Applying the sick role
There’s an unfashionable (at least it is until I become Emperor) sociological theory about ‘the sick role.’ In short, Talcott Parsons posited illness was social (as well as biological). Ill people cannot perform their normal social roles, e.g. work, family. Parsons argued that if too many people claimed to be ill then this would have a dysfunctional impact on society, (I know, I know, but remember this research was done in the 1950s) therefore entry into the ‘sick role’ needed regulating. The sick role outlines two rights of a sick person and two obligations:
Rights:
The sick person is exempt from normal social roles. The sick person is not responsible for their condition
Obligations:
The sick person should try to get well.
The sick person should seek technically competent help and cooperate with the medical professional(s).
You’ll immediately see where I’m going. Britain should move rapidly to a formalised acceptance of these principles. You get the rights along with the obligations. Or you get neither. I’m specifically excluding people under specialised addiction services because that is so much less straightforward than community mental patients spending their unemployment and disability benefit on recreational illicit drugs that worsen their illness.
*) benefits are in themselves an exemption from the normal, working social role.
A couple of side points.
The sick role is also a valuable lens to look at things other than drugs but that’s for another post.
Lack of insight can be a factor when a patient refuses medication but not a justification.
Most of our patients are making some/a lot/an amazing effort to manage their illness, keep well, avoid risky behaviours, take care of their responsibilities (work, family, neighbours etc). They should receive the sick role.
And then there are the piss-takers.
Here are some of the nice things that should be but currently aren’t conditional. Extra benefits on top of the basic freebies e.g. PIP. (Maybe Motability?) Get out of jail free cards for violence, abuse, property destruction, driving without, not paying rent and utilities (i.e. de facto immunity from eviction), drug-taking, drug driving. Being nudged up the housing ladder (diagnosis) into a nice house or flat, maybe supported living that you don’t have to pay for. Would you consider these nice things to have? Or having the right to complain about anything, with a phalanx of managers chasing round to uphold your complaint, or to be nursed with few or no restrictions on you, where you have more freedom (and discretionary income) than the minimum waged staff running around to please you. Then you must make every effort to get well and remain well. (Another series of posts)
Or looking through another lens, if you refuse your medication and dodge your CPN, (*) relapse (again), threaten staff or the public, carry weapons, take drugs, sell drugs, commit crime and violence, refuse to turn down your stereo, keep cutting up and overdosing and wasting ambulance time, are a neighbour from hell, then you lose it all.
*) The sick person should seek technically competent help and cooperate with the medical professional(s).
Britain would have to build a lot of new hospitals (*) for these failed community patients. But my, as soon as they were housed in them, the other costs (financial, national and social) would plummet. Staff would flock to work there. They would, primarily be safe places to live (because we’d make them so) and to work. (See ‘How we used to seclude’ and ‘When the nurses were in charge of the asylum.)
*) I had a risky patient on my books once. Complicated too, because he was at risk of sexual exploitation (from people known to us) and minors were at risk from him. He’d come out of prison, on licence, on probation and was living in supported bail accommodation. Apart from the staff, what do you suppose was the strongest protection for the public. A two plus mile walk to the nearest main road and bus stop. That’s where we’d build them.
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