Since the outbreak of COVID-19 the UK laws about being sectioned under the Mental Health Act have changed and mean that only one doctor is needed to section someone and the time they can be detained seems to have been extended.
Given that people can get a core psychiatric disorder diagnosis (IE FND/conversion disorder) on the basis of having an entrainable tremor/on the basis of confirmation bias/partly on the basis of referral notes/on the basis of normal scan results etc etc I am concerned that people with this diagnosis in the UK may be vulnerable because of this change in the law.
I would appreciate it if the admins here would post their response to this change in the law and give advice to people about what they can do if they get sectioned. With the awareness month for FND coming up, I hope the admins will ask all people raising awareness about FND to include any information advice and guidance that comes from them about this in as many posts as possible.
Thanks in advance.
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I'm in the US so it's a bit differnet. In order to be committed (sectioned?) or to be held for observation against your will....up to 72 hours typically, there are certain criteria that have to be met.
The big kicker is ......are a danger to self or others? Answer or act yes and you can be committed on the reccomendations of a therapist or other mental health professional (State by state there are small differences on the degree/qualifications needed).
This involuntary commitment...a.k.a. Baker act or 5150'd..... this action can occur in the emergency room, or in the community if someone's having an outburst. Or even in the therapist office.
if you verbalize a desire to hurt self/others or become a danger to self or others. You get a ride. Obviously you would be assessed at the receiving pysch unit. You may not even stay the full 72 hours. Typically they're not going to Baker someone unless the person is really struggling and need a safe place to go.
It's interesting to learn how this works in other places. Please keep us updated on these changes.
Yes, committed and sectioned are roughly the same thing in the UK and it was usually the potential of harm to self and/or harm to others that was the deciding factor here, whether verbalised or assumed or fabricated by the drs doing their thing.
However that has been eroded over the years and there were people in psych units who had rare and/or poorly understood physical conditions, eg Third Window Syndrome, that was misdiagnosed as Conversion Disorder. I put that in the past tense but apparently it's still happening. Enough, already.
With the change in the law here, my concern is for people diagnosed with FND/Conversion disorder for the reasons I mentioned about the diagnostic processes for this condition, which also involves drs being told to disregard the info from the physical records when making this diagnosis. It's also for people with rare conditions who often pick up psych diagnoses during our diagnostic odysseys (Cushing's being a classic example, but there are many others) and it's also for people with audio-vestibular/neuro-vestibular conditions who are vulnerable to similar misdiagnoses. Oh and those with vitamin and mineral deficiencies and those who are experiencing side effects from prescribed medications. Oh and also those who have XP and Neimenn Pick C and so on.
I've contacted the Care Quality Commission and The Kings Fund here in the UK to ask about their response to the, hopefully temporary, changes in the law. Rare Disease UK ditto and they replied very quickly because they are concerned about any disruption to health and social care.
Looking forward to hearing from the admins here about their response and blessings to you too, Daesin
Hi. I think one would hope that the primary danger to self/others stands. While we’ll probably all need to be committed after this/are already in essence committed(!), I don’t know how that has been eroded.
I would like to ask about how drs are told to disregard the info from the physical records when making this dx? You’ve said that before and I’m interested where this is from...
Hi artmom - yes, we would hope that but people are being and have been sectioned for other reasons than threat to self or others, both in the UK and elsewhere.
Unfortunately lots of human rights have been eroded in the UK due to austerity measures . COVID-19 crisis measures here are somewhat different from austerity measures but may also erode human rights and I am interested in this from the perspective of mental health advocacy.
The instructions about disregarding the info in the physical notes comes from Hon Prof Stone, one of the main content providers/thought leaders re FND/Conversion Disorder/Core Psychiatric Disorder (aka 'medically unexplained symptoms' in the UK - *sigh*). I first came across it in his 'bare essentials, functional symptoms in neurology' paper where he gave a caveat re why this was a good idea (healthy organs might have been removed, panic attacks might have been misdiagnosed as asthma), although this caveat didn't stack up for me. More recently the caveat seems to have been removed but I can't post the screen shot of that without visiting his site and I have no intention of doing that again if I can avoid it. (Click-bait bugs me, big time)
Maybe we just need to wait for the admins here to respond about this and then put any questions we have to them.
