In the UK we do not inflict physical punishment on convicted criminals yet it is considered acceptable to inject potent chemicals, by force, into someone’s body purportedly in the interests of helping them or, depending on who the supporters of CTOs are addressing, to avoid potential future crimes.
This is despite reports by many of the people who are being drugged that they feel degraded and brutalised by what is happening to them, rather than cared for, and the clear evidence that the risk of being harmed by someone with mental health problems is miniscule.
We know that certain groups within the population are statistically more likely to commit crime but we would never contemplate removing them from society in anticipation of a possible offence. CTOs destroy lives and serve to conceal the lack of proper and meaningful healthcare for people in mental distress. We want to see an immediate end to them.
Although CTOs were already in use in a number of countries, they were introduced in the UK in 2008 following a vigorous campaign by Jayne Zito whose husband, Jonathan, was killed in 1992 by Christopher Clunis, a man diagnosed with paranoid schizophrenia. In 1994, Jayne Zito set up the Zito Trust, strangely referred to as a mental health “charity”.
I recall attending a lecture in the Institute of Psychiatry (IoP) at which she was speaking. She told us that Care in the Community had been a failure. We certainly knew that it was underfunded and was, by and large, a cost cutting exercise, however many people in the audience at the IoP were being cared for in the community and one by one we told her that we were living fulfilled lives within the community and there was absolutely no need for us to be locked up or forced to take devastating drugs.
She seemed not to hear anything that contradicted her message and insisted that society should have the power to drug us against our wills.
As it stood, society already had that power in the form of inpatient sectioning, but she wanted more, that we should not be allowed onto the streets un-medicated. Jayne Zito never argued for an increase in funding for mental health care. She was eventually awarded an OBE.
The introduction of CTOs eliminated the need for the provision of more costly community care or long-term hospital bed occupancy but then gained popular support by being presented as a risk issue through the work of a campaign that I believe was set up in a spirit of revenge.
The Zito Trust greatly exaggerated acts of violence perpetrated by people with mental health problems. Like the rest of the population, people with mental health problems can be capable of violence and this could be regardless of any mental health problem they have. Not all acts of violence by someone with a mental health problem can be attributed to their mental health condition. But at that time there were a few highly publicised killings by people with mental health problems and these were sensationalised by the tabloid press so that, eventually, all people with mental health problems were seen as guilty by association.
The mental health survivor community campaigned against CTOs. I recall attending a march to the offices of SANE were we met with Marjorie Wallace, CEO of SANE, a woman who felt that the first and most important way of treating mental distress was by imposing strict control and discipline on our lives. At the time, SANE stood for Schizophrenia A National Emergency.
Ms Wallace, CBE, was a tabloid journalist and presented mental health issues in the same sensationalist way that the tabloid headlines did. There is indeed a link between mental health and violence and that link is that people with mental health problems are far more likely to be victims of violence than the wider population.
The whole CTO debate was carried out by the tabloid press in a mood of hysteria, headed by quietly-spoken, middle-class, white women, fighting what was presented as a threat posed by big, black, working-class men living freely in the community and not fully under control.
The introduction of CTOs was based on cost-cutting; on asserting the authority of the psychiatric profession; on promoting the pharmaceutical industry as holding the answer to mental distress; on the drive to uphold mainstream ways of thinking of, and experiencing, the world; and on racism and classism.
A disproportionately high number of black men are placed on CTOs. At the time of their introduction, there was little evidence from elsewhere in the world that CTOs reduced the need for hospital readmission or reduced relapse and risk. Recent research confirms that CTOs simply do not reduce hospital readmission or relapse.
We know of one certain case of suicide directly related to someone being on a CTO. Jean Cozens, a founding member of the Mental Health Resistance Network, hung herself in her home on Christmas Day 2012 because her life on a CTO was unbearable. Jean had never harmed anyone. She was told repeatedly that she had no insight into her condition and, after numerous attempts, simply could not get the CTO lifted. Once on a CTO, it is notoriously difficult to be taken off it.
So we are to believe that the drugs acted to help restore her insight, yet years after being on the drugs, she still didn’t have enough insight into her condition to warrant the CTO being lifted at her request. So how long does it take for CTO drugs to restore insight? Or perhaps they never do. (Jean speaks for herself on the video she made two weeks before her death.)
Acute inpatient psychiatric wards are full of people who were fully compliant with their medication regime at the time of their admission. The simple fact is that, for many people, psychiatric drugs just don’t work. This may be because many, if not all, mental health problems are not physical in origin. But the pharmaceutical industry is very powerful and they fund much of what is presented to us as psychiatric care.
The drugs most commonly used in CTOs are antipsychotics. The side affects of these drugs are legion. Tardive dyskinesia, a movement disorder similar to Parkinsons, is often referred to but is more common with the older types of antipsychotic.
The more common side-effects of the newer drugs can be even more devastating. Obesity is very common and it is not unknown for people forced to take anti psychotics to then go on to have gastric bands and bypass surgery. Other side-effects are impotence, depression, a devastating loss of energy, loss of ability to think, loss of ability to experience the full range of emotions, diabetes, nausea… the list goes on and on. It is usually because of these side effects that people stop taking medication and not because of any lack of insight into their condition.
(I have been unable to move from a lying position on my sofa for weