Table of contentsSummaryIntroductionInsanity, madhouses and 'tug of war'The Mental Health Act 1983Patient classificationDetentionTreatmentVoluntary admissionCommunity careThe medical intervention as social control – increasing care or increasing labels?SummaryMore Over the past few centuries, our perception of mental illness has changed significantly, from the idea that "crazy people" were a deviant group who had need, for the good of society, to be controlled and hidden, through the era of psychiatry, medicine and healing. whereby medicine became an agent of social control that would normalize the sick ready to re-enter society, until today, where therapy has become the latest trend and emotional states are easily used as currency in certain social circles. So what has changed our view of the mentally ill so dramatically, and does this latest therapeutic development represent the whole picture? I believe that, centuries after the days of locking up and hiding the insane, the underlying feature of our mental health care provision is still the "secure center", with emphasis on the idea of “risk assessment” rather than care, and the term “dangerous and serious personality disorder” being used readily, without a psychological or medical definition. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essayIntroductionMental illness, in many ways, consumes our daily lives. According to the National Union of Students, 1 in 4 students will suffer from a mental health problem while at university, with the figure for non-students not much further behind. As a nation we have ready access to counseling services face to face, online and through listening services such as The Samaritans, and the local doctor is now often fully versed in topics such as stress, depression and therapy. In fact, I'm told so often that I'm "stressed" or "depressed" by a doctor looking for a reason for this cold that keeps coming back, that I might well believe I need a dose of late therapy. But is this really the current state of our mental health services? Perhaps a more accurate observation is that there is a fine line between acceptance of what are considered somewhat minor and more fashionable personality "weaknesses" and the much more daunting prospect of a personality disorder. the personality fully formed, and if this line is crossed, the barriers of social acceptance disappear and are very difficult to break. “The question of how to manage mental illness and provide appropriate care has, throughout history, been the subject of significant inquiry and a source of debate,” and remains so today. Are mentally ill people prisoners or patients? Dangerous to the public or dangerous to themselves? All of these questions remain unanswered, but the real problem is not how to approach mental illness per se, but how to define it. Is this what we have come to embrace fondly in today's society, or should we in fact still be protected from it? And perhaps more importantly, who should decide? Madness, madhouses and “tug of war” Not so long ago, the words mental illness and mental disorder did not exist. These words would not have accurately described the attitudes of society in the 18th century and would in fact be better replaced by madness, insanity and insane. Crazy people, like uscalled them then, received no support or care, often relying either on the care of their families or on traveling from parish to parish, as well as other small offers of charitable relief. People with mental illness were not considered a distinct class of people, but "were equated with the much larger and more amorphous class of the morally disreputable, the poor and the powerless." They were often found in local poorhouses and workhouses, as in those days there was no other suitable way of caring for the insane. However, as the 1700s progressed, interest in hiding these people grew and the need to control certain groups in society became a high priority. This is the beginning of the “Great Confinement”, which began in Paris in 1656 with the creation of the General Hospital, a place of confinement for what were called the “socially useless”. However, confinement was not motivated by medical reasons: in fact, medicine had very little to do with the insane until the 19th century. In an emerging capitalist society, there was no place for the poor or the insane, and "the 18th century saw a gradual separation of madness from other points of dependence and deviance." In fact, it was at this time that protectionist attitudes began, with confinement not intended to cure, but to protect society from the “contagion of madness”. Many institutions began to emerge, with a mix of private and state-funded institutions, However, many private madhouses took advantage of the opportunity to make more and more money from the madhouse trade , especially since charitable aid could only extend so far. There was no need for treatment – ​​only restraint and control in the form of restraints and cages, and many private madhouses could charge large sums of money to house the insane while demand began to rapidly outstrip supply. No laws controlled this growing trend – in fact, anyone could easily operate in the “insanity business.” The majority of those who entered a madhouse were not seen again, almost as if they no longer existed – but that only seemed to add to its benefit. However, it soon became apparent that these institutions were only a financial enterprise and that little was provided in the way of care and security – the few institutions that did were dwarfed by the majority whose treatment of the insane could be called ruthless. This began to worry some, and an investigation was launched in 1763 which denounced the institutions as mere "big businesses". Despite opposition from the owners of these madhouses engaged in harsh practices, 11 years later the law began to change, notably with the Madhouse Law of 1774. The Madhouse Law was intended to aimed at protecting wealthy patients in private madhouses and ensuring compliance with standards. were maintained. There was, of course, one glaring omission in the legislation: it did nothing to protect the poor, even though their numbers far outnumbered the crazy rich. No restrictions on practices could be imposed, and no punishment for cruel treatment could be inflicted under the law – this may be partly due to the large sums of money circulating through several institutions, although one can say that if private madhouses were more numerous than public madhouses, the struggle for better treatment of the insane would be long. Despite this, it would be a member ofrich insane people who would begin to disrupt the provision of care for the mentally ill. When King George III became “insane,” the focus shifted from restraint to care and, even more radically, to treatment. Various medical practices emerged, most involving burning, cutting, and other physically painful treatments that today would be called torture. However, despite its focus on the physical body rather than treating the mind, it was an important step forward. Alongside this was what was called “moral therapy,” an even more important phase in the development of mental health care. Kindness, coercion, and work therapy, combined with artistic activities, were seen as a diversion from their state of mind, and the overall approach was much more humane than the physical treatment many "patients" had begun to receive. Many retreats were created as an alternative to the many institutions that had emerged at this time, notably by the philanthropists William Tuke and Bentham. The York Retreat, founded in 1792, became the model for moral therapy, and the book Description of the Retreat, which was based on the retreat and its practices, described appropriate approaches to moral therapy and guidelines for carrying it out. This was very important and allowed moral therapy to be received by a much wider cross-section of society. Its popularity spread and it soon became clear that there was no place for medicine in this new treatment – ​​in fact, it went a long way to affirming the doubts many were beginning to have about the capacity of the medical profession to treat the mentally ill. This doubt was further heightened when the retreat (with its good practices and dignity) was compared to York Asylum which was controlled by doctors and relied on medical treatment that was neither effective nor humane. With the growing popularity and faith in moral treatment, and with its organization in the hands of humanitarians, the medical profession appears redundant. “Since moral treatment began to work, the medical profession has had to find a way to adapt it.” The medical profession therefore began to integrate the practice of moral therapy and, thanks to its status in society and better organization, it became known as part of its general expertise, leaving far behind the lay people who used it. had created. Legally, the treatment of the insane was in the hands of the medical professions. With the Victorian era, the Asylum was born, which replaced the now obsolete Madhouse. These institutions were purpose-built, as they took into account architecture and design to facilitate treatment. However, the positivism initially associated with the asylum transformed into great concern over the overcrowding of public institutions, which made moral therapy and associated curative treatments almost impossible to achieve, subjecting them to the same fate suffered by asylum seekers. madhouses. Institutionalization became a major concern during this time, as many believed that a person could no longer live in the community after being admitted to an asylum. Harsh treatment and poor conditions crept in and by the end of the 19th century the insane were in no better situation than at the end of the 18th. , honest personalities being incarcerated for financial reasons, this is not enough to combat the real concern of the time: the protection of public and social order. So, with the introduction of the Lunacy Act 1890, legal intervention occurred. Medical control was no longersupported by society, as no positive results had materialized, placing control of the insane in the hands of the law. The detention process, certification, and treatment were all regulated, to the point where medicine no longer played a role in the treatment of mental illness. However, as always, attitudes quickly changed and positions began to shift. Once again, legal control yielded no appropriate results, so society once again turned to medicine for an answer. Medicine began to flourish: a new system of care for the mentally ill came into effect and preventative medicine became popular. The profession of psychiatrist was