I managed to take a screen shot of the relevant advice but can't figure out how to copy and paste it for you It says 'Don't believe all the physical diagnoses in notes' but gives no guidance as to which diagnoses should be believed and which should not.
It is unethical, as is the over and misdiagnosis of FND/Conversion Disorder. My Dad took the Hippocratic oath and will be turning in his grave over this.
When I wrote the original post the law hadn't been changed in the UK although many people thought it had - and it has now. Additional changes, necessary as a result of issues associated with COVID-19, include one person tribunals and several other human rights issues have been eroded. Although these measures are temporary they may be in place for some time to come so this is an important issue for patients with FND/Conversion Disorder.
I am disappointed that non of the admins have responded to my post, whether they are in the UK or not, since similar law changes are being implemented elsewhere. I understand that they may not feel they have a duty of care to people with FND/Conversion Disorder in this respect and if this is the case, maybe they could ask one of the content providers/influencers from the medical profession to respond - IE those who have taken a Hippocratic oath.
We have requested a response from Professor Mark Edwards, St George's University Hopsital, London.
I cannot really conceive of a situation where the diagnosis of FND alone would be a reason to detain someone against their will under the Mental Health Act (i.e. to section them). This is used in a situation where someone lacks capacity to make decisions for themselves and is at immediate risk to themselves or to others. The commonest reason for sectioning a person is because they have severe psychosis, which is not a feature of FND. Whether or not one conceptualises FND as a psychiatric disorder, it does not follow that having a psychiatric diagnosis means one can be sectioned. It is only in very specific circumstances which I think would be very unlikely to apply to people with FND, and would not be related specifically to the FND diagnosis.
There is a broader point here about civil liberties at this time and a reduction in the normal safeguards around sectioning, but I don’t think it specifically applies to people with FND.
Thank you Dawn and I agree with the points you make. However as you know, there is still not much known about FND/Conversion Disorder and doctors are not always aware of some of the nuances - eg that psychosis is not a feature of FND. My concern is that this lack of training and awareness means that errors could be made under the new laws, to the detriment of patients.
It is noted that people get angry when given this diagnosis so if that anger/fear doesn't dissipate, that could be taken out of context and seen as risky behaviour. Likewise people can develop medically-induced PTSD as a result of being misdiagnosed with FND/Conversion Disorder and develop a suicide ideation as a result of how their misdiagnosis was made. On that count I speak from personal experience.
FND is conceptualised as a core psychiatric disorder. Unless there has been a robust challenge to the Perez paper to show otherwise, it is not a matter of opinion.
Personally I am aware of two situations where people only avoided being sectioned through family intervention (under the old UK laws). Both were in cases of Vitamin D deficiency combined with adverse side effects for medications. In both cases the individuals concerned had previously been misdiagnosed with FND/Conversion disorder.
We don't have to look far into the past to see that all sorts of 'behaviours' that we now know are parts of recognised bio-medical conditions could result in doing time in an asylum or to know that the lived-experiences of sectioned people were not always life affirming.
I look forward to reading Prof Edwards' response. I am not on twitter but someone reported that, re FND/Conversion disorder, apparently he'd said something like 'we've turned possible contributing factors into causes' and if he did say that, I will have more admiration for him. I hope he will address this issue not just from the perspective of the impact on patients with FND/Conversion disorder but also from the perspective of people who have been misdiagnosed with it. I would also hope he brings his own perspective - IE that of a doctor - and will comment on the huge stress doctors who section people could be under if they get it wrong. This is as much a human rights issue as it is, or could be, an issue for patients with FND/Conversion disorder and where I have brought it up in other medical fora, doctors and researchers have stepped in almost immediately. I remain grateful that I was empowered to bring it up here, too.
Dawn - I am concerned that we haven't heard from Prof Edwards about this although it is now old news since we're now on pandemic as a portal episode 73 or whatever other number you want to put on it. I hope he is safe and well and that you are too. I do not feel that this is likely to be a problem for people who have been given an FND diagnosis although the exception may be for people who have PTSD as well.
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It says 'Don't believe all the physical diagnoses in notes' but gives no guidance as to which diagnoses should be believed and which should not.
Anyone had experience with getting care for FND in prison (UK)?
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