A few years ago, I was contacted by an organization that provides diversity training. Part of its mission was the following:
We seek to be an open, transparent, inclusive non-profit organisation, promoting diversity and equality. We also firmly believe that individuals should be treated equally regardless of disability, gender, ethnic origin, religion and sexual orientation.
I met with its Chairperson, who asked me to take a look at the organization’s Articles.
I did that and found that they were (a slightly adapted version of) older standard Articles, even though the organization was set up more than half a year after the change in the standard Articles (28 April 2013).
Different in the newer version was that it no longer discriminated against mental health versus physical health. The Mental Health Discrimination Act 2013 had something to do with that.
This is the offending sub-clause in the articles up to 28 April 2013:
18. A person ceases to be a director as soon as—
(e) by reason of that person’s mental health, a court makes an order which wholly or partly prevents that person from personally exercising any powers or rights which that person would otherwise have;
Compare it with sub-clause 18d, which is not discriminatory toward mental health relative to physical health:
18. A person ceases to be a director as soon as—
(d) a registered medical practitioner who is treating that person gives a written opinion to the company stating that that person has become physically or mentally incapable of acting as a director and may remain so for more than three months;
The newer version reads:
18. A person ceases to be a director as soon as—
(e) [paragraph omitted pursuant to The Mental Health (Discrimination) Act 2013]
Even though the fact that the sub-clause in question (18e) was rendered invalid by the Mental Health Act because of its discriminatory nature, I felt that the organization should update its Articles.
It would reflect the organization’s stated values and objectives.
Unless the person was familiar with company law, whoever read that sub-clause might not know that it was invalid.
A world mental health survey shows that about 5.2% of people who lose loved ones suffer from PTSD. But how do you know who suffers from PTSD after a traumatic loss so that you can give them the care they need?
Unfortunately, in Africa most people go undiagnosed. This is because only two countries on the continent have carried out national surveys on mental health – South Africa and Nigeria. Concerning trauma and PTSD, the only significant data emanated from the South African Survey, since the Nigerian one did not have a high enough prevalence rate to enable detailed analysis.
The recent global survey identified a number of predictors that significantly increase the risk of PTSD after a loss. These include: whether the deceased is either a spouse or child, being female, believing that one could have done something to prevent the death, prior exposure to a traumatic event and having a previous mental disorder before the trauma.
Using these predictors it was possible to construct a model that can be used to determine those with the highest risk of developing PTSD after the unexpected death of a loved one. This model makes it feasible for clinicians helping people who have suddenly lost loved ones to develop interventions that are evidence-based and with high probability of success. This should provide opportunities for affected people being able to be provided with the appropriate care after this traumatic event.
PTSD and death
PTSD happens after a person is exposed to an event that poses a threat to their life. It is a group of symptoms that include re-experiencing the event, changes in emotions and cognitive functions. Irritability, reckless or self-destructive behaviour, sleep problems and low concentration are common.
Families and caregivers can recognise PTSD in a loved one because the symptoms are a change from their usual behaviour. These signs and symptoms begin within a month of experiencing the traumatic event like the unexpected death of a loved one.
The person may experience nightmares or flashbacks, will avoid distressing memories, thoughts, or feelings associated with the traumatic event.
Due to the trauma, the person may also develop memory problems and feelings of detachment from friends, colleagues and family are common. The person may also display exaggerated negative beliefs about themselves, others or the world. In some cases, depression and drug abuse is noted.
People who have unexpectedly lost a loved one are at a higher risk of getting PTSD so they should be identified early enough and appropriately counselled.
The high prevalence and meaningful risk of PTSD makes the unexpected death of a loved one a major public health issue. Due to a collaborative initiative under the World Health Organisation (the World Mental Health Surveys Initiative) it is now possible to predict the occurrence of PTSD after a traumatic event such as the unexpected death of a loved one.
The resulting screening assessments will be useful in identifying high risk individuals prone to PTSD for early interventions.
Raising relevant data is one of the biggest challenges to tackling the issue of PTSD in Africa.
African countries should carry out national mental health surveys because they provide information that can be used for planning care and rationally allocating resources in mental health. They also provide information necessary in policy formulation and mental health interventions.
Without a national survey, countries often misallocate resources, ending up with situations in which they neglect the most important problems and intervene disproportionately in low priority areas. This is responsible for the current situation in which what is probably a silent mental ill-health epidemic which is sweeping across the continent.
Lukoye Atwoli, Dean, Moi University School of Medicine, Consultant Psychiatrist and an Associate Professor in the Department of Mental Health, Moi University
Dutch daily Trouw prominently featured anger about a human rights violation on its 6 September front page (online version).