born. The First World War solidified this respect as their role in society increased and the idea of ​​certification began to attract some aversion, with stigma becoming a concern. Society did not want war heroes, who returned home with illnesses such as “shell shock,” to be labeled as crazy. The Mental Treatment Act of 1930 went further than expected, granting treatment without certification under the Temporary Treatment Order and voluntary admission. Overall, the treatment was more relaxed, but most importantly, the treatment took place. Another change in social outlook has led to a change in the provision of care. The Mental Health Act of 1959 pushed the era of medicine even further and gave psychiatrists even more credibility. Greater emphasis on tackling stigma by facilitating access to voluntary admission and legal intervention has declined significantly, although mental health review tribunals have been established to regulate compulsory admission. This was a positive step in care delivery, as it began to take into account the needs and rights of the patient – ​​but despite this constructive influence of the law, control remained firmly in the hands of psychiatrists . Nevertheless, it was a positive time for medicine and patients had options that were previously unknown to them. There appears to be a sensible balance between appropriate care and patients' rights, embodied by the emphasis on voluntary admission, and protection of the public no longer appears to be of great concern. Despite this, the standoff between legalism and medicalism was not yet over, “confidence was short-lived and, by the mid-1960s, disillusionment and criticism had begun to resurface again.” regulates the majority of healthcare services. This reflects another shift in the social perception of mental health, particularly regarding the role of medicine and law in this matter. This law largely typifies the era of rights and the new concern about patient protection and medical intervention. Positions were changed and patients began to be seen as having rights, despite their mental state. A growing interest in rights, with movements such as feminism, has given weight to this idea, as has a growing awareness of the European Convention on Human Rights. Add to this growing pressure from MIND, which gathered support throughout the 1970s for patient protections and a legal framework for the provision of care, a legalist revival was beginning to take shape. . Shortly after the 1959 Act came into force, the recent 'psychiatry boom' began to become an anti-climax. No further advances in treatment were made and the 1960s/70s werea period of consolidation – the lack of activity was not popular and the once optimistic view of psychiatric capabilities began to decline. Furthermore, protection of the public was left in the hands of the medical profession with little legal support, which alarmed many members of society. Finally, much of the success of the 1959 Act rested on community care, which proved to be far too great a financial burden to bear, leaving care underfunded and undermanaged. This led to numerous investigations and the emergence of the new Mental Health Act of 1983. Its objectives were very clear: to regain legal control over mental health provision and care. We wanted greater control of the power of the professional over the patient and the establishment of more guarantees for the protection of the patient and, more importantly, of society as a whole. This would take the form of a legal framework, setting out policy on liability, detention and treatment, and reviewing the roles of members of the profession, to ensure that appropriate care is administered and received. Patient Classification Patient rights are extremely important and this encompasses issues such as the appropriateness of care and the level of rights a patient should have based on their mental state. The MHA 1983 s(1) defines the term “mental disorder” in four distinct categories: “mental illness”, “arrested or incomplete development of the mind”, “psychopathic disorder” and “any other mental disorder or disability”. This definition is very broad and many types of illnesses can fit this definition, although under section 1(3) exclusions are made in relation to drugs, sexual behavior and immoral conduct. What is perhaps important to note are the distinctions made between different forms of mental disorder – this now means that depending on what you are suffering from and the severity of your suffering, rights will be granted in consequence. However, these terms do not attract a medical definition, but rather a legal definition or several with precisely "what an ordinary person would consider" these terms to mean. Detention· s2 – allows compulsory detention for assessment for up to 28 days. This does not exclude treatment. · s3 – mandatory detention for up to 6 months for treatment. Must reapply at the end of each 6 month period. · s4 – mandatory detention of up to 72 hours for emergency assessment and treatment. These provisions provide a clear legal framework within which the medical profession must work. The reasoning behind this is that by adhering to strict detention guidelines, no patient is detained unnecessarily or unfairly, and to be detained for a period of 6 months, treatment must be administered, meaning that there is a better chance