Month: August 2020

Mentally unwell or criminal? My experience of being criminalised for my mental health.

In June 2017 my life fell apart. I was raped and endured a year long police investigation into the matter. I had always had a good life up to this point but suddenly it was flipped upside down; I was out of work and struggling with thoughts of suicide and self-harm. My way of coping was to overdose and I was constantly in and out of general and psychiatric hospitals.

As some of the overdoses were away from home and, on occasion, I would abscond from hospital when in severe distress, the police decided to issue me with a Community Protection Notice Warning (CPNW). It read:

 “This letter should be considered as formal notification of your need to put these problems right to avoid further consequence. Please ensure you take the following action/s within the timescales detailed.”

The actions were as follows:

  • not to have any unprescribed medications on me
  • not to act or ‘behave’ in a way as to cause another person to believe I’m in danger of harming myself.
  • not to contact anyone by any means to make threats or allude to any thoughts of self harm or suicide. This includes my close friends and family.

In a time where “just talk” and “reach out for help if suicidal” narratives are everywhere, being under a police-ordered notice NOT to talk is incredibly isolating. It goes against all the research that talking about suicidal thoughts is crucial in managing them. It gives the police powers over my health, where they have no place. It is a violation of human rights.

Unsurprisingly, the letter didn’t help my feelings of hopelessness and my struggles to engage with mental health services. Instead of being instantly cured from my mental health problems and suddenly stopping the self-destructive ‘behaviours’ like the police had hoped, I continued to be admitted.  My admissions became a lot more severe each time, and I usually ended up in intensive care units. Health professionals would mention the CPNW whenever I asked about signing forms to leave, and they would constantly threaten to contact the police and tell them I’d breached the notice. Health professionals became an extension of the police force and I found it impossible to trust them.

Eventually in May of 2019 the police decided to issue me with the full Community Protection Notice (CPN). This is valid for 2 years and includes all the same actions contained in the  warning letter that I must abide by. Once when I was struggling I text a friend to say I was thinking of harming myself. She ended up calling for help and the police showed up, who told me I had broken my notice.

I have never felt more isolated than I am now knowing that if I do need help I can’t so much as tell a friend or even a family member. I’m not even allowed to tell my mum I’m struggling. What sort of life is that? If my family call for help, it’s me who will get arrested. The only people I’m allowed to talk to about suicidal distress are specified mental health professionals, yet they are the ones who’ve put me in this situation. My trust in them is at an all time low. Talking about my distress and asking for help is now a criminal offence.

Increasingly more people, often those given a BPD diagnosis label, are being arrested and sent to prison because of suicide attempts or their communication of extreme distress, despite the fact suicide has been decriminalised since 1961. More and more of us are ending up in the criminal justice system because of our mental illness. It seems we are seeing a resurgence of the criminalisation of the mentally ill by the back door, in the name of ‘public protection’.

If you genuinely want to help people like me, please start by just listening. Provide me with appropriate support, talk to me, offer me therapy – just don’t call the police.

Mental capacity and suicide: “He has mental capacity” is not a reason for clinicians to stand back and do nothing.

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Elaine tried desperately to get help for her son during the final days of his life. She felt he was too unwell to ask for help himself. His mental health had deteriorated and he was hearing voices. He was having suicidal thoughts and she was worried that he was going to end his life. He was under a community psychiatric service for people who experience psychosis.

When she asked the mental health crisis team to contact him over that final weekend, they told her that her son needed to phone them. They had often said that they wanted him to take more responsibility. Their usual approach was to tell Elaine: “He is welcome to call us”.  He never did, and tragically he took his own life on the Monday morning, while Elaine was downstairs on the phone trying once again to get help for him.

At the inquest into his death, the coroner commented that he had “mental capacity”. In her summing up, she said that he had the mental capacity to make decisions. The coroner made that statement based on psychiatrists’ evidence at inquest. They emphasised during and after the inquest that James “frequently” had capacity.

