THE
P RTAL
April 2019
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and their care coordinator. We cross examine the
witnesses and hear from the patient. At the end of it we
have to decide whether they met the specific criteria
under the Act; that they are suffering from a disorder
or impairment that is of a nature and/or degree that
warrants their being detained in hospital. Detention
in hospital is for their own health, safety, protection, as
well as for the protection of other people; and that they
can be treated and that detention is the least restrictive
may of handling it.
“It is informal. We sit around a big table, we are not
as formal as a court. We have to do the job and abide by
the rules, but we try and handle it very sensitively. It can
be very difficult for someone who is mentally ill to sit in
a room with a gaggle of people being talked about and
hearing things they do not like or disagree with.
“There are a fair number of us. We have to have
enough people on the books to make a panel of three for
each hearing. There is quite a mix of people,including
former magistrates, district judges, retired senior
police officers, social workers and nurses, all from a
variety of backgrounds. Its not something people just hospital on seven occasions. When unwell the patient
walk into. It’s an area that a lot of people don’t want to shows the following symptoms. So for me as a lay
know about.
person that’s good enough; I believe that.
“I am lucky, that I work in an area where the quality of
mental health provision is good. It is a bit of a postcode
lottery. In Essex we have a strong Mental Health Trust.
Many of the old Victorian and Edwardian asylums
have been shut down and the new units have been
built They are to a very high standard. All the patients
have single rooms with en-suit bathrooms. The days
of the big wards and curtains between beds are gone. “Then: ‘Is it of a degree that requires attention?’
He goes into remission, then relapses and is back in
hospital. How bad is it? Well, at the moment the patient
relapsed because after being released from hospital
three months ago they stopped taking medication. Off
we go again. It is common sense stuff. You aren’t trying
to be a psychiatrist. The evidence is there, and the law
is clear.
“Things are still changing. There have been big
advances in the last twenty years. For example, some of
the anti-psychotic drugs are very advanced. Someone
with bad schizophrenia and who may never be cured,
but get them on the right medication and they can live
a reasonable life. There has been some great progress “We send everyone out and make our decision. Then
we have them back and tell them our decision. We give
them a brief version. Once that is done I have to sit
down and write up the reasons. A full account of our
reasons.
“They have had that since 1992. I assume the
doctor isn’t telling me a fairy story. So my first note
is an established diagnosis of paranoid schizophrenia.
Why do I believe that? I would have had a report that
tells me since 1992 this patient has been admitted to It is obvious that Michael is working with some very
vulnerable people, and doing his best to do the best
for them. We are very grateful to him for his time,
inviting us into your lovely home, and providing us
with tea.
“A decision has to be made. The power we have is to
“The important thing to remember is that I am not discharge the patient either through substitute FROM
a psychiatrist. I am not a social worker. I am not a detention or a community treatment order. The three
nurse. My only guideline is the law. It’s quite straight- managers must exercise that power. It cannot be two
forward. The first question I have to fill in on the form: to one. It has to be the three. We only have the power
‘Is the person suffering from a mental illness?’ The to discharge. If you feel you can’t agree, you don’t
psychiatrist has said in his report that the patient has discharge, but refer it to another hearing for a separate
bi-polar or schizophrenia.
panel.”