that a patient will be detained. are now receiving appropriate care. Treatment · s57 – serious treatments must have consent (e.g. psychosurgery) · s58 – less serious and reversible treatments (e.g. drugs) must have consent first, if this is not obtained, a second medical advice should be obtained. · s62 – the above safeguards do not apply in an emergency (necessary to save the patient's life or relieve their suffering or to prevent further deterioration). In this context, consent must be given freely and the patient must fully understand the nature of the treatment. This once again shows the efforts of the MHA 1983 to provide more rights and protection to patients receiving care andtreatment. Voluntary admissionUnder the MHA 1983, there is an even greater emphasis on voluntary care, and this is found in section 131(1). It allows patients to seek treatment informally or remain in hospital informally after their detention ends. This is perhaps one of the most important provisions of the law, because "it recognizes that a person can seek hospital care for psychiatric difficulties in the same way as for a physical disorder." This in turn should help combat “social stigma”. this has long been associated with mental health, an intention of all mental health laws throughout the 20th century. Although the progress made by the MHA of 1983, it has not been and is not without its problems. Hospitals and institutions are still overcrowded, with the NHS struggling to provide the kind of care and treatment envisaged by campaigners in the 1970s. There is little money or resources, meaning there is no There is no long-term care for seriously ill patients. Volunteer patients are increasing rapidly, as desired, and yet the legislation makes no provision for their protection – this is only ensured for detained patients. The Mental Health Act 1983 failed to strike the right balance, and this is perhaps its greatest flaw, and the flaw of all other mental health laws that preceded it. What is needed is equal emphasis on the rights of patients, their well-being and the rights of society as a whole, and yet we have an unsatisfactory mix of all three, with different things applying at different times. Stigma and labeling still exist, and are much worse today, and society has once again shifted from caring for patients to protecting third parties – society is now more concerned with its own well-being, and yet the law does nothing to reflect this. Perhaps it is time, in the 21st century, to move forward again? Community CareIn December 1992, Ben Silcock, a schizophrenic, entered the lion enclosure at London Zoo to "talk to the animals" , and in doing so he was mutilated. and killed. He was released back into the community and left alone to deal with his illness and the society around him. The same year, Jonathon Zito was stabbed to death by Christopher Clunis, another schizophrenic left without care. Following the 1983 MHA, there was much talk about community care, and in the early 1990s real policies began to take shape. Yet the above cases are just a few examples of where community care has gone wrong. Community care was intended to be a breakthrough in the provision of mental health care – not only would it relieve institutions and hospitals, but it would allow the patient to live in society with family and friends and retain their dignity and independence. . However, the reality was very different. Providing adequate facilities and patient cooperation was a more difficult task than expected – and it was seriously underfunded, leading to the cases above. At the time, MIND estimated that it would cost £300 million to bring community services up to standard, but the government's response was the Community Treatment Order, a policy debated throughout the 1980s and into early 1990s. The community treatment order would allow medical treatment for the disorders. outside the hospital setting, and thus overcome the problems of patients in the community who cannot or do not want to continue their medications or treatment –​​this would be mandatory, thus avoiding the types of incidents so often associated with mentally ill people who live in society. This had many advantages: cost, less patient labeling, and the ability for patients to continue to live safely with their families. However, organizations such as MIND were far from supportive, believing the orders were a serious violation of civil liberties – to what extent were patients actually free to live in the community? These treatment orders, in one form or another, were discussed and studied for some time before a suitable solution could be found. The Department of Health developed a ten-point plan for caring for the mentally ill in the community in 1993, and in 1994 the head of the NHS introduced a register for supervision of patients discharged to the community. This was a precursor to legislation that was to be passed in 1995, with the Patients in the Community Act. This law introduced post-care monitoring and aimed to gain more control over patients released into the community. However, while many people remain concerned about civil liberties and increased coercion, even when patients are expected to be relatively free in the community, this law was limited in its results. After the tragedies of 1992, mental health services, and particularly those occurring in the