Mental health diagnosis being a death sentence

[Fiz]

Just wondered what your thoughts are on the fact (imo) that some mental health diagnosis are actually a death sentence. Putting aside the fact that a mental health diagnosis is merely a subjective opinion masquerading as fact (credit Sami Timimi NHS Consultant Psychiatrist) and that three Psychiatrists could give the same person three different diagnosis following the same assessment, NICE guidelines set plans for care for certain diagnosis. The guidelines for inpatient care is set at 72 hours for people diagnosed with both EUPD and for people with Complex-PTSD diagnosis. That means they can be discharged days after being detained under the MHA despite being as acutely suicidal or too depressed to sleep or wash having made no improvement at all. The discharge decision is all based on the diagnosis rather than the feelings, thoughts and mental state of the person.


Therefore in my view when people with certain diagnosis end their lives, my view is that it isn't because they may or may not fit the criteria for a diagnosis and are unwell and that's caused the suicide. Instead it's because they have learnt that there is no hope or help for them that meets their needs within mental health services and they feel 100% hopeless and helpless.


This lack of care came about because of the diagnosis and therefore it's the diagnosis that is the death sentence and is the cause of death. Not the perceived "illness".

[Sunny Clouds]

I think that there are multiple ways in which mental health diagnosis can be a death sentence.  I want to focus on a couple of different ways that overlap with what you've said, like a sort of Venn diagram, and heaven help you if you're stuck in the middle of it.

Something that first struck me many, many years ago was that how people are treated by mental health professionals and others, both in a clinical sense and in what I'll call a social or behavioural sense, is often governed by stereotypes.

So you are unwell.  Someone thinks you may have Wotsit disorder.  There's a bit of general waffle in the diagnostic manual they're using, then 8 criteria.  They go through them and interpret your behaviour and what you say as meeting 5 of them.  The textbook says that means you have Wotsit disorder.

Thereafter, almost everyone you encounter in mental health circles or umpteen other 'official' contexts such as physical health, social work, police, employment etc., will treat (in one or both senses) as having all 8 criteria.  That may make you worse, not better.

Secondly, as is pretty evident to all of us here, there are more negative attitudes held and expressed towards people with some conditions rather than others.  I was first diagnosed manic depressive in the early seventies, and mostly had little to do with the mental health services.  But briefly, in the early years of this century, two psychiatrists thought I had, or might have BPD/EUPD.  I wasn't treated well with a bipolar label, but the way I was treated when they swapped the diagnosis was utterly disgusting, absolutely revolting.

I had a long-term friend who, having been labelled BPD, was ground down by the way she was treated to the point at which she was barely functional, yet, in my opinion, most of her problems were down to the harm done  by the way she was treated once the label had been stuck on her, which meant her actual needs weren't taken care of.

Thirdly, there seems to be a rigidity of how various problems, symptoms, behaviour etc. are treated that goes beyond 'official guidelines' etc.  E.g. feel at the end of your tether and harm yourself in some way?  Gosh, you must be engaging in manipulative behaviour designed to make people do what you want.  It couldn't possibly be that you didn't actually expect to be alive long enough for them to have to consider helping you, could it?  (Grrhh.)  But if you did want help, why no sympathy for someone so desperate they'd hurt themselves to get help?

In short, I agree with you, and also feel labels and guidelines etc. have negative effects on our wellbeing and health care in multiple ways.

[Fiz]

   The whole system is warped, harmful and potentially lethal.

[Sunny Clouds]

This makes me want to spew forth account after account of incidents in my life where encounters with mental health services have done more harm than good, primarily where they stuck labels on me and treated the labels.

Something that bugs me about this is that it's not even cost-effective.  Why does that bother me?  Well, as a leftie, I want the state to provide services in a way that promotes and supports equality, which is only possible if resources are used wisely.  Not that they are if people take equality to mean rigid sameness.

