Keep Society's Most Vulnerable Out Of Cells

People with mental health problems are far too often subject to custody suites, they must be taken to an appropriate place of safety. "You should stop using police station cells as a place of safety for people with mental health problems" said Deborah Cole, Co-director of the charity Inquest – which provides advice to bereaved families and carries out policy work on contentious deaths.

Coles was addressing members of the House of Commons Affair Select Committee, she was speaking after being questioned by Conservative MP James Clapperson about practical steps that could be taken to mitigate the risks of deaths following police contact. She stated that police officers must stop using cells to detain society’s most vulnerable people.

The Inquest Co-director is also a member of an independent panel assisting the IPCC with the review into deaths in custody that started last month. On October 23 she appeared at the Palace of Westminster, alongside Marcia Rigg, whose brother Sean died following a police contact incident, to give evidence. Both she and Rigg were giving evidence as part of an inquiry MPs have been holding into the work of the police watchdog. Both witnesses said they were concerned about the large number of ex-police officers who now work for the IPCC and are responsible for conducting investigation.

While Coles said she understands the rationale behind employing ex-officers, there should have been a transfer to a more independent ethos in the eight years since watchdog was created, with the employment of more independent investigators. She also added that private security companies providing services to police forces should also be subject to IPCC scrutiny where necessary.

Marcia Rigg shares Cole’s belief and concerns, stating that people would have greater confidence in the IPCC if they employed less ex-police officers. She welcomes the implementation of the £4 million package to improve and enhance the CCTV in Metropolitan Police Vans but added that it is of the utmost importance that they keep up their commitment to transparency.

Mentally ill offenders: Our fear of introducing them back into society

Forensic nursing is one of the most demanding and misunderstood areas of care in the NHS. Nursing manager Theo Bello gives an inside view about the challenge of working with mentally ill offenders and public fear about their release back into society.

Mental health is one of the least popular areas of nursing and you can go one better – by specialising in forensic nursing which looks after offenders whose mental illness precludes them from prison.
At present, there are about 4,000 patients being treated in secure units around the UK for a variety of conditions. Typical crimes include murder, rape and sexual offences influenced by accompanying mental illnesses including bi-polar, schizophrenia and personality disorders.

Everyone coming into a secure unit is assessed before admission and we get our fair share of fakers who pretend to be ill thinking life in a forensic unit is preferable to prison. However, it’s difficult to fake mental illness for any length of time and it is often people’s rationality that trips them. People with full-blown psychosis are genuinely distressed and that can be someone who is climbing the walls or standing stock-still for hours at a time.
I can’t pretend nursing started as a personal choice for a vocation, but it has certainly become one in the 15 years since my initial career in civil engineering hit the rocks after my overseas qualifications weren’t recognised in the UK.
I remember asking a careers advisor at the time what was the most cast-iron job in terms of employment and demand, and he said people were always going to get sick so why not try the NHS?
Nursing can be a tough profession, but also a very rewarding one and you learn a lot about yourself in the process – especially in an environment like forensic services. People do however carry a lot of preconceptions about working on secure wards. I know I did before I joined the service, with the usual concerns about the threat of physical violence and wondering if I could work with people who’d committed some disturbing crimes.
I remember one patient who had murdered his girlfriend’s child while she went out to get a pint of milk. He calmly sat down after leaving the body in the kitchen, lit a cigarette and waited for her to come back as if nothing had happened. This  really shook me up because I had a child of same age at the time and I just kept re-running it through my mind. I was looking at this patient’s actions with my own moral compass and values which is pointless when someone has a serious mental illness.
People do the most shocking and bizarre things but at some level it makes perfect sense to them even if it leaves the rest of us shaking our heads in disbelief.
Our job is to find out why patients behave the way they do, what triggers their behaviour and if their condition can be effectively treated.
I’d say good communication skills, empathy, maturity and respect are key skills in being a good mental health nurse, along with a commitment to build a strong therapeutic relationship with patients and colleagues.
A lot of incidents involving confrontation are down to a perceived lack of respect that staff shows patients. It’s something we work hard to bridge because so much rests on it. Just a fraction of a correction in that social interaction makes a huge difference and everyone gets what they want.
One of the biggest conflicts of interest I have is restraining a patient from hurting themselves or others. I personally struggle with the fact that I am here to build relationships with patients and help treat and support them yet may also be called upon to restrain them if they become violent.
At present, we’re at something of a watershed in forensic services because we need more effective mechanisms for getting patients back into the community which is free from political interference.
There is huge public fear around mental health and that irrationality goes through the roof when a murderer is mentally ill.
The circumstances are tragic but no-one can provide a cast iron guarantee that any offender won’t commit another crime on release and that fear is multiplied when it involves mental illness.
Politics, sensationalist media coverage and widespread public prejudice about mental illness are a potent cocktail that keeps us in stalemate because it’s the safest position to occupy. Ideally, all mental health services will maintain a safe and effective process of treatment and rehabilitation through the stratification of patients according to the risks they present.
I believe specialised community housing, a close-knit support group of mental health workers and close monitoring would all make a move into the community more effective in the long-term.
Re-offending rates are low compared to those leaving the prison system and the chance of an individual being murdered by someone with a psychosis is about one in ten million – the same as being struck by lightening.
A revised approach has to be found and it’s a case of who is going to be brave enough to seek a new way forward free from the blame game when a serious incident does take place.

