The mental health act review and the definition of ‘mental disorder’

Simone Aspis  (Changing Perspectives)   

I am a disabled person who is acting as an advocate for detained in-patients with learning difficulties and autism who want to be released from psychiatric hospitals.

I have over 20 years experience campaigning for disabled peoples’ human and civil rights, working for People 1st, the United Kingdom’s Disabled Peoples Council and the Alliance for Inclusive Education and Not Dead Yet. 

Over the past decade the number of people detained under the Mental Health Act is rising – alarming rate up by 47% in 10 years.    

One of the reasons for the increased use of state sponsored sectioning powers is amendments made by the Mental Health Act 2007 to the Mental Health Act 1983.   

Firstly, the definition of mental disorder was removed and therefore leaving it undefined.  And secondarily, it’s no longer a requirement that hospital compulsory treatment must be of therapeutic benefit for the patient.        
The Government’s Mental Health Act Review’s focus is on rising rates of detention, particularly amongst the black and minority ethnic (BAME) communities and whether processes (MHRT, Second Opinions etc) provide effective safeguards for patients.

What appears to be omitted from the terms of reference is the definition of mental disorder, which I believe is one central cause of who is at risk of incarceration within a psychiatric system.   

Under the Mental Health Act 2007 anyone with a mental disorder as defined under the International Classification of Diseases (ICD) published by the World Health Organization (WHO) could fall under the Mental Health Act provisions
Over the years, there has been increasing numbers of new mental disorders being constructed through medicalising what would have been considered within the normal patterns of being, thinking and behavouring of humankind. 
Now, mental disorder has been extended to cover individuals patterns of learning departing from cognitive norms such as dyslexia, dyspraxia and dyscalculia.

Classifying certain types of being, thinking and behaving in western world as a “mental disorder” involves value judgements on what constitutes “normal” and “abnormal” by psychiatrists.

“Correct” ways of being, thinking and behaviouring in a western society is culturally and socially constructed; Homosexual was classified and declassified as a mental disorder in response to society’s changing opinion about sexual orientation.

If society wants disabled people with learning differences and their patterns of being, thinking and behaving to be accepted, then WHO could remove Learning Difficulties conditions from the list of mental disorders.

Understanding that all mental disorder conditions falling under the mental health act are socially constructed; a person’s experience of their mental wellbeing can be interpreted in a various ways, leading to disputes over different mental disorder diagnosis.    

A disabled person’s patterns of being, thinking and behaviouring could lead to an autistic, borderline emotionally unstable personality or psychotic mental disorder diagnosis or without a diagnosis by various psychiatrists.

In recent years, many disabled people with Learning Difficulties and Autism are being detained under the Mental Health Act.

All the state-appointed authorities, psychiatrists and approved mental health professionals are required to confirm that the person’s behaviour is abnormally aggressive or is of a seriously socially misconduct nature and that there is a health and safety risk to oneself or others.

The standard is determined by “social norms”, i.e. normal level of acceptable aggressive behaviour or seriously socially irresponsible misconduct amongst the general population of neuro-typical people.

As we become increasingly more intolerant towards peoples differences, what constitutes as normal becomes more narrow.

As a result more disabled people with learning difficulties (including those with specific learning difficulties) and autism could fall under the Mental Health Act provisions.

The MHA review panel must consider the construction of mental disorder if we are going to tackle the over sectioning and inappropriate sectioning of disabled individuals under the Mental Health Act.

  • What constitutes as mental disorder label?
  • Should we ditch the “mental disorder” label?
  • Medical and Social construction of mental disorder
  • Individual or social causes of mental disorder
  • Individual or social solution to people with mental disorder labels