Friday, 2 March 2012

A Young Person’s Guide to the Mental Health Act

It's March. The days are getting longer. Spring is just around the corner. A young man's thoughts turn to -- the Mental Health Act...

Son: Daddy, what do you do for a job?

Dad: I’m an AMHP, son.

Son: A lamp? Do you light up?

Dad: No, son, I’m an AMHP. An Approved Mental Health Professional.

Son: An Aluminium Metal Shelf Partition?

Dad: No, an Approved Mental Health Professional. I have the power to detain people in hospital under the Mental Health Act.

Son: Is that a special power?

Dad: I suppose it is.

Son: Like Spiderman – he can climb up the side of buildings and squirt spider webs out of his wrists! Are you like Spiderman?

Dad: I must say, being able to squirt spider webs out of my wrists would be useful sometimes, but no, I can’t do that.

Son: So can you climb up the side of buildings?

Dad: No, but I can get police officers to force open someone’s door with the right warrant. Which is nearly as awesome.

Son: I don’t think so, Daddy. You’re not really like Spiderman at all, are you?

Dad: No, I’m not, son. I only have the powers given me under the Mental Health Act by being approved. I haven’t been bitten by a radioactive spider.

Son: What is the Mental Health Sack, Daddy?

Dad: (Takes deep breath) The Mental Health Act was written by the Government to provide a legal framework for the treatment of people with a mental disorder.

Son: What is a mental disorder, Daddy?

Dad: A mental disorder is when there’s something wrong with your head.

Son: Like a bump, Daddy?

Dad: Not exactly – although a bad bump on the head could give you a mental disorder. It’s more like feeling very, very sad, or having funny thoughts.

Son: Funny thoughts, Daddy? Like jokes? Knock knock!

Dad: Who’s there?

Son: Peter!

Dad: Peter who?

Son: Peter Bananas!

Dad: Peter Bananas? Peter Bananas?

Son: It’s funny, daddy. It’s a joke.

Dad: No, not like jokes. It’s more like having beliefs that other people find strange.

Son: Like wanting to eat broccoli? Ech! I hate broccoli!

Dad: No, not like that. Like thinking that you’re related to the Queen.

Son: But if you’re Prince Harry, you are related to the Queen. Is Prince Harry mentally disordered?

Dad: Not as far as I know. Like thinking you’re related to the Queen when you aren’t. Or thinking that God is controlling your breathing.

Son: But God does control everything. He’s everywhere and knows everything. Even when you put a bogie on Susan’s back at school.

Dad: Did you do that?

Son: No, no, Daddy. That’s just an example. So what do you do for your job, Daddy?

Dad: Well, let’s see. Here’s a little story.

Son: I like stories, Daddy!

Dad: Once upon a time there was a man called Derek. His doctor was very worried about him, because Derek had been doing strange things.

Son: What sort of strange things, Daddy?

Dad: Erm, well he has been spending lots of money. He has been buying hundreds of plastic ducks and keeps them in his living room, all around the walls. He has told the doctor that the Duck Man wants to take him to Duck Land, where he will have to float around on a lake all day and night.

Son: He’s a funny man, isn’t he?

Dad: Well, the doctor thinks that Derek is mentally disordered and needs to be in hospital. So he asks Daddy to see Derek and arrange for him to go into hospital.

Son: I see! You’re like an ambulance driver! You take people to hospital!

Dad: No, no, son. I’m not like an ambulance driver. Although I do use ambulances sometimes. My job is to go and see people like Derek to see if they’re mentally disordered and to decide whether or not they need to go into hospital. After all, Derek might have a good reason for buying lots of plastic ducks.

Son: He might have a big bath, mightn’t he, Daddy?

Dad: Yes, he might. But he might be mentally disordered. If Derek wants to go to hospital, then there’s no problem. But if I think he needs to go, but Derek doesn’t, then I can section him and make them go into hospital, even if he doesn’t want to.

Son: Do you make people do things they don’t want to do? Like when I don’t want to eat my broccoli? Are you a bad person, Daddy?

Dad: No, I’m not a bad person. Not really. I try not to be. I try to do what is the best for somebody like Derek. Although they don’t always like it.

Son: When they go into hospital, do they make them better?

Dad: They try to. They give them tablets to make the funny thoughts go away.

Son: Do the tablets always work?

Dad: Usually. Often. Sometimes. Look, why don’t I read you a story from one of your story books?

