Oh the places you’ll go…

“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You’re on your own. And you know what you know. And YOU are the one who’ll decide where to go…”
Dr. Seuss, Oh, The Places You’ll Go!

For those who regularly read my bog and twitter feed (@AC_MentalHealth) you will have noticed that there has been a distinct lack of posts recently.

Lying in bed last night, I stumbled across the above quote and felt that it was more than apt to my current situation. Things may not go to plan, but it is me in the driving seat and I have control of which way I steer.

It’s pretty obvious that I absolutely love my job. I started working in a regional office of a London firm in March of this year as an Admin Assistant. The hope was to work my way up with the firm and, in a perfect world, secure the elusive training contract that every law graduate in the country would also be applying for.

Six months on, I have worked my way up to the position of Mental Health Caseworker with Admin responsibilities. When I tell people my role, a lot of people have absolutely no idea what it means. A few of my family, through no fault of their own, simply lack of knowledge, thought that mental health law meant that someone with mental health issues had committed a crime and mental health lawyers try to ‘get them off’.

The role of a mental health lawyer is to ensure that the rights of those with mental health problems are upheld. For me, it’s about protecting the most vulnerable in society. Now, some people with mental health problems are detained under the Mental Health Act if they are really unwell, but that doesn’t at all mean that the person has done something wrong. There is something called a ‘forensic section’ which deals with those who have committed crimes, but, generally, those detained under the MHA are just like you or I and Doctors simply feel that they ought to be in hospital for assessment (section 2) or treatment (section 3). There are other sections but these are the most common.

Now, on Facebook recently, a fellow Warwick University Graduate who works as a mental health paralegal in London, posted a status saying that he was representing someone detained under the MHA at a Hospital Managers’ Hearing the next day. It’s safe to say that I was incredibly jealous! Then, someone who I don’t know, commented on the status saying that he was a junior doctor in psychiatry and asked why the person was detained. My friend said that the gentleman had schizophrenia with paranoid ideations. To this, the JUNIOR DOCTOR IN PSYCHIATRY replied “then why are you contesting it. Dude needs help”. Well, that got me angry, because help isn’t always a hospital.

The role of the mental health solicitor/paralegal is to advance the rights of the client, so if they say that they would like to be discharged from hospital then this is what we tell the Tribunal or Hospital Managers’ when the person appeals their section, with arguments added that discharge would be appropriate. We’re not ‘getting people out’.

For some people, being in hospital can make them worse. Especially if the ward is particularly disruptive, and where drugs are rife that can make things a lot harder. Assessing/treating those with mental disorder should not be about keeping someone in hospital until a doctor decides that they’re better. It’s about the individual, who may find it helps more to be at home with community psychiatric support, than in the often chaotic surroundings of a ward.

Anyway, I digress. What I’m trying to say, and what I could have said in eight words is, I really love working within mental health law.

And that’s when the rug of contentment was pulled right from underneath my feet…

All employees at my Firm were recently given notice of redundancies. Such an unexpected life-changing shock isn’t the best for someone with anxiety disorder. For the past week, I have had the worst headaches, and I never get headaches. Although, interestingly, there was no headache on Wednesday when I had my University day. It’s difficult because I got to the point where the stress of not knowing what was going on was really starting to become an issue, but I felt that I couldn’t say anything because of that fear of mentioning anything related to my own mental health having a detrimental impact on my future, as if it would show that I “can’t hack it”. Of course, that’s me being ridiculous but it is how the vast majority of those with mental health issues feel.

When I told my Grandma that I was potentially losing my job, she said “well you’ll just have to get another one won’t you”. God, if only it was that simple! Basically, there are no mental health paralegal jobs being advertised for in the whole of the North East, so that isn’t looking great.

All I can hope is that I will be able to continue doing the work that I love, wherever that may be. For now, I need to focus on my own mindfulness and wellbeing. One thing is for sure though, I won’t give up because I’ve worked too hard for that.

Dr Seuss is right, and every time I see my #semicolonproject tattoo, I’m reminded that I can conquer anything.

semicolon project

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Nicholas Salvador – not guilty by reason of insanity

Today’s news has been filled with the face of Nicholas Salvador, a 25 year old gentleman who, last year, killed two cats before going on to behead an 82 year old grandmother in her own back garden.

Nicholas Salvador is a paranoid schizophrenic. He has today been found not guilty by reason of insanity and will spend an indefinite amount of time in a secure psychiatric hospital. What is not discussed in the news is how such a verdict works in practice. Well, officially, Nicholas Salvador will be detained under section 37/41 Mental Health Act 1983.

Section 37 is a hospital order and it operates as an alternative to a prison sentence. Section 41 is a restriction order and this is something added by the Crown Court if there are concerns regarding public safety and the patient’s own risk. Prior to someone being admitted to hospital in such circumstances, two medical practitioners must carry out assessments of the person. For a judge to give a restriction order, one of these medical practitioners must speak in court.

It is possible that Mr Salvador will have to spend some time in prison whilst waiting for a bed to become available for him – the procedure is that the Hospital Managers should find a patient a bed within 28 days.

The reason that the newspapers are stating that Mr Salvador will be detained indefinitely is because, since 2007, a section 37/41 does not have a time limit, meaning that it can run for as long as necessary with no need for it to be renewed.

Although unlikely to happen, it would be possible for Mr Salvador to appeal against today’s order of the court to the Court of Appeal, but this would need to be done within the next 28 days.

A section 37/41 is naturally strict – a patient detained on this section cannot leave hospital without the agreement of the Secretary of State for Justice. When the person’s Responsible Clinician (the doctor in charge of their care) thinks that the patient is well enough to be discharged from hospital, he will ask for the Secretary of State’s agreement. The reasons for such strict rules are clear – the person, had they not been suffering from a mental disorder, would have been sent to prison. It is section 41 that places these extra restrictions on the detention. Even if the patient wants leave from hospital, and a request for leave is made by the responsible clinician, the Ministry of Justice must agree to grant that leave, and it may simply be leave to go to the local shop.

Once the hospital order has been in place for six months, the person detained may apply for a Tribunal. With a Tribunal, a successful appeal of a section would mean that the patient can be discharged. Such discharge can be either absolute or conditional. With absolute discharge, the person will be released from detention. It is unlikely that someone who has been subject to a forensic section i.e. a section 37/41, will be granted absolute discharge. Conditional discharge is much more likely as it allows the person to remain subject to the Mental Health Act whilst living within the community. Should any of the conditions specified be broken, the patient can be recalled to hospital by the Secretary of State. As soon as a patient on a section 37/41 is recalled to hospital, there is an automatic tribunal within the first month of discharge. Following this, the section must last for six months before the patient is able to apply to the Tribunal himself.

Alternatively, if the conditional discharge goes well and all conditions are complied with, the patient may wish to apply for absolute discharge, although they do have to wait at least one year. If the application for absolute discharge following one year of conditional discharge is not successful, the person is only able to apply two yearly.

Nicholas-Salvador-_3349677b

Ta-dah! Hopefully this explains what all of the newspapers are talking about and the process involved when detaining Nicholas Salvador.