{"id":43609,"date":"2018-12-04T12:39:12","date_gmt":"2018-12-04T11:39:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43609"},"modified":"2018-12-10T15:37:36","modified_gmt":"2018-12-10T14:37:36","slug":"sarah-markham-dealing-with-iatrogenic-harm-in-mental-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/12\/04\/sarah-markham-dealing-with-iatrogenic-harm-in-mental-health\/","title":{"rendered":"Sarah Markham: Dealing with iatrogenic harm in mental health"},"content":{"rendered":"<p><span style=\"font-weight: 400\">When the prime minister Theresa May commissioned the current independent review of the Mental Health Act (MHA), she committed to dealing with \u201cthe burning injustice of mental illness.\u201d One aspect of this injustice is the iatrogenic harm which patients may experience during detention under the MHA.<\/span><\/p>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Iatrogenesis\"><span style=\"font-weight: 400\">Iatrogenic harm<\/span><\/a><span style=\"font-weight: 400\"> refers to the harm caused inadvertently by the process of treatment. This may manifest as uncertainty and anxiety caused to the patient by a failure of staff to provide them with important information regarding diagnosis, treatment, or discharge planning; adverse reactions to drugs; negligence; or unnecessary treatment resulting from a psychiatrist\u2019s decision.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The media often report on cases of patients who have raised concerns about their treatment at the hands of mental healthcare services. The <\/span><a href=\"blank\"><span style=\"font-weight: 400\">interim report<\/span><\/a><span style=\"font-weight: 400\"> of the MHA review acknowledges that these concerns go beyond the harms mentioned above, and states that there are \u201cserious issues\u201d with the use of the Mental Health Act. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Awareness of the need to protect the human rights and social rights of those with mental illness is seemingly ever present in the <\/span><a href=\"https:\/\/www.independent.co.uk\/voices\/mental-health-act-detention-review-psychiatric-hospital-abuse-trauma-a8332301.html\"><span style=\"font-weight: 400\">news<\/span><\/a><span style=\"font-weight: 400\">. Such concern is not limited to the MHA, but also the Mental Capacity Act (MCA). In July 2018, the government published a <\/span><a href=\"https:\/\/www.scie.org.uk\/mca\/dols\/practice\/lps\"><span style=\"font-weight: 400\">Mental Capacity (Amendment) Bill<\/span><\/a><span style=\"font-weight: 400\">, which if passed into law will reform the Deprivation of Liberty Safeguards (DoLS), and replace them with a scheme known as the Liberty Protection Safeguards. In its current form the bill fails to include reforms around supported decision-making and best interests, as proposed by the <\/span><a href=\"https:\/\/www.lawcom.gov.uk\/\"><span style=\"font-weight: 400\">Law Commission<\/span><\/a><span style=\"font-weight: 400\">. These omissions have proved <\/span><a href=\"http:\/\/www.carehomeprofessional.com\/exclusive-scie-chair-paul-burstow-voices-unease-mental-capacity-act-reform\/\"><span style=\"font-weight: 400\">controversial<\/span><\/a><span style=\"font-weight: 400\">, with practitioners anxious about what this could mean for them in practice. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The independent review\u2019s service user and carer group, of which I am a member, is raising awareness of the very real need for an effective means of dealing with iatrogenic harm. We need a way to manage perceived harms that helps patients have their experiences validated, and helps services to learn from these experiences, so that clinical practice and service provision can be improved.<\/span><\/p>\n<p><span style=\"font-weight: 400\"> A possible means that I have suggested is a truth and reconciliation process of <\/span><a href=\"https:\/\/restorativejustice.org.uk\/what-restorative-justice\"><span style=\"font-weight: 400\">restorative justice<\/span><\/a><span style=\"font-weight: 400\">, known as restorative practice. <\/span><a href=\"https:\/\/restorativejustice.org.uk\/resources\/rjc-principles-restorative-practice\"><span style=\"font-weight: 400\">Restorative practice<\/span><\/a><span style=\"font-weight: 400\"> brings those harmed by conflict and those responsible for the harm into communication, enabling everyone affected by a particular incident to play a part in repairing the harm and finding a positive way forward. <\/span><\/p>\n<p><span style=\"font-weight: 400\">There are already positive <\/span><a href=\"https:\/\/restorativejustice.org.uk\/resources\/evidence-supporting-use-restorative-justice\"><span style=\"font-weight: 400\">evidence-based<\/span><\/a><span style=\"font-weight: 400\"> examples of the value of restorative practice in meeting the needs of victims and reducing reoffending. Restorative practice isn\u2019t limited to the criminal justice system and can be used anywhere, including within healthcare systems. The focus of restorative practice within a mental healthcare setting would be to facilitate a full exchange of testimonies and experiences in a manner which ensures that the recipient of harm is able to express all their concerns and opinions to the healthcare provider in order for them to learn from the process, and implement necessary changes in their clinical practice or the service provision.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Integrated working between a restorative justice practitioner and a regulator, such as the <\/span><a href=\"https:\/\/www.cqc.org.uk\/\"><span style=\"font-weight: 400\">Care Quality Commission<\/span><\/a><span style=\"font-weight: 400\"> (CQC) would allow the implementation of learning gained from the restorative practice to be tracked and monitored.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In their 2017 <\/span><a href=\"https:\/\/www.emeraldinsight.com\/doi\/full\/10.1108\/MHRJ-01-2017-0011\"><span style=\"font-weight: 400\">paper<\/span><\/a><span style=\"font-weight: 400\"> \u201cExploring the case for truth and reconciliation in mental health services,\u201d Spandler and Mckeown suggest that healing and restitution may not be achieved until the full extent of service user grievances has been acknowledged. Hopefully the current Independent Review of the MHA, is a start.<\/span><\/p>\n<p><span style=\"font-weight: 400\"><em><strong>Sarah Markham<\/strong> is an academic mathematician and patient representative currently pursuing a second PhD in theoretical computer science. She\u00a0is a\u00a0member of the BMJ Patient Advisory Panel.<\/em><\/span><\/p>\n<p><span style=\"font-weight: 400\">Twitter: <a href=\"https:\/\/twitter.com\/drsmarkham?lang=en\">@DrSMarkham<\/a><\/span><\/p>\n<p><strong>Competing interests<\/strong>: None declared<\/p>\n","protected":false},"excerpt":{"rendered":"<p>When the prime minister Theresa May commissioned the current independent review of the Mental Health Act (MHA), she committed to dealing with \u201cthe burning injustice of mental illness.\u201d One aspect [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/12\/04\/sarah-markham-dealing-with-iatrogenic-harm-in-mental-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42636,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5749],"tags":[],"class_list":["post-43609","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-patient-perspectives"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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