Son: All right. Derek wasn’t a very good story. Can I have Numpty the Sloth Gets Sectioned?

Dad: Not tonight. That’s a bit too much like Derek. How about The Famous Five Appear to be Mentally Disordered in a Public Place?

Son: All right, then.


  1. I realize that if someone said that s/he is, for example, a sibling of the Queen, you would be able to know that this is not the case (although, to play devils' advocate, even then you can't know for sure that this is not a secret case of illegitimate birth that was covered up). But how can you tell true delusion from being indeed "related" to the Queen through some common ancestors or by being, for example, a distant relative of someone who married into the family? Maybe the Middletons or the Spencers or someone from centuries past had some lesser-known relative who can nevertheless be said to be "related" to the royal family. What about illegitimate children? Maybe it happens less nowadays due to birth control, but royal and noble families used to produce lots of illegitimate offspring. There was a short story by Guy de Maupassant where a man who was considering marriage to a suspiciously rich but somewhat secretive woman (she had placed an ad in the paper looking for marriage and she was still unmarried at 25 or 30 even though she was rich) assumed that she was probably the illegitimate daughter of influential parents who had made her rich without publicly acknowledging her. He had not even thought of the more likely (and true) scenario of her being paid off by her own rich lovers, with whom she had several children. Nowadays, instead of being something one would actually think of as a plausible explanation, stories of illegitimacy would just suggest mental illness. How sad! No, but, seriously, how can you tell the difference? Are you sure you have not detained the eleventh cousin twice removed of a celebrity or something?

  2. By the way, if I'm a little touchy about the subject, it's because, as I have mentioned before, there is some Eastern European politician who's a distant relative of mine through marriage into my grandmother's family. I don't live there. I'm in Canada. I would certainly not appear unannounced at some public event or at his house claiming to be related to him. Still, I can imagine that, under the wrong circumstances, if told that I have such relatives, a psychiatrist would be more likely to send me to the loony bin then to check my ancestry.

  3. Just being deluded should not in itself constitute grounds for detention under the MHA. There has to be substantial additional risk to the person or others as a consequence of that belief -- for example, one person I detained thought her central healting boiler was talking to her. That it itself did not justify detention, but she then trashed the boiler, causing a gas leak in the process, which would have endangered her and her neighbours.

  4. If that's how it works in your country and mental health professionals are indeed following the rules, that makes sense. The problem is that in the history of psychiatry, there have been many cases of abuse of power or rushing to conclusions about people's supposed diagnosis. Moreover, by your own admission, little to nothing can be done to challenge your decisions in court, even by a currently asymptomatic patient, since there is no way to prove that the supposed illness will not get worse in the future. But if you are indeed allowing possibly delusional people to remain free as long as they don't do anything dangerous, that actually makes sense.

    By the way, what happened to the woman with the boiler? Did she lose her apartment? Was she criminally charged or asked to pay for the damages? Was anything done to prevent her from having access to boilers in the future, at least not in her own apartment building and to a boiler that is not safely locked inside a separate room or solid enclosure?

  5. This blog is fantastic :) I hope it gives other patients like me an insight into the world beyond their own and the countless individuals trying to make the best of a terrible situation. But I do have a question, you write quite explicitly about patients and their cases, doesn't this require consent or breach patient confidentiality?

  6. He does not breach confidentiality because he does not identify patients by their real names or provide so much identifying information that one could reasonably identify them. For all we know, the patients could be fictitious or dead, or the description of one patient could be based on several cases.

  7. Thanks for reading, Ruby Rose, and Monica. The cases I write about are all "truthful", ie based on real cases. However,certain identifying factors have been omitted or altered in order to preserve anonymity. I also attempt to keep my location and identity unknown in order to avoid any risk of identification of cases.

  8. Can you answer my questions about the boiler, though? Did the woman pay for the damages, or get charged with any crimes, or lose her housing? I really hope she did. You see, only because I tend to question psychiatric and police interventions, that does not mean that I don't believe in individual responsibility. On the contrary! I'm pretty much for leaving people alone but then whoever damages a boiler should pay for it and for any other damages to property, and get criminal charges, too, if the damage was intentional. And get kicked out of the building, too.

  9. Good post as usual just one little mistake AMHPs are Approved Mental Health Professionals not practitioners feel a bit mean for pointing it out but it bugs me when i hear AMHPs say it

  10. Of course we are John! The Masked Approved Mental Health Professional should know that! I'll fix it right away.