IndexAbstractIntroductionMadness, asylums and the 'tug of war'The Mental Health Act 1983Patient classificationDetentionTreatmentVoluntary readmissionCommunity careMedical intervention as social control: increased treatment or increased labelling? AbstractOver In recent centuries, our perception of mental illness has changed considerably, starting from the idea that "crazy people" were a deviant group who needed, for the good of society, to be controlled and hidden, through the era of psychiatry , of medicalism and care whereby medicine became an agent of social control that would normalize the sick ready to return to society, until today, where therapy has become the latest trend and emotional states are readily used as currency in certain social circles. What, then, has changed our view of the mentally ill so dramatically, and is this latest therapeutic development the full picture? I am convinced that still, centuries after the days of locking up and hiding the insane, the fundamental feature of our mental health care provision is the “safe centre”, with the emphasis placed on the idea of ​​“risk assessment ” rather than cures, and with the term “dangerous and serious personality disorder” used easily, without a psychological or medical definition. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay Introduction Mental 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 studying at university, while the figure for non-students is not far behind. As a nation, we have easy 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 so often told that I'm "stressed" or "depressed" by a doctor looking for a reason for that cold that comes back, that I could almost believe I needed an overdue dose of therapy. But is this really the state of our mental health provision today? A more accurate observation is perhaps that there is a fine line between the acceptance of what are seen as somewhat minor and more fashionable personality "weaknesses" and the much more daunting prospect of a fully formed personality disorder, and if this line were crossed, the barriers of societal acceptance are broken down and are very difficult to open. “The question of how to address mental illness and the provision of appropriate care has, throughout history, been the subject of significant investigation and a source of debate,” and remains so today. Are the mentally ill prisoners or patients? Dangerous to the public or dangerous to himself? All these questions remain unanswered, but the real problem is not how to deal with mental illness as such, but how to define it. Is this what we have come to fondly embrace in today's society, or should we actually still be protected from it? And, perhaps more importantly, who should decide? Madness, Asylums, and the Tug of War It wasn't long ago that the words mental illness and disorder didn't exist. These words would not have accurately described the attitudes of society in the 18th century, and in fact would be better replaced with madness, madness and insane. The insane, as they were then known, were offered no support or care, often relying on family assistance or moving from parish to parish on handoutsand other small charitable relief offerings. Those with mental illness were not seen as a separate class of people, but "were assimilated into the much larger and amorphous class of the morally disreputable, the poor, and the powerless." They were often found in poor houses and local workhouses, because at that time it was believed there was no other suitable way to deal with the insane. However, as the 1700s wore on, interest in hiding these people grew and the need to control certain groups in society became a top priority. The "Great Confinement" began, which began in Paris in 1656 with the creation of the Hopital General, a place to confine what was defined as "socially useless". Imprisonment, however, did not occur for medical reasons: until well into the 19th century, medicine had very little to do with the insane. In an emerging capitalist society there was no place for the poor or the mad and "the 18th century saw a gradual separation of madness from other points of dependency and deviance". Indeed, it was in this period that protectionist attitudes began, according to which imprisonment was not aimed at treatment, but to protect society from the "contagion of madness". Many institutions began to emerge, with a mixture of privately owned and publicly funded ones, however many private asylums took the opportunity to make increasing sums of money from the insane trade, especially in light of the fact that aid of beneficence could only extend to a certain point. There was no demand for treatment – ​​only restraint and control in the form of chains and cages, and many private asylums could charge large sums of money to house the insane as demand began to rapidly outstrip supply. There were no laws to control this growing trend – in fact anyone could easily get involved in the “madness trade”. Most of those who entered an asylum were never seen again, almost as if they no longer existed, but this only seemed to increase the benefits. However it soon became apparent that these institutions were only a financial enterprise, and little was provided in the way of care and security: those few institutions that did were overshadowed by the majority, whose treatment of the insane could be described as ruthless. This began to become a cause for concern for some and in 1763 an inquiry was launched which revealed that the institutions were simply "big business". Despite opposition from the owners of those asylums engaged in harsh practices, 11 years later the law began to change, not least with the Madhouses Act of 1774. The Madhouses Act was there to protect wealthy