Residential Care … Not Medical Coercion

Abstract

I have spent my career divided between clinical and academic work. Much of my work has been focussed on in-patient settings and with people who have quite severe and disabling problems. After qualifying, I divided my working week between in-patient, hospital-based, psychiatric ward and an out-patient clinic. When I conducted my PhD, I spent a great deal of my time interviewing people who were resident on in-patient psychiatric wards. In my academic career, I have been responsible for randomised, controlled trials of CBT for people with serious mental health problems: this again frequently brought me into contact with people staying in hospital. And throughout my career I have continued to work with people with serious problems, who are often frequently admitted to hospital. But I have to confess that I had not visited a psychiatric ward for several months until recently, when one of my clients was briefly admitted to hospital. And I was, again, shocked by her experience.

When people are in crisis, they may need residential care, but this should not be seen as a medical issue. Hospitals should therefore be replaced with residential units designed and managed from a psychosocial perspective. Medical expertise may well be an important part of the service, but medical colleagues should act as consultants to the team, not be seen having sapiential authority over the team. In cases where, regrettably, the powers of the Mental Health Act are needed and compulsion is required, any decisions we take should be subject to judicial oversight and based on the risks that individuals pose to themselves and others, together with their capacity to make decisions about their own care, rather than whether or not they are considered ‘mentally ill’.