In fact, none of us know whether he had the capacity to make decisions or not, in the period leading up to his death. No one from the mental health teams had spoken to him for several days.  A person’s mental capacity to make decisions can change from hour to hour. High levels of distress or mental illness are just two of the factors that can affect it. And James had a history of psychosis.

So why is it so important for psychiatric professionals to emphasise that someone has mental capacity? Too often, it seems to be about “responsibility”. If the person is assessed as having “mental capacity”, then the mental health team can argue that they have no responsibility to do anything. The mental health crisis team didn’t contact James, despite his mum’s pleas. But he had mental capacity, so they didn’t have to – that seems to be the sub-text.

But James’ mum had described James’ deteriorating mental health to the crisis team. He had completely isolated himself, was hearing voices and had a history of psychosis and she explicitly said that she was frightened that he was going to kill himself.  Armed with that kind of information, professionals surely have a duty to take active steps to contact, assess and support the person.

When professionals refer to “mental capacity” as a reason to stand back and place responsibility on the person who is in crisis, I would remind them of article 2 of the Human Rights Act: the Right To Life. It takes precedence.

It is as if the “right to life” is being usurped by the “right to take your own life” when someone is in mental health crisis. Surely the balance is all wrong. If you are in mental health crisis, it is a time when you are least likely to be able to think clearly and rationally, or to be able to “weigh information”. Despite this, the system appears to respect your right to take your own life.

Surely there is a duty to do everything we can to help the person to survive. We should protect life, whether or not someone is assessed as having “mental capacity” – and whether or not they are detainable under the Mental Health Act, which is a different piece of legislation.

We cannot even be fully confident that all professionals are assessing mental capacity accurately. I have described in a previous article how a paramedic and a policeman made entirely different assessments of my mental capacity, on a night when I intended to end my life. I believed I had received messages to end my life on that date.  Astonishingly, one of the professionals concluded that I had mental capacity. He said that I could understand and retain information. Fortunately the other professional quickly intervened and detained me. My ability to weigh information was clearly being impacted by the “messages” I had received. (Reference: Why do mental health professionals tell patients “It’s your decision to end your life”? https://www.savinglives.blog/uncategorized/suicide-why-do-mental-health-professionals-tell-patients-its-your-decision/ )

It is this ability to “weigh up information” which I think professionals may be getting wrong quite frequently. Depression often affects our ability to weigh information. We see life through its distorted lens. If depression makes you feel that things will never improve, that there is no hope and that you have no worth, then this is affecting your ability to weigh information and make decisions. And yet frequently, someone will explain all that and be assessed as being capacitous and able to make the decision to end their life. We know this from what we witness with clients at our Suicide Crisis Centre. I frequently express concerns to our local mental health services about individual clients, when depression appears to be impacting on their thought processes.

We have to redress the balance to place more of the responsibility on us, as professionals. It is our job to protect life.  I run an independent Suicide Crisis Centre where we focus on doing everything we can to help our clients to survive. We actively intervene, whether or not we think someone has mental capacity.  We know that the person is probably about to make a decision that they would not make if they were not highly distressed, or mentally unwell. Therefore, protect life – always.

For information about the Suicide Crisis Centre, which provides face to face support: http://www.suicidecrisis.co.uk

Elaine kindly gave her permission for me to write about James, who was known to his family as Jay. Elaine added: “Jay didn’t want to die. He wanted help. He was crying out for help.” Elaine found out about our charity after Jay died. We attended his inquest in 2019, to support his family. This article draws on evidence from the inquest. Our thoughts are with Jay’s family as they continue to fight for justice for Jay.

Other sources of help include The Samaritans on 116123 and the NHS 111 service (just call 111).

 Joy Hibbins is the author of the book “Suicide Prevention Techniques: How A Suicide Crisis Service Saves Lives”:  https://www.jkp.com/uk/suicide-prevention-techniques-2.html

Reproduced with kind permission of Joy Hibbins Saving Lives ©.