Use of force in mental health services

Seni's law, also known as the Mental Health Units (Use of Force) Act 2018, will come into effect on 31 March 2022 (see Mind press release) . The government published guidance at the end of last year to support its implementation. 

As the guidance says, "For too long the use of force has been accepted as the norm in many mental health services". People’s dignity and their civil and political rights must be respected. Although there may be circumstances in which it may be difficult to avoid the use of force, any compulsory treatment should only be used as a last resort after all other treatment and non-treatment options have been considered and excluded, and only when needed to prevent serious and imminent harm to people (see previous post). The aim should be to eliminate seclusion and segregation (see previous post). Restraint, including chemical restraint, needs to be regulated (see eg. previous post). Progress in removal of compulsion should be compliant with the UN Convention on the Rights of People with Disability (CRPD) (see eg. yet another previous post). 

NHS and independent hospitals must appoint a 'responsible person' to produce a policy to reduce the use of force in mental health units and collect data on any use of force. These figures will be published nationally. Staff must receive appropriate training. Hospitals have been given time to ensure Seni's law is implemented and I look forward to seeing its impact in reducing coercion.

Reaction against the neo-Kraepelinian approach

Jerome Wakefield has an article in World Psychiatry on the 'credo' of nine propositions of the neo-Kraepelinian movement. One of my articles examined the same nine assumptions from the hypothetical critical point of view of Adolf Meyer. 

I agree with Wakefield that Robert Spitzer, Chair of the DSM-III taskforce, should not necessarily be seen as a typical neo-Kraepelinian. Spitzer was very clear that, from his point of view, DSM-III was atheoretical (see eg. previous post). I also agree with Wakefield that Spitzer was concerned to counter anti-psychiatric critiques (see eg. another of my articles), particularly the study by Rosenhan (1973) 'On being sane in insane places' (see previous post). The subsequent DSM-5 has of course failed (see eg. previous post).

Where I think Wakefield may have missed a point is that Klerman anticipated a neo-Meyerian revival. He does mention that Klerman noted there was bound to be "a reaction against what will be perceived as the [neo-Kraepelinian] movement’s excesses”. As I said in my 1990 article, this response has been "slow to be formulated". I’ve always argued that critical/relational psychiatry is a neo-Meyerian position in psychiatry (see eg. my talk). 

In defence of the human being

Thomas Fuchs (who I've mentioned several times previously eg. see post) has an important book from last year: In defence of the human being: Foundational questions of an embodied anthropology. I've mentioned before (see previous post) that his earlier book Ecology of the brain: The phenomenology and biology of the embodied mind was also important. 

I've made a twitter thread of quotes or amended quotes from the new book as I've been reading it. Fuchs counters naturalistic-reductive approaches to human understanding by focusing on the person as embodied and alive. For psychiatry, this naturalistic approach, as Fuchs says, has 

led to a reductionist, 'cerebrocentric' view of mental illness, which does not do justice to the patients' experiences and relationships. ... Such views can be contrasted with an embodied and ecological view of the psyche, which can provide a new foundation for psychiatry as relational medicine [emphasis in original].