Terminology in mental health can be an extremely sensitive business, we see a lot of discussion about it, including from Time to Change. I will admit, I do keep tripping over myself. In fact, such is the complexity of this, I don’t think I’ve addressed the subject specifically in almost 600 posts despite this being important stuff. Language has the potential to discriminate, to disenfranchise and to demoralise so it’s often sad that we often see counter-protest from time to time about perceptions of excessive political correctness with suggestions ‘the world’s gone mad!’ – see what I did there, to make the point?! – when those of us affected by mental health problems make representations about how we describe people, conditions or responses, whether they be medical or otherwise.
I remember one of my favourite comedians, Dara O’BRIAIN, being heckled in a show by some bloke about political correctness and Dara replied, “Yes, that f*cking politically correct brigade with their … good manners and courtesy!” This rather sums up where I try to spend my linguistic time – in the territory where people affected by the language in question would prefer us to be. That having been said, it’s not always easy to work out – when I first began in this area of work I remember being surprised about the extent to which terminology is carefully questioned and whilst I’ve not got used to it, I admit to still tripping over myself. Whilst drafting a recent document I’d used the term ‘restrictive practices’ several times in a paragraph and for nothing more than the sake of variety I used the term ‘coercive practices’, but this received a big veto from mental health professionals party to that work.
So some patients doesn’t see themselves as patients, some service-users object to that particular term and prefer ‘patients’ – once upon a time, a mental health professional commented on a draft policy document about criminal investigation and prosecution by suggesting that the term ‘suspect’ should read ‘those accused of or at risk of offending’. That caused one hell of debate because anyone who is at risk of offending is not necessarily, yet, a suspect – that only occurs once there are reasonable grounds in law to suspect that the person has committed an offence. This ‘suspicion’ may not amount to grounds to prosecute the person but if a criminal inquiry has started and is continuing, then the person may no longer be at risk of offending because they’ve completed what they were previously at risk of doing – but they’ve now become a suspect.
Is this all making sense?!
The post however, is about my exception to my norm: where I feel there is a need to insist upon certain terminology even thought it is uncomfortable and down-right objectionable. I’m the first to admit there is much within our Mental Health Act to object to, being essentially 1950s legislation as I’ve previously shown. I have a particular dislike for phrase used in s135(1) as one of the grounds upon which a warrant under that section may be sought to search a premises and potentially remove someone to a Place of Safety: it sub-section refers to someone ‘kept otherwise than under proper control’. I know what it’s getting at, but we must be able to come up with a more appropriate way of describing a vulnerable person at risk?! Whether or not anyone is trying to do so, that’s the phrase AMHPs and police officers currently have to work with and understand, because that’s what it is in the Mental Health Act.
Paraphrase that at your peril, especially if you’re also doing the six or seven other individual, component parts of the sub-section and trying to piece together what it all means. Re-phrasing or paraphrasing things risks a change to the precise meaning of words that can affect decisions. It is only where this risk is present that I think I change my approach about terminology.
Two real examples for you –
- Where the police have detained someone under s136 of the MHA – or for that matter under ss18, 35, 36 , 38 or 138 MHA – that person has been arrested, in law. Not arrested for an offence, obviously – but arrested nevertheless. This is precise legal terminology and it then affects other matters, like the powers available to search someone after arrest in order to keep the situation safe. We need police officers to understand these sections of the MHA are preserved powers of arrest under s26 and Schedule 2 of PACE because it helps officers understand what rights and protections are then afforded to the people they’ve arrested and it informs officers’ decisions about managing safety, post-arrest. You cannot search someone for implements that may cause you harm if you haven’t arrested someone – telling officers that “section 136 is not an arrest!”, as some mental health professionals have, risks causing confusion on rights and authorities, post-arrest. Of course, none of this means the police run up to vulnerable people in crisis and say “Hands up – you’re under arrest!” – language used should fit the circumstances and be sufficient to allow someone to understand without frightening or antagonising them. But officers need to know the legalities in their head, so they properly handle the fact that detention, arrest or whatever you’d prefer to call it is fundamentally a legal process that removes someone’s liberty and affords further opportunities as well as responsibilities.
- There was discussion on Twitter today about autism and in particular whether the terminology ‘mental disorder’ or ‘mental health’ applies to it. Of course, I’m aware that autism and Asperger’s are more usually described as neuro-developmental spectrum conditions and that the terms mental health and learning disabilities are objected to from the point of view of classifying conditions. But from a legal point of view, it is important than police officers, lawyers and courts understand that autism is a condition that comes within the definition of mental disorder that we see in s1(1) MHA, not least because autistic victims and suspects are entitled to certain safeguards if they come in to contact with the criminal justice system. Someone with autism or Asperger’s would be considered for vulnerable or intimidated witness provisions, potentially removing the need for them to give evidence in chief in court, if they were robbed or assaulted, for example. In custody, someone with autism would be entitled to an appropriate adult to support them whilst in the cells and in interview – you’re not entitled to this under PACE because you are recognised as having a neuro-developmental condition in medical terms, but because such a condition means that someone is ‘mentally disordered or otherwise mentally vulnerable’, in legal terms. Again, the language is far from ideal – I get it! But we need to keep in mind the difference between medical / scientific terminology and legal terminology and why professional terminology is often important.
Does that make sense?!
SO WHAT’S THE POINT HERE?!
Somewhere in today’s debate I was firmly told, based on things I’d said, that I really didn’t understand autism. I admit to being rather surprised that this came as a shock or was considered a major criticism – I am a policeman! I don’t particularly understand lots of things and I will never, ever have much more than a lay person’s understanding of the variety of conditions and disorders that the police encounter and only to the extent that it helps me understand how to do my job. Like most police officers, I’ve got my examples of where consultant psychiatrists with twenty years of post-qualification experience and education get things wrong around responding to someone experiencing an acute psychotic episode – given that we know this will happen, to what extent is it reasonable to think police officers can get bombproof around a particular condition that even advocates describe as ‘invisible’. Mistakes and oversights made in good faith are somewhat inevitable.
But the legal terminology exists precisely because the language on mental health or mental disorder is very, very far from settled. Over the years, I’ve been told that dementia is not really a mental health problem, but an organic brain disease. Anyone who has suffered a brain injury, in a car crash for example, is not ‘mentally ill’ in the sense usually meant when we reference to someone with schizophrenia but even that is a condition that once led a Professor of Psychiatry at Cambridge (no less) tell me in a lunch queue, “Schizophrenia isn’t really a disease, you know?” So there is a sense in which the police being fairly practical people who have to keep policing whilst all this erudite debate continues to evolve, need to keep it simple.
When they meet a person with any of the conditions or injuries, syndromes or disorders that I’ve named in this post, they need to be able to say whether that means someone is ‘IN’ or ‘OUT’ for the purposes of whether they can use section 136 of the Mental Health Act to keep that person safe when they otherwise wouldn’t be. If that approach doesn’t sit easily with the medical / scientific system then perhaps we just need to remind ourselves that police officers are usually making legal decisions of one kind or another because outside those situations, interaction with the public cannot be presumed to sit astride a guarantee that someone’s medical background is known or knowable – the best you might be able to expect is that officers are attempted to de-escalate situations and to communicate, clearly and professionally with whoever they’ve encountered, regardless of whether they’re vulnerable or not. So nobody here is trying to offend anyone else, but merely to be legalistic and realistic about can be achieve – and why we need to be clear about the language we use when playing with the rights of vulnerable people.
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