I am against compulsion at any level in mental health care. And in principle I uphold service users’ right to free decision making when it comes to issues of treatment (drug and other treatment) and care.
But I have questions too and I would like to interrogate further the notion of ‘the right to free decision making’ within mental health care:
What happens when people are so emotionally distressed that their capacity for agentic and responsible decision making is severely compromised? Yes, they have the right to decide, but can they make decisions that indicate conscious agency and responsibility? People in detention under the Mental Health Act (MHA) are most of the time in an extremely distressed state. If people in detention cannot make conscious and responsible decisions for themselves due to extreme levels of emotional distress, then what needs to happen, if anything?
Let me illustrate this. When I was detained under the MHA back in 2009, I absconded from the hospital twice in my first 2 weeks of detention. I only remember the one time – you can imagine how over-medicated, distressed and disorientated I was. You can say that by absconding I exercised my right to decide whether to stay or not stay under compulsory care. You can also say that my absconding was an act of resistance where I exercised some agency. But I doubt it was conscious agency – I guess it was more agency linked to desperation, desperation that makes you ignore risk.
Most important, my absconding was by no means a responsible decision I made for myself as it completely ignored risk. Anything could have happened to me in the journey from North Manchester General Hospital where I was detained to central Manchester and then to Levenshulme (area in central Manchester) where I was living at the time. I could have been run over by a car, I could have killed myself (I was suicidal), I could have been taken advantage of and abused as I was very vulnerable. Luckily, none of that happened and I reached home safely both times (a miracle?). I think somebody (nurses or psychiatrists) should have done something, should have intervened and engaged with me to stop me from absconding and endangering myself in such a way. Perhaps I should not have been detained in the first place- in an ideal world my extreme distress and suicidality would have been responded to differently and not with coercion. In principle, I had the right to decide to leave compulsory care but could I exercise this right for decision making in a consciously agentic and responsible way that needed to involve vital considerations of risk on my part?
I am against compulsion at any level in mental health care. And in principle I uphold service users’ right to free decision making when it comes to issues of treatment and care. But I also wish to problematise the notion of ‘the right to free decision making’ within psychiatric care and have this notion looked at in context and in its full complexity.