The national policy of ‘Least restrictive practice’ puts everyone but the most dangerous patients at greater risk. Fact.
Moving on from the least restrictive diktat we come to 2. Insight.
Below is another example of the Theemis writer using misdirection and not telling ‘the whole truth and nothing but the truth’.
‘VC’s ability to fully understand the implications of his mental health condition were limited by his lack of insight. This may have meant he lacked full capacity to make decisions in relation to his care and treatment and engagement, particularly in the community.’ (My emphases)
Translated into truth – ‘VC had precisely NO insight, refused to accept he had a mental ILLNESS (calling it a condition is woke PC bullshit, schizophrenia is an illness) and therefore didn’t ‘not fully understand’ but had no understanding at all and no intention or willingness to gain any (even when well).’
NB to Neil Hudgell. What you say here is correct – the extent to which Valdo Calocane had insight into his own condition. He got better in hospital, he got worse when he was released. He knew what taking his medication did to him – but that isn’t (necessarily) insight.
Plus – where Theemis frame this obstacle as merely about ‘understanding’ or knowledge isn’t being straight. Insight is far more than knowledge. It’s also about self-image, self-esteem and value, status, denial or the lack of it. It’s about acceptance, serenity (as in the Serenity prayer) and adjustment to something happening to you that’s life changing and awful and stigmatising and so on.
Insight means accepting (or refusing to accept) the life you hoped for is gone forever. Cancer, Crohn’s and diabetes are in similar brackets and who doesn’t know a diabetic who’s gone blind or whose fingers don’t work right because they remained in denial until it was too late?
There’s a moral dimension to insight too. Criminals frequently absolve themselves of guilt and responsibility for their crimes but still ‘understand’ they have got to behave in prison, do their bird, attend probation and so on. Paedophiles are an especially good example of self-absolution, so are alkies and drunk and drugged drivers i.e. they can operate on two levels at the same time, refusing to take moral responsibility for their crimes and dumping the responsibility elsewhere but also being fully aware they must either obey the law or be punished again. I think I’ve expressed this rather clumsily.
Status. I’ve known many patients who could and did accept they were guilty of crimes but would not accept being nutted off. They were, in their own self-image, 100% con 0% nutter. Mental illness is the lowest group on the pecking order. Don’t ask Guardian readers, ask the people (druggies) on the rung above. It’s complicated.
One more. Adding another layer of complication to Calocane’s (and other patients) insight was ‘paranoid schizophrenia’ which is different from other sub-diagnoses/varietals of schizophrenia. The illness skews and twists the patient’s perceptions of innocent events, of other people’s motives and intentions.
3. Capacity. Yet another dishonesty is Theemis framing the problem as ‘capacity’. It isn’t. The Mental Capacity Act (and policies proceeding therefrom) is legislation so generously embellished with dozens of added-on requirements or ‘guidelines’ and written so slipperily that managers can ‘get’ their enemies who’ve transgressed while absolving their allies who’ve breached exactly the same guideline. When Theemis focus exclusively on capacity, it’s so they can dodge tackling morality and criminality. They pretend that there are no bad actors, no people who have combinations of madness and badness, no long term criminals who are skilled and experienced in their crimes who become psychotic. If only. My job would be a piece of cake.
What’s the solution? I’m coming to that in ‘What could and should have been done differently?’
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