Not only had Dutch police tasered a patient in so-called drive-stun mode (“pain compliance“), the patient in question already was in solitary confinement.
I was shocked when I read this. It seems to signal a return to practices I thought we had left behind a long time ago, and it particularly worries me that this happened in the Netherlands of all places.
“This is torture,” say Amnesty International as well as organizations of patients and their relatives, and Amnesty has called for an immediate suspension of the use of this type of weapon by Dutch police, so I understand. According to Trouw, the taser’s manufacturer advises against use on psychiatric patients and Amnesty believes taser use may actually be life-threatening in such cases.
This is likely the first time a taser was used to subdue a hospitalized psychiatric patient in the Netherlands, where three-hundred police officers are currently testing tasers.
The following appears to have transpired.
On 17 July, police officers were called to a hospital in Cappelle aan de IJssel, in which a male patient in his twenties was having a psychotic episode. (When Dutch police are called to a hospital for a problem with a patient, police take over responsibility.)
The patient was having a bad day, apparently, and had refused to take his antipsychotic medicines. Rotterdam police were first called to force the patient into solitary confinement (to reduce sensory input and calm the patient down).
In the evening, police were called again, for unknown reasons. That’s when the tasering occurred.
The patient’s mother, Marijke Bos, found out about the incident a few days later during a visit on her son’s birthday. Her son had dark bruises under his eyes, several bruises on one of his hips and roughly thirty small taser-related lesions on his back. The patient had also been tasered on one of his feet.
The patient’s mother has filed several formal complaints.
The hospital staff reportedly is also extremely dismayed about the taser use.
Solitary confinement in itself can be damaging and can be seen as a human rights violation. Tasering a patient who already is in solitary confinement and clearly no danger to anyone else raises eyebrows, to put it mildly.
It seems to me that tasering in drive-stun mode is even worse than using a baseball bat to knock someone out as it deliberately causes pain, so it is more comparable to stabbing someone with a knife or throwing scalding water or oil.
The incident made me wonder about taser use on patients in other countries and I did a quick web search. It is not clear whether other reports of taser use on patients concern drive-stun mode or probe mode, but probe mode is the usual taser mode.
New Zealand police used a taser on a mentally ill man earlier this year as well and it was the country’s second case this year in which taser use against a mentally ill person was ruled (excessive and) unjustified:
“Police told the 21-year-old he would need to be strip searched, the man repeatedly refused to remove his clothes telling the officers he had a history of sexual abuse and didn’t feel comfortable being touched by males.”
In Britain, even taser use in general has turned out to concern mainly mentally ill persons, according to Home Office figures:
I agree with Matilda MacAttram (director of Black Mental Health UK and writer of the above article in the Guardian) that there is no role for police in mental healthcare, just like police have no business in heart surgeries and appendectomies either.
For most women, PMS is an unpleasant but manageable part of their period. But for 5-8% of women (around 80,000 in the UK), their symptoms are so severe they can be fatal.
Laura experienced anxiety and panic attacks into her twenties, and was forced to temp because she couldn’t hold down a job. “Every month I’d get so tired I’d have to sleep 18 hours a day for three days. I started getting suicidal thoughts.”
She was suffering from Severe PMS or, as it is sometimes referred to in the UK, Premenstrual Dysphoric Disorder. The condition is recognised by the NHS.
“PMDD is actually the American Psychiatric Association’s definition of one type of Severe PMS,” says consultant gynaecologist Dr Nick Panay. The UK’s definition is slightly different. “‘Severe symptoms interfere with someone’s ability to function normally.”
I mention something similar in my book “We need to talk about this” in relation to a woman whose child was taken from her womb because she was in advanced pregnancy and has bipolar disorder. Hormones can wreak havoc. Blame the hormones, not the women. Don’t punish the women. Support them.
I happen to know a highly intelligent and spunky woman with bipolar disorder. She has a PhD and her own business. She was hospitalized twice. Want to take a guess as to when that happened? Right. When she had her daughter – who is now an adult and doing fantastically well, I might add – and when she was going through menopause.
Cut people some slack. Don’t punish them for their conditions, certainly not when the condition is otherwise highly manageable and well-managed by the woman in question. Punishing someone with bipolar disorder for going through a rough patch is like punishing someone else for having a bad flu.
By the way, Italy has just introduced period leave for women. And in case that makes you wonder about this, the gender pay gap in Italy is lower than in quite a few other European countries.