Capacity symposium speech

Good morning everyone.

This morning I will be talking to you as a person with lived experience of mental health issues, and with lived experience of hospital and detention.  I currently work for as a Policy Officer for a mental health charity in Northern Ireland, and prior to this role worked as a human rights litigator, including specialising in detention cases.

All of us in society make decisions daily, mostly of our own volition, and without question.  This is a most integral part of our human autonomy and integrity. Often, when there is much at stake, or a decision is difficult, we seek advice, moral support or a listening ear from somebody who we trust, a friend, loved one, or even a colleague and most of us do all of this without realising the freedom we are exercising, as it is so fundamental.  In a sense, this freedom and responsibility is one which defines our maturity from being a child to being an adult.

This is something I also took for granted, and did not ever expect to experience a situation where my wishes, insight and direction would be overruled, and fundamental decisions about my care and my freedom would be made for me. 

A crucial part of this discussion we are having today is the impact that has on a person, in their sense of self, their confidence, and ability to recover, and how the process itself can be deeply traumatic.

I hope the discussions we have today will allow us to design a law which redresses the inequalities in this process and minimises the harm which can be caused by the current system.

Many patients are admitted to hospital voluntarily and their status is later changed to detained.  This can follow something as simple as disagreeing with a care plan or communicating, even informally, an intention to leave the care of the ward.

The process of assessment for detention can be incredibly traumatic and unequal.  Patients often have little, if any, information about the process, or their rights, including to representation.  The process can happen very quickly, and unexpectedly.

Whilst we live in a risk adverse society, there are real risks to people who are subject to the detention process, and this can have a lasting consequence on their life.  It is important to bear in mind that this happens when a person is at their most vulnerable, when they are already in a crisis situation.  In reality, seemingly small changes and support can radically reduce the potential harm to a person.   It is important to remember that the process can change how a person views their care team, and when they feel they can trust them with their care moving forward.

Mental illness does not exclude anyone. It can hit anyone of any class, or profession, or age, at any time and how a person is cared for in crisis is critical to their recovery.

It is an absolute myth that only certain types of people are detained and to proceed with that perspective risks failing many truly vulnerable people by a presumption that it is necessary. 

Detention in my opinion is overused, and overused as a precautionary measure, and this can often be as the result of a snapshot judgment made on the basis of someone’s diagnosis or because they are difficult to work with, without consideration of their perspective.  Decisions can be made quickly and can then take months to overturn.  In the interim time, the harm caused to a person (who is already in a place of great vulnerability) can be deeply and irreversibly traumatising and can actually delay or even prevent recovery.  

Supporting a person through this process can greatly reduce the harm caused by facing it alone. Support must be independent and neutral and where a person is unhappy with the outcome, quick and effective remedies must be available. In England, delay of 4 weeks before the mental health tribunal was held to be unlawful.  Here, in Northern Ireland, we often have delays of over twice that.

My story is not unique.  Through my involvement in support groups, through my work with Members of Beacon and in the Bamford Monitoring Group, I have heard many other people recall similar experiences, where as a result of complaining too much, or challenging their team, or threatening to leave, they were threatened with detention and even detained.

We must remember the seriousness of depriving another person’s liberty – most commonly this is used in the penal system.  It is abhorrent in our modern day that a person suspected of a crime is entitled to greater legal support in pre-trial detention, and in review and extension of that detention, than a vulnerable person who is held in a hospital.

In European and International human rights law, detention is to be used only as a measure of last resort, and only where effective and quick remedies are available to challenge it.

It is my sincere hope that we get this piece of legislation right, to truly protect some of the most vulnerable people in our society, and those whose voice is so rarely heard.   When this debate goes to the Assembly and is discussed in the media, it must be discussed in a sensitive way which does not further stigmatise people with experience of mental health issues.  We must choose our examples responsibly, with consideration given to the nuanced and wide range of people and experiences who have been subject to the current legislation, and can offer insight into the likely pitfalls and challenges of the next one.