community, were subject to intense media scrutiny, and it became clear that services were lacking. However, what followed was not what members of the psychiatric profession or those in activist organizations had hoped for. Instead of proper community care, patients were given forced prescriptions and medications. What about other benefits of community care, such as patient independence and care within the family? There seems to be neither the money nor the inclination to give them much regard, which means a shift from community care to community enforcement. Yet how can community-based treatment be expected to succeed in the absence of appropriate housing, financial security, and professional opportunities? The law has done nothing to address these much broader social concerns. The role of the public in the success of local care is also an important factor. Often, even though the public sees the benefits of treating a patient not in a facility, but in a friendly community environment, they are reluctant to have these types of facilities in their own neighborhood. This is not surprising, given the nature of education and society's level of knowledge about the mentally ill. If the public is unable to accept the mentally ill in their neighborhood, this will surely only increase stereotypes and stigma, meaning any positive effects of community care will be lost. That was the attitude of the 1980s, has it changed that much in the 21st century? Ben Silcock has succeeded in getting the government to think about patients in the community, but not all of his effects are seen as positive. Community care and its failures illustrate governments' approach to mental health policy in the 1990s – the first signs of coercion and repression of the mentally ill. Medical intervention as social control – increasing care or increasing labels? “Medical solutions are sought for a variety of deviant behaviors or conditions. » It has often been thought that deviance and mental illness are linked in some wayother: both are known to be forms of "social abnormality" and, as such, carry a similar label, whether voluntary or involuntary. This has long been the case, since the days of insanity and insanity, when all types of social anomalies were treated equally. As mentioned above, it didn't matter if a person was sick, poor, crippled, criminal, or mentally ill, they were locked up and hidden together, without treatment or help, just left so that they could no longer be a threat or a threat. a drain on society. This is a dilemma that civilization has faced throughout history, and social control has always been a burning issue. Many solutions have been applied, and their success or failure can be traced, but throughout the 20th century medicine became the method of choice. For most forms of deviant behavior, treatment, rather than punishment, is sought, with rehabilitation programs, institutions and community care being used for different types of people, particularly criminals. Medicine began to replace religion, whose appeal waned in these cynical times, and even confidence in the criminal justice system and its apparent ineffectiveness in “solving” repeat offenses waned. As knowledge and science have grown, so have expectations of what medicine can accomplish, leading to its dominance over anything considered abnormal in the recent past. In his attempts to normalize illness and allow individuals to successfully readjust to their role in society, he managed to capitalize on the term "disease" and use it to refer to a multitude of subgroups: Are criminals sick? Are they mentally ill? The reality is that, even if the question exists, medicine will play an important role in this regard. Formerly, "confinement [was] explained, or at least justified, by the desire to avoid scandal", and although the types of people were detained, they were distinct from each other, and their grouping attracted a very similar stigma. , for some reason. Understanding mental illness wasn't easy in those days, and it was just another form of deviance – not an illness that needed to be treated and cured, so it wasn't really a problem. “Some have argued that the stigmatization of the mentally ill is an example of the common human tendency to dismiss devalued subgroups and blame them for social unrest” – and despite efforts to the contrary, legislation has not changed this situation . In fact, this problem is only getting worse, simply adapting to the social attitude of the times. Today, the focus has shifted from containment to care, through the medical profession. While “deviance” as a whole is now a matter of medical practice and influence, the labeling of the mentally ill has not diminished, but simply changed. Now everyone who requires any kind of treatment is part of the same subgroup of society and therefore one and the same person – but this time they are receiving care, so it is more acceptable to treat them consider it this way. We can look at it this way; “Today, Americans live under two sets of laws: one applicable to the sane, the other to the insane. The legal provisions that apply to the former – with regard to hospitalization for illness, marriage or divorce, standing to appear in court or the privilege of driving a vehicle or exercising a profession – do not apply to seconds. In short, individuals classified as mentally ill work.’’