Psychiatry: Breaking the ICE
Stringer, S., Hurn, J. and Burnside A.M., eds, 2016. Psychiatry: Breaking the ICE.
- There are two types of laws. Statutes are laws passed by parliament which must. Be absolutely obeyed. Case law are principles derived from judges’ decisions on individual court cases
- The Mental Health Act (MHA) and Mental Capacity Act (MCA) are both statutes
- The MHA was passed in 1959 and was replaced by the MHA in 1983, which remains in force.
- Use of the MHA requires that the patients are:
o Protected from harm and have their human rights recognised
o Respected for their qualities, including their background, race, religion, gender and sexual orientation
o Treated in the least restrictive setting
o Communicated with, and enabled to participate in care-related decisions.
The 2007 Mental Health Act
In this, some of the key amendments were:
- The definition of mental disorder. This moved from mental illness, mental impairment and psychopathic disorder to any disorder or disability of the mind (to include personality disorders)
- Nearest relative : patients can now displace their NR if that person is unsuitable e.g. estranged or abusive (Note shows some level of responsibility)
The laws of the mental health act
- Under s2 of MHA, a compulsory detention in hospital assessment (with or without treatment) can be forced upon a person suffering from mnetal disorder of a nature or degree warranting detention in hospital for own health/safety, or risk to others. This must be authorised by an approved mental health professional and two registered medical practitioners. Treatment may be administered without consent and it can last up to 28 days
- S3 can give compulsory detention in hospital for treatment. The same above conditions apply, except is it up to 6 months.
- S135 warrants a police constable, accompanied by an AMHP to enter an adress and remove a person to remove a person to a place of safety for assessment. This applies to someone who is suffering from a mental disorder and may be a risk to self o r others. It is authorised by magistrate and can result in up to 72h in a place of safety.
In a lot of these the AMHP plays a large part. This is someone with appropriate mental health training and approved by the local authority. This may be a psychologist, social worker, nurse but never a doctor.
Consent to treatment
Where the consent to treatment law applies:
- Attempts to gain consent must be made before giving any treatment
- Treatment can’t be given to an objecting, informal patient who has capacity
- The MHA cannot enforce treatment for medical condition unless the conditions is caused by or is causing the mental condition, for example, feeding for anorexia nervosa
- Certain treatments can only be given with the patients consent and a SAOD’s agreement e.g. psychosurgery
Mental capacity act
The mental capacity act is generally viewed as something that empowers mentally ill over 16 in treatement. The guiding principles are:
- Mentla capacity should be presumed unless proven otherwise
- People should be supported to make their own decisions
- An unwise decision does not mean somebody lacks capacity
- Anything done on behalf of someone lacking capacity should be in their best intersts and least resrtrictive option with respect ot teir basic reights and freedoms
To assess mental capcity psychiatrist must:
- Estbilsh and impairment or disturbance in function of the mind or brain
- Check whether the person can understand the information relevant to the information, retain the information, use of weigh that information as part of the decision-making process and communicate their decision.
Philosophical views on the insanity defence
Walton, D., 1975, Philosophical Perspectives on the Insanity Defense
The Mcnaghten rules
- In 1843 Daniel McNaghten shot Edward Drummond (secretary of the british primeminister Robert Peel) dead, in the belief he was killing Peel.
- This occurred in a time where a new theory was being considered in English law, surrounding the mentally ill
- This case was very controversial as they questioned his responsibility. Fifteen judges of common law courts were brought to the house of commons, where they were asked 5 questions in regards to the issue. This set of five questions and five answeres constituted the McNaghten rules. The five questions asked:
o What is the point of law regarding crimes commited by persons with insane delusions? The response was that if the delusion was only partial the person is punishable as they knew they were acting against the laws of the land.
o The second and third questions were in regard to what form the issue should be presented to the jury. The response is as follows: 'To establish a defense on the grounds of insanity it must be clearly proved that the accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know he was doing what was wrong.' In their response, they also included that the defendant is to be presumed sane until proven otherwise and actual knowledge of the law of the land is not essential, but rather, what one ought to do is what needs to be comprehended.
o The fourth question asked if a man who commits under delusions is thereby excusable. The reply is that we should understand his delusions as factual and take the circumstance from his perspective. For instance, if he believed the he murdered was attempting to kill him, we should see the murder as an act of self-defence.
o The fifth question asked was the matter of expert (medical) testimony. The response was that the medical man cannot be asked for his opinion for matters that are in the hands of the jury, but it may be useful to put the question to the medical man.
- It is important to note that the rules are not “if and only if”. They do not cover every case of criminal exemption from mental disease. These questions were specifically about insane delusions.
Philosophy of Psychiatry
Murphy, D., 2017, Philosophy of Psychiatry, The Stanford Encyclopedia of Philosophy (Spring 2017 Edition), Edward N. Zalta (ed.), Available from: https://plato.stanford.edu/entries/psychiatry/#PsyMorPsy
Manipulative behaviour – purposefully changing someone’s mind using psychological process, trickery or charm.
Thought insertion Delusions
Thought insertion delusions is when somebody believes they have had thoughts put into their mind by somedbody else, or that they are witnessing somebody else’s thoughts.
Graham and Stephens propose we can understand these thoughts as alienated self-conciousness. In the same way that Frankfurt argued only some actions represent our agency, for instance, having your arm pushed would not be your action. When somebody has a thought insertion, which they have no control over, it makes sense for them to attribute the thought to somebody else, as this is one way explain non-voluntary acts.
Note this simply helps one to understand thought insertion delusions, not explain them.
Morality and psychopathy
There are two philosophical debates that psychopathy is particularly relevant to:
- Are morally judgments intrsically motivating, or it is possible to make a moral judgement yet remain unmoved? Psychopaths are used a test case for this question.
- Are moral judgments the result of affective sentiment or reason?
Nichols argues psychopaths may show that moral judgements are not “empirically rational”. This is the idea that morality is simply a process of being rational. Psychopaths are very well rational, but lack emotions such as empathy. So, whilst they are able to form moral judgements, they will not follow them, refuting empirical rationalism.
Heidi Maibom challenges this. Evidence shows that Psychopaths lack some levels of rationality. They have problems in learning from experience and lack means-ends planning and cannot plan for longer goals. If the psychopath was to be used as proof, they ought to have the same rationality.
However, maiboms criticism does not necccesarily hold. Psychopaths do not neccesarily have impairments that puts thme below averge, and nobody has perfect reason anyway. For maibom to be correct, the shortcoming of psychopaths should distinictly put them into another category of raitonal thinking.