Theo Bello is a nursing manager with Barnet, Enfield and Haringey Mental Health NHS Trust and oversees the management of several low and medium secure units at Chase Farm Hospital in north London.
This article first appeared in the Independent 

Why is Mental Health illness on the Rise? by Omar Shahid

This piece was first published in the Huffington Post

New findings from the European College of Psychopharmacology reports that 164.8 million Europeans - 38.2% of the population - suffers from a mental disorder.

However the recognition and medicalization of mental illnesses is now more prevalent then ever; doctors are accused of too hastily classifying 'abnormal behaviour' as a mental ailment. This is cited as one of the reasons for the 'increase' in mental health.

Furthermore, the stigma attached to mental disorders is nowhere near as heinous compared to previous decades. Only 50 odd years ago, those who struggled with mental disorders were locked up in a clandestine environments, today, thankfully, we're much more willing to admit that we have a problem and receive a diagnosis.

The findings also tell us that women suffer disproportionately more from mental disorders than men do. Hans-Ulrich Wittchen, one of the report's authors, says the reason why women suffer twice as much depression and anxiety disorders is because of their inability to successfully balance work with their family life.
While some misogynists or religious zealots may claim that women were not somehow 'designed' to simultaneously balance work and family life, an alternative explanation - and one supported by evidence - is that women go to see the doctors more often than men do.

There are a couple of factors relating to mental health that time and time again seem to evade public attention.
The first is the increase in prescription of antipsychotic drugs. In 2008, antipsychotics became the best-selling therapeutic prescription drugs in the United States - exceeding drugs to treat high cholesterol and acid reflux. Investigative journalist James Ridegeway said in a piece he wrote for Al Jazeera recently that drug companies now encourage the prescription of atypical antipsychotics to patients for off-label use. This should concern us. For what other reason would drug companies be doing this other than to boost their profits? And will British drug companies soon copy their American counterparts?

The second thing that is seldom discussed is the ubiquitous refrain propounded by some anti-consumerists: 'depression arises when we can't satisfy our insatiable wants'. While it is true that we live in a profoundly consumerist society (I don't think anybody denies this), whether consumerism leads to depression or other mental illnesses seems like a proliferative jump. The relationship between consumerism and mental illness isn't generally taken seriously, but why isn't it?

It is not unusual to hear that mental illness is on the rise, but we rarely hear what is being done to prevent the issue. If we concede that it is not that mental health is increasing, it is that we are able to diagnose it better, that still doesn't solve the problem. The World Health Organisation has said by 2020, depression is expected be second most burdensome disease worldwide; shaving the life expectancy of countless people.
When we do decide to confront the issue, antipsychotic drugs and consumerism should both be discussion points.

Locking up women with mental health needs.

 The female population in custody has different demographic characteristics to the male population, with 19% being foreign nationals, and 29% being of an ethnic minority compared to 13% and 27% respectively for men (Prison Service, 2010). Half the women in prison have experienced domestic violence, and women are
twice as likely as men to have experienced some form of mental illness in the year preceding their
admission to custody (Singleton et al., 1998).
Sixty-five per cent of imprisoned women have substance use problems, compared to 70% of men (Social Exclusion Task Force, 2009). Worryingly, 83% of women in prison have a longstanding illness, compared with 32% of the general female population, and many are on prescription medication (HM Chief Inspector of
Prisons, 2009).
From a report by the Centre for Mental Health
http://www.centreformentalhealth.org.uk/pdfs/under_the_radar.pdf

Corston? What Corston?

Such promise after the findings of the Corston Report, which the coalition government has decided to ignore.  It wouldn't be so bad, if they had an alternative agenda, but the longer the White Paper to Breaking the Cycle is delayed ( After the Health Reform Bill listening excercise, some time late summer) , the longer women are locked up unfairly and with devastating consequences. The cost of locking up one woman for one year, in related court, police, housing, welfare and other societal costs over ten years exceeds £10million.

Get your cheque books out, then. This round's on you, Mr Taxpayer.


When will they DO something?

Baroness Jean Corston