Terminology in mental health can be an extremely sensitive business, we see a lot of discussion about including from Time to Change and I do admit, I do keep tripping over myself. In fact, such is the complexity of this, I donâ€™t think Iâ€™ve addressed the subject specifically and this is important stuff. Language has the potential to discriminate, to disenfranchise and to demoralise so itâ€™s often sad that we also see counter-protest from time to time about perceptions of excessive political correctness or suggestions â€˜the worldâ€™s gone mad!â€™ â€“ see what I did there, to make the point?! â€“ 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 Oâ€™BRIAIN, being heckled in a show by some bloke about political correctness and Dara replied, â€œYes, that f*cking politically correct bridge with their â€¦ good manners and courtesy!â€ This rather sums up where I try to spend my linguistic time â€“ in the territory where people affected by the language in question would prefer us to be. That having been said, itâ€™s not always easy to work out â€“ when I first began in this area of work I remember being surprised about the extent to which terminology is carefully questioned and whilst Iâ€™ve not got used to it, I admit to still tripping over myself. Whilst drafting a recent document Iâ€™d used the term â€˜restrictive practicesâ€™ several times in a paragraph and for nothing more than the sake of variety I used the term â€˜coercive practicesâ€™, but this received a big veto from mental health professionals party to that work.
So some patients doesnâ€™t see themselves as patients, some service-users object to that particular term and prefer â€˜patientsâ€™ â€“ once upon a time, a mental health professional commented on a draft policy document about criminal investigation and prosecution by suggesting that the term â€˜suspectâ€™ should read â€˜those accused of or at risk of offendingâ€™. That caused one hell of debate because anyone who is at risk of offending is not necessarily, yet, a suspect â€“ that only occurs once there are reasonable grounds in law to suspect that the person has committed an offence. This â€˜suspicionâ€™ 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 theyâ€™ve completed what they were previously at risk of doing â€“ but theyâ€™ve now become a suspect.
Is this all making sense?!Â
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. Iâ€™m the first to admit there is much within our Mental Health Act to object to, being essentially 1950s legislation as Iâ€™ve previously shown. Â 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 â€˜kept otherwise than under proper controlâ€™. I know what itâ€™s getting at, but we must be able to come up with a more appropriate way of describing a vulnerable person at risk?! Â Whether or not anyone is trying to do so, thatâ€™s the phrase AMHPs and police officers currently have to work with and understand, because thatâ€™s what it is in the Mental Health Act.
Paraphrase that at your peril, especially if youâ€™re also doing the six or seven other individual,Â 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 â€“
Does that make sense?!
SO WHATâ€™S THE POINT HERE?!
Somewhere in todayâ€™s debate I was firmly told, based on things Iâ€™d said, that I really didnâ€™t understand autism. I admit to being rather surprised that this came as a shock or was considered a major criticism â€“ I am a policeman! I donâ€™t particularly understand lots of things and I will never, ever have much more than a lay personâ€™s understanding of the variety of conditions and disorders thatÂ the police encounter and only to the extent that it helps me understand how to do my job. Like most police officers, Iâ€™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 â€“ 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 â€˜invisibleâ€™. 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, Iâ€™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 â€˜mentally illâ€™ 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, â€œSchizophrenia isnâ€™t really a disease, you know?â€ 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 Iâ€™ve named in this post, they need to be able to say whether that means someone is â€˜INâ€™ or â€˜OUTâ€™ for the purposes of whether they can use section 136 of the Mental Health Act to keep that person safe when they otherwise wouldnâ€™t be. If that approach doesnâ€™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 someoneâ€™s medical background is known or knowable â€“ 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 theyâ€™ve encountered, regardless of whether theyâ€™re vulnerable or not. Â So nobody here is trying to offend anyone else, but merely to be legalistic and realistic about can be achieve â€“ and why we need to be clear about the language we use when playing with the rights of vulnerable people.
Winner of the Presidentâ€™sMedal from the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award