SKELLERN LECTURE, Dr Russell Ashmore -  The Fall of Icarus: the Trials and Tribulations of the ‘Informal Patient’ in the 21st Century

Introduced by Mick Mckeown

​Lecture Synopsis: The recent Independent Review of the Mental Health Act (DH, 2018) has suggested that there has been a “…steady decline of informality in mental health settings despite the provisions of section 131, which explicitly protects the status of informal patients” (DH, 2018).  Whilst the review recognised there has been little commentary on this, it seems to dismiss its significance with a figurative shrugging of the shoulders with the statement, “…it is inescapable now that we live in a society where trust in professionalism is a steadily decreasing commodity, and we prefer regulation and the law as safeguards and protections” (DH, 2018).

 

However, this “decline” may have been overstated.  Recent statistics from England and Wales suggest that individuals admitted to hospital informally, remain informal for the duration of their stay or become informal prior to discharge, represent a significant group (approximately 48 per cent).  A further concern is whether the laws, safeguards and protections referred to in the review actually mean that the legal rights of informal patients are “no more than a legal fiction” (Houlihan, 2000). This lecture will draw on ongoing research to argue that (at least) some mental health trusts and health boards in England and Wales are producing policies stating that informal patients should be “managed as if detained”, thus creating a de facto two-tier system of detention. Others state that practitioners should consider anyone who does not meet the criteria for detention for discharge if they do not comply with treatment. In relation to leave, organisations appear to be operating de facto section 17 leave policies for informal patients enforced through ‘leave prescriptions’ or ‘contracts of leave’. A final concern is that less than half of mental health healthcare providers in England and Wales give informal patients written information about their legal rights on admission.  In this lecture, using a socio-legal historical approach, I will explore the history, current position and potential future of informal inpatient care.  Drawing on historical documents, national and internal legislation, statistics pertaining to the use of the Mental Health Act, personal narratives, research and the human rights agenda to offer a personal and hopefully coherent argument that informal inpatient care is as important now as it was when first introduced in 1959.  In addition, that it must be preserved at all cost to prevent a return to the worst excesses of admission to hospital under the 1890 Lunacy Act. Finally, I will draw on over 25 years of experience in nurse education to offer a view on how we equip mental health nurses of the future to take lessons learnt from history back into practice.

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JPMHN LIFETIME ACHIEVEMENT AWARD, Professor Eimear Muir-Cochrane

Introduced by Patrick Callaghan

Professor Eimear Muir-Cochrane - Chair of Nursing (Mental Health) at Flinders Uni University in Adelaide, South Australia and a Visiting Professor at City, London University, UK. Eimear was elected as President to the Australian College of Mental Health Nursing in 2017 for a three year term. She undertook a BSc Hons in Nursing at the then Chelsea College, University of London, commencing in 1979 and had the privilege of being taught by luminaries such as Professor Jenny-Wilson-Barnett. Her Honours thesis was supervised by the late Dr Julia Brooking and was published in the first text in the UK on psychiatric nursing research, edited by Dr Brooking in 1986. Eimear worked at St Georges Hospital, London as a Staff Nurse in medicine and then undertook her mental health nurse training at the Maudsley and Bethlem Hospitals in London in the early 1980’s.

Eimear was a student on the interview panel of Ben Thomas at the Maudsley when he was interviewed for a Nurse Educator position!   Eimear worked at the Bethlem post her training until 1987 and then travelled in Asia and Australia where she settled, married and had a daughter, Caitlin who is now an intensive care nurse. Eimear is a career academic teaching and researching in mental health nursing for the last three decades.  Eimear’s first publication was in the Nursing Mirror in 1984 on the nurse as a change agent and has since published multiple books, chapters, monographs and papers in mental health with funded research on seclusion, aggression and violence, physical restraint, youth homelessness, absconding chemical restraint and the use of community treatment orders. Eimear also acts a mentor to nurses and mental health nurses and attempts to improve care practices through applied research in mental health nursing. It is de rigeur in academia to cite metrics to show how significant your research is, how many people reference your work and to state how much money you have won in research grant funding. However, Eimear’s passion is in making a difference to service users experiences of psychiatric hospitalisation, to reduce the use of restrictive practices used in hospitals and to contribute to the practice and education of mental health and mental health nursing.

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