RATES of mental illness are soaring: at any one time, a quarter of the population will be suffering. The number of male suicides, in particular, is on the rise. Mental-health support is being withdrawn, and councils are cutting back rather than raising council tax to counter the real drop in government funding.
Clergy are still on the front line where mental health is concerned. If we are confronted with someone whose mental health is obviously precarious, we need to understand enough of their illness to be of support. We also need to be familiar with the relevant parts of the Mental Health Act (MHA), not only for the sake of the ill person and their family, but also for ourselves.
Where to turn
When I was ordained, the GP was always the first port of call, because they would usually know the person in front of you. Sadly, these days, the chances are that you will be told to contact someone else, or be transferred to the practice’s out-of-hours service. There are also mental-health “crisis teams” that can be contacted.
The last resort is always the police; for they are often part of the “it’s all gone wrong” management protocol, and will take the damaged person into custodial protection as part of the sectioning process they are trained to deploy.
THE possible outcomes, in increasing order of severity and seriousness, are as follows:
The storm is weathered and abates
The person is calmed, encouraged to take their medication (if they have already been diagnosed), and normality is restored. In my experience, this is the most common outcome. The crisis averted, you liaise with the care-givers, such as the GP, mental-health key worker, or psychiatric-care professional, and a care plan is drawn up.
When I trained, clergy were regarded as partners in this process, and we were often a key part of the care plan, but now, many of my colleagues appear as unwilling to take on the burden that the mentally ill represent, because the “professionals” are unwilling to engage and involve us. Although this is not always the case, it is increasingly rare for clergy to be invited to contribute to the process.
The voluntary “section”
The vulnerable person has been engaged with, and calmed enough to accept that they are in the middle of a “brain squall”, and that they need some consistent and focused medical care; they are prepared to allow themselves to be taken to the nearest mental-health unit or hospital for assessment and treatment.
This is referred to as a voluntary section, meaning that, although it is an admission under the MHA, the patient is admitted “voluntarily”; so there is less stress and loss of control for the individual. The downside is that, unless they are considered a danger to themselves or others, they can also discharge themselves at will, which means that the person can remove themselves from the system before anything solid can be done.
The storm continues
The situation has now become serious, and we have to consider sectioning someone against their will. This is never easy, but it is essential, should the person become a danger to themselves or others. Obviously, it causes someone more stress as they lose whatever control they had.
Section 136: This has been the most common of the involuntary admissions with which I have been involved. A police officer can take the person into custody under Section 136 of the MHA. The officer will do this if they consider the person before them has a mental-health issue, and presents a risk to themselves or to those around them. They will call an ambulance, and the person will be admitted for a maximum of 72 hours for assessment, and, if needed, treatment. After that, they may be discharged, or kept in hospital under Sections 2 or 3 of the MHA.
Section 4: This is, in effect, the same as a Section 136, but the decision to admit is made by a Community Psychiatric Nurse and a doctor. It still allows 72 hours for assessment and treatment, by which time a decision to release or continue treatment under Sections 2 and 3 will be made.
Section 2: On being admitted to hospital, and having been assessed (often by a CPN or mental-health support worker) as a person “in crisis”, the person is subject to a compulsory section, and admitted for up to 28 days (if two doctors agree with the diagnosis and sign the relevant paperwork). There is no right to leave the place of treatment, but some treatment can be refused. At the end of the 28 days, the patient must be discharged unless a danger to themselves or others is apparent, in which case they can be further sectioned.
Section 3: This “section” lasts for up to six months. There is no right to refuse treatment, and no discharge, unless the medical professionals decide that the person presents no danger, either to themselves or to others.
ONE experience I had recently in which such help was needed was when I was confronted with someone in obvious need of professional help.
I first tried the telephoning the person’s GP. A recorded message offered a number of options relating to booking and cancelling appointments, getting a prescription, and the like. Finally, the message reached its climax with the “in case of emergency” option — “Ring 999 and ask for an ambulance.”
The situation before me was worsening: the person in need was deteriorating fast, and there was not even an out-of-hours service on offer.
I called the mental-health “crisis team” on their out-of-hours number; after another daunting list of options, I found myself talking to someone who suggested that I dial the NHS helpline (111).
Whenever I have used the 111 service in the past, the advice has been to call an ambulance, or take the person to the nearest Accident and Emergency department. This usually results in a long wait in an overstretched A&E unit, and, sometimes, dismissive treatment from the overworked staff for taking up their time.
I tried, however, and the person at the other end of the phone duly worked through their list of standard questions, culminating in: “Do you consider them to be at risk?”
“Yes, this is a mental-health issue,” I answered.
“Call 999 and ask for an ambulance,” was the response.
If I could have done so, I would already have taken the individual to the local Mental Health Unit. To call an ambulance and get them to go voluntarily was a long shot; persuading them to stay there for what could be a wait of several hours would have been an impossibility. So, I called the police. They duly arrived, and eventually the ill person was taken away by force on a Section 136, causing stress on all sides. (The patient was subsequently placed on a Section 2.)
MY QUESTION to clergy and others in the Church is: “How do we deal with the mentally ill among us?” Mental illness can afflict anyone, but if you break a leg, you will be offered sympathy and support. If you become depressed, it is likely that you will largely suffer alone.
Anyone in mental distress who exhibits slightly bizarre behaviour is likely not only to be avoided, but also possibly be laughed at, and further isolated. One person I have worked with was asked not to come to church again until “cured” of their depression, in case others “caught” it. Clearly, this sort of treatment merely compounds the sufferer’s distress.
For those with friends or family members who are mentally ill, the best advice is to treat them as you would treat someone with a physical injury: with care, kindness, and understanding.
A psychiatrist I once worked with used to say: “Your problem, when you’re here, is that you’re not the only one hearing voices from on high. I’m never quite sure whether I should let you leave.”
It seems that it was not just me who thought you needed to be mad to be a Christian in ministry.
The Revd Vic Van Den Bergh is resident minister of St Francis’s, Leyfields, in Lichfield diocese.