patients in private asylums and to ensure that standards were met. were maintained. Of course there was one glaring omission in the legislation: it did nothing to protect the poor, even though their numbers far outnumbered the crazy rich. Under this law it was not possible to impose any restrictions on practices and no punishment for cruel treatment – ​​perhaps this is partly due to the large amounts of money that are distributed to various institutions, although it can be said that while private asylums They were more numerous than the public ones, the fight for better treatment of the insane would be long. Despite this, he would be a member of the crazy rich who began to overturn the provision of care for the mentally ill. When King George III went “mad,” the focus shifted from restraint to cure and, even more radically, to treatment. Various medical practices emerged, most resembling burning, cutting, and other physically painful treatments that today would be calledtorture. However, despite his focus on the physical body rather than on caring for the mind, this was a major breakthrough. Alongside this was what became known as “moral therapy,” an even more important phase in the development of mental health care. Kindness, coercion, and work therapy, along with artistic activities, were thought to serve 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 established as an alternative to the numerous institutions that arose in this period, notably by the philanthropists William Tuke and Bentham. The York Retreat, founded in 1792, became the model of moral therapy and the book 'Description of the Retreat', based on the retreat and its practices, outlined the appropriate approaches to moral therapy and guidelines for carrying it out. This was very important and it 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 – ​​indeed, it helped affirm the doubts that many were beginning to have. to have about the medical profession's ability to treat the mentally ill was further increased when compared to the retreat (with its gentle practices and dignity) in the York asylum, which was supervised by doctors and relied on. on medical care that was neither effective nor humane, the rise of popularity and confidence in moral treatment, and with its organization in the hands of humanitarians, the medical profession appeared redundant. “Ever since moral treatment began to work, the medical profession has had to find a way to adapt it.” The medical profession, therefore, began to incorporate the practice of moral therapy and, due to its position in society and better organization, it became known as part of its general expertise, leaving the lay people who created it far behind. Legally, the care of the insane was in the hands of the medical professions. With the Victorian age came the birth of the mental asylum, which replaced the now redundant asylum. These institutions were purpose-built, meaning they took architecture and design into consideration to help with treatment. However, the positivism initially associated with the asylum turned into great concern for the great overcrowding of public institutions, which made it almost impossible to carry out moral therapy and related curative treatments, consigning them to the same fate suffered by asylums. Institutionalization became a serious concern at this time, as many believed that one could no longer live in the community after entering an asylum. Harsh treatment and poor conditions crept in, and by the end of the 19th century the insane found themselves in no better position than at the end of the 18th century. However, although the madmen were accorded sympathy for the conditions and anguish at the thought of being sane, the imprisonment of honest members of society for financial reasons, this was not enough to counter the real concern of the time: the protection of public order and social. Then, with the introduction of the Lunacy Act 1890 came legal intervention. Medical control was no longer supported by society, as no positive results had materialized, which placed control of the insane firmly back in the hands of the law. The detention process, certification, and treatment were all regulated, to the point that there was no longer any role for medicine in mental illness. However, as always, it wasn't long before attitudes changed and the position began tochange. Once again, no satisfactory results were obtained from the forensic audit, so the company once again turned to medicine to find the answer. Medicine began to prosper: a new system of treatment for the mentally ill came into force, and preventive medicine became popular. The profession of psychiatrist is born. World War I solidified this respect as their role in society increased and the idea of ​​certification began to meet with antipathy, as stigmatism became 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 Provisional Treatment Order and voluntary admission. Overall the treatment was more relaxed, but more importantly, the treatment happened. Another change in social perspective meant a change in the provision of care. The Mental Health Act of 1959 brought the medical era even further and gave psychiatrists even more credibility. Greater emphasis was placed on combating stigmatism through increased access to voluntary admission and legal intervention declined significantly, despite mental health review tribunals having been created to regulate compulsory admission. This was a positive step in the provision of care, as he began to realize the needs and rights of the patient – ​​however, despite the constructive influence of the law in this way, control was still firmly in the hands of the psychiatrists. Nonetheless, it was a positive time for medicine, and