However, what has long put me off is where rightwingers, particularly what I'll characterise as small state neoliberals, set things up in a way that's rigid and profit-driven, but in a way that doesn't actually give them profit anyway.  In terms of benefits, Iain Duncan Smith's benefit reforms are a classic example.  If he'd done his homework, he could have had a lovely win-win - personal glory, more help for people, cut costs to state/taxpayer.  But no, make things worse for everyone.

It's like that with mental health services.  Tailor it so you don't keep people locked up when they're safe and ready to leave, then you've got space for people who do want and/or need help and care.

Meanwhile, you mention "the feelings, thoughts and mental state of the person".  I think if they cared more about that, masses of stuff could be achieved.  Just to give one example, I reckon loads of money could be saved if more people with addictions were given kindness and love.  Not just sitting round a room in a 'support group' (not that those can't be helpful) but lots of community activities.  Years ago, where I am, there was a mental health arts group.  I reckon that did loads more to help me than lots of other 'treatment'.  I contrast, though, with the utterly useless 'occupational therapy' I encountered in hospital, which wasn't uplifting for most patients.

And for all those of us that have issues following being hurt in some way, where's the 'treatment' that consists of respect, dignity etc., and maybe some 'how not to get hurt' life skills coaching?

But no, follow a textbook.  Devise a 'pathway', enter into a contract with an NHS trust or private company to provide the relevant services, rigidly apply the small print of the agreement, keeping some locked up when that makes them worse, whilst turfing out others who need the safety of being in a hospital or similar for longer.

Daft.

[Tony_Demoncy]

My thoughts are that you are completely right.
I think that care and compassion and treating the person is the right way to go about things. I agree that art therapy is very helpful and indeed, I often use poetry as therapy and catharsis and communication. I tend to prefer the Soteria Houses model of treatment within the community while treating the person suffering distress with respect and dignity rather than punitively and carcerally.

[Tony_Demoncy]

Decarcerating Care

Why when we wobble – when we feel too much –
Or when the world is just too much
Do they then lock us up?
In cells and halls like monks or felons
Then drug us and leave us to rot
With occasional interrogations
To make us “think right”
To make us conform
To a social straight jacket –
As if our distress is our fault
Why does society not find another way -
Less traumatic, less confining – less abusive
There are so many other ways to treat distress
Carceral care is not conducive to healing or de-stressing

One example I like is the Soteria House –
A place where one can go when things become too much –
Where one can cry, can laugh, can talk, can rant, can curse,
Where one can smash crockery or paint or sing or dance
Or talk the night away until the pressure equalises
Can discuss the things that are on one’s mind, on one’s plate
Without oneself being the dish, the subject, the object
Where one can express without judgement, find an even keel

Another thing that one should consider
Are the societal ills that drag us under
That smother and drown us
In inequality and money worries
In Power imbalances and state violence
In lack of support and care and community.
Perhaps these are things that could be addressed –
Therapy for our nation and for our world
Perhaps we could shape our countries into healing places
Instead of places of state and social violence and condemnation
That tear us into bits – put us on the rack
Crush us and tear at our souls
So perhaps we should put our world into
The locked ward and therapize it until it
Conforms to OUR notions of what is right and sane
Perhaps we can cure it of its ills
And teach the world to learn compassion
To give freedom for expression, for letting off steam
Freedom for hugs and comfort
Freedom to smash plates out the back
Freedom to convalesce, to heal at our pace,
To grieve without being pathologized

To howl at the moon and rail at the sky
To provide wings for those who cannot fly
To provide care and sufficiency
To trade want and woe for enough
So that there is time enough
So that there is space enough
So that there is room enough
Room to love -
To love oneself and the other
To be a good sister
To be a good brother
To love the stranger and to pass it on
To spread the load and share our shoulders
To be free in freedom unconfined
To be healed in spirit and in mind
To share one’s soul,
 To share one’s care
Carceral Care should be put on the shelf
State violence confined instead

Tony Demoncy 12/04/2022

[Sunny Clouds]

That's moving and I agree with so much of it.

[Tony_Demoncy]

Thanks Sunny Clouds