren’t harmful objects just simple things like  objects of clothing, flowers, and a radio to name just a few.

restrained blog

The power imbalance is huge for patients especially those on the wards, for more than 60% of my time as an inpatient I have been informal. I have only had one rather long hospital stay as a Section 2 and than 3 patient, but even as an informal patient my rights were stripped bare, the staff controlled the times we could have hot drinks, what time we went to bed, what times the TV was on, our meal times, our visiting times. I have been in locked wards as an informal patient, and still denied the right to leave without any justifiable reason or the legal support of a section to detain me.

The power imbalance wielded by psychiatrists and mental health staff  against me has left me no longer the compliant unquestioning patient I was on my first admission. I now have higher expectations of the staff even those in the community, I don’t try and cause issues indeed I want to work with these professionals.

But my experiences of the power imbalance within psychiatry has left me scarred, it has also left me suffering trauma from some of the encounters, as someone who has suffered childhood trauma the impact of being held against my will in hospital  whether sectioned or informal was terrifying, especially when during that time there were periods when I was forcible restrained, medicated and more.

Whilst I understand that staff need to have some degree of responsibility and authority when dealing with patients,  how they communicate this and explain this difference can magnify or minimise the impact of this imbalance of power. Perhaps if staff were able to step back and think for one moment how their actions would feel to them if they were in the patients position, then maybe there wouldn’t be quite so much oppression or wielding of power. Maybe its time for there to be a reassessment of the power imbalance.

Copyright DID Dispatches 2014

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4 thoughts on “The Power imbalance within Mental Health

  1. Here, here! Have lost count of the times when Ive said similar.

    Humanity, dignity and basic decency are of no “cost” to these services, but investing more of those three basics would make a huge difference; not just to patients, but to society as a whole.

    This post is so well written, thank you for sharing. It`s likely I`ll be commenting again on it if I manage to translate the thoughts in my shared brain into something coherent.

    sending hugs your way.
    x

  2. I have just read your blog and I think it is very brave of you to write about your experiences. I thought the blog is very well written. I am pleased you now have the strength of character to question but yet still want to work with the professionals. It is someone like you who could help my daughter. I was shocked to hear of your experience and I meet with a group of former patients who have also had shocking experiences. Despite this they have been supportive towards myself and my daughter and I admire their strength of character in speaking out about much needed changes to the current system and portraying a very different picture to what you read about in the press. These are people who wish to be involved and help others. Recently I have come across some very honest professionals too. I do not think everyone in the profession is bad but I too have had a terrible experience and have been outspoken for my daughter but this has not gone down well. Some patients are too weak to speak out and too drugged up. To even visit on some of the wards I was shocked at what I saw. Everything is so orderly when the doctors do their rounds in the morning but if you go on the wards in the evening that are crowded and noisy and full of patients.

    I was not outspoken from the beginning – I did not know about the drugs or really understand anything about mental health but there has been more than 1 case in my family. I have not been affected myself but have been a carer to nearly everyone, my mother with cancer, my father with Alzheimers, someone else in the family and two of my daughters, one just a child who was sectioned and put on the drugs and the minute I spoke out when I discovered something wrong or when my daughter complained to me about her treatment, you really get to see the reaction of the teams involved. Trauma has been the cause and I wanted counselling for both my daughters but I had no idea what “care” would be on offer and in respect of my elder daughter this has been around 16 mind altering drugs and one admission after the other since the age of 19.

    I have been upset at finding out serious things that have happened which I cannot write about on my blog but no one from the team tells you anything. Everything is secretive and if there is a major incident on the wards this is kept quiet and when I got to find out various things I became outspoken and what I and a group of other parents would like to see is because if someone is a trauma victim but I would also like former patients to be involved and maybe students on nursing, psychology or psychiatry courses – I think they should meet the families where possible and learn about the background and what has happened to that person before they prescribe drug after drug. I have seen more than 1 diagnosis in the files for my daughter which this has also led me to question things. The professionals seem not to care about the physical health of my daughter and the courts at Tribunal level do not seem interested in that either just about compliance with treatment and risk to the patient or others. What about the risk to my daughter’s physical health especially when a diagnosis is in question and especially when someone suffered trauma and in my opinion should never ever have been put on the drugs in the first place. Same with my younger daughter diagnosed with Schizophrenia. Given anti-psychotics against my wishes as a child and sectioned. They have made am mistake with her diagnosis as she is on top of the world and working and I just would like to see better forms of assessment and a full look at nutrition and environment and whether someone has PTSD for instance. Choice of care should be available when acute wards to not work and an end to enforced drugging and ECT. I met Mr Burstow recently and have spoken to Mr Lamb and told them what was really needed. I know of people sectioned for many years and the mothers do not give up and wish for a centre like Chy Sawel to be set up. I wish for my daughter to be on the minimal of drugs and have holistic care and I would like to see open dialogue and patient involvement – there are some very remarkable former patients I am in touch with who would be wonderful for peer support – it is only when you have been through so much like you have that you can really have a proper understanding and how many are sectioned needlessly for years and years on end transferred miles from home to private sector care. Something needs to be done more than just spending £25,000,000 on MH professionals to work alongside Police. I would like to see some of the former patients involved as well and a fraction of this money could be given to help a specialist centre set up. Something more needs to be done for people who end up back on the wards time and time again because of lack of care in the community and they become isolated. I would just like to see choice as my daughter always wanted a peaceful environment and on an acute ward it is not peaceful. The same with the scheme with loud music and disturbance from other residents. The money being spent on years and years sections under private sector should be used to properly assess these patients and not just let them be written off. I totally disagree with this and there is nothing being done about this from what I see.

    • Sbev I agree something needs to change, I think unless you have been on a ward as a patient you never fully realise what kinds of things go on. It’s not just ‘Time to Talk’ it’s ‘Time to change’ as well.

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