patients had options that were previously unknown to them. There appeared to be a reasonable balance between appropriate care and patient rights, exemplified by the strong emphasis on voluntary admission, and public protection no longer appeared to be of great concern. Despite this, the tug of war between legalism and medicalism was not yet over, "trust was short-lived and by the mid-1960s disillusionment and criticism began to re-emerge again". regulates the majority of assistance services. It reflects yet another shift in social perception of mental health, especially regarding the role of medicine and the law in the whole issue. This act largely characterizes the era of rights and the new concern for 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, as has a growing awareness of the European Convention on Human Rights. Add to this growing pressure from MIND, which during the 1970s rallied support for patient protection and a legal framework within the provision of care, a legalist revival was beginning to take shape. Not long after the 1959 law went into effect, the recent psychiatric law boom began to go into anti-climax. No new advances were made regarding treatment, and the 1960s and 1970s were a period of consolidation: lack of activity was not popular, and the once optimistic view of psychiatric capabilities began to fade. Furthermore, public protection has been left in the hands of the medical profession with little legal support, and this has caused alarm among many in society. Finally, much of the success of the 1959 Act relied on community assistance, something that was proving to be far too much of a financial burden to be able toendure, leaving care under-resourced and under-managed. This stimulated much investigation and with the emergence of the new Mental Health Act 1983. Its objectives were very clear: to regain legal control over the provision and treatment of mental health. There was a desire for greater control of the professional's power over the patient and for greater guarantees for the protection of the patient and, above all, of society in general. This would come in the form of a legal framework, setting out policy on accountability, detention and treatment, and reviewing the roles of those practicing, to ensure appropriate care is administered and received. Classification of patients Patient rights were extremely important and this included issues such as the appropriateness of care and the level of rights a patient should have depending on their mental state. The MHA 1983(1) defines the term “mental disorder” into four separate categories; “mental illness,” “arrested or incomplete mental development,” “psychopathic disorder,” and “any other mental disorder or disability.” This is a very broad definition and many different types of disease can be adapted to the definition, although there are exclusions in s1(3) in respect of drugs, sexual behavior and immoral conduct. What is perhaps important to note are the distinctions made between different forms of mental disorder: this means that, depending on what you suffer from and the severity of it, your rights will be granted accordingly. However these terms do not attract a medical definition, rather a legal one or more accurately "what an ordinary person would consider" these terms to mean. Detention · s2 – authorizes mandatory detention for investigation of up to 28 days. This does not exclude treatment. · s3 – mandatory detention of 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 operate. The reasoning behind this is that by adhering to strict detention guidelines, no patient is detained unnecessarily or unfairly, and in order to be detained for a period of 6 months, treatment must be given, meaning there is a greater likelihood that a patient will now receive 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 forthcoming then must be a second medical opinion obtained. s62 – the above safeguards do not apply in an emergency (necessary to save the patient's life or relieve suffering or prevent further deterioration) Consent in this context 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 ensure greater rights and protection for patients undergoing care and treatment. Voluntary admission Under the MHA 1983 there is an even greater emphasis placed on voluntary treatment, and this can be found in s131(1). It requires patients to seek treatment on an informal basis or to remain in hospital informally after cessation of detention. This is perhaps one of the most important provisions of the law because it "recognizes that an individual may seek hospital treatment for psychiatric problems in the same way as they would for a physical ailment." This in turn should help combat the "social stigma" that has long been associated with mental health, a goal of all mental health legislation throughout the 20th century.century. Although the progress made since the 1983 MHA has not been, and is not, without problems. There is still severe overcrowding in hospitals and institutions, with the NHS struggling to provide the kind of care and treatment envisaged by 1970s campaigners. There is little money or resources, which means there is a lack of long-term care of seriously ill patients. Voluntary patients are increasing rapidly, as hoped, yet the legislation does not provide any protection for their protection, which is only provided for detained patients. The Mental Health Act 1983 failed to get the balance right, and this is perhaps its main flaw, and the flaw of all the other mental health laws that came before it. What is needed is to give equal weight to the rights of patients, their well-being and the rights of society at large, yet what we have is 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 the patient to protecting others: society is now more concerned with its own well-being, yet the law does nothing to reflect this. Is it time, in the 21st century, to move on? Care in the community In December 1992 Ben Silcock, a schizophrenic, climbed into the lion enclosure at London Zoo, to "talk to the animals", and was mauled and killed as he did so. He was discharged into the community and was left alone to deal with his illness and the society around him. That same year Jonathon Zito was stabbed to death by Christopher Clunis, another schizophrenic left without treatment. In the wake of the 1983 MHA, much focus was placed on community care, and real policies began to take shape in the early 1990s. Yet the cases mentioned above are just some of the examples of where community care has gone wrong. Community care was supposed to be an epiphany in the provision of mental healthcare – it would not only take the heat away from institutions and hospitals, but would allow the patient to live in society with family and friends and maintain dignity and independence. However, the reality was very different. The burden of providing adequate facilities and patient cooperation was a more difficult task than initially anticipated – and was severely underfunded, leading to the cases above. At the time MIND estimated that it would cost £300 million to bring community services back to zero, but the government's response was the Community Treatment Order, a policy debated in the 1980s and early 1990s. The Community Treatment Order would allow medical treatment for ailments outside of the hospital setting, and thus overcome the problems of those patients in the community who cannot or do not want to continue therapy or treatment – ​​it would be mandatory, thus avoiding the kind of incidents so often associated with the mentally ill living in society. It had many advantages: cost, less labeling of patients, and the ability for patients to still live safely among their families. However, organizations such as MIND were far from supportive, believing that the orders constituted 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 an adequate solution could be found. The Department of Health developed a ten-point plan for the care of the mentally ill in the community in 1993, and in 1994 the NHS Management Executive introduced a register ofsupervision of patients discharged into the community. This was preliminary legislation for the legislation that would come in 1995, with the Mental Health (Patients in the Community Act). This act introduced after care supervision, and was designed to gain greater control over patients released into the community. However, with many still concerned about civil liberties and increased coercion, even when patients are supposed to be relatively free in the community, this act was limited in what it could achieve. After the 1992 tragedies, mental health services, and particularly what happened in the community, came under intense media scrutiny, and it became apparent that services were lacking. However, what followed was not what those in the psychiatric profession or those in the organizations behind the campaign had hoped. Instead of proper community care, patients were served forced orders and medications. What about the other benefits of community care, such as patient independence and family care? There seems to be neither the money nor the desire to hold it in high esteem, which means a shift from community assistance to community enforcement. But how can community treatment be hoped to be successful in the absence of adequate housing, financial security and employment opportunities? The law did nothing to address these much broader social concerns. The role of the public in the success of community care is also an important factor. Very often, even if the public sees the benefits of treating a patient not in an institution, but in a friendly community environment, they would be reluctant to have these types of facilities in their neighborhood. This is not surprising, given the nature of education and the level of knowledge society has regarding the mentally ill. If citizens are unable to accept the mentally ill into their neighborhood, this will surely only serve to increase stereotypes and stigma, meaning that all the positive effects of community care are lost. This was the attitude of the 80s, can it have changed that much in the 21st century? Ben Silcock has succeeded in pushing the government to think about patients in the community, but its effects are not all seen as positive. Community care and its failures show the 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: increase in care or increase in labels? Medical solutions are sought for a variety of deviant behaviors or conditions. It has often been thought that deviance and mental illness are somehow linked: both are known as forms of "social abnormality" and as such attract a similar label, regardless of whether they are voluntary or involuntary. It has been this way for a long time, since the days of madness and madness, when all types of social abnormality were dealt with equally. As mentioned above, it made little difference whether a person was sick, poor, crippled, criminal, or mentally ill: they were confined and hidden together, without care or help, simply left so that they could no longer pose a threat or drain the society. This is a dilemma that has faced civilization throughout history, and social control has been a burning issue throughout time. Many solutions have been applied and their success or failure can be traced, but during the 20th century, medicine emerged as the method of choice. For most forms of deviant behavior treatment, rather than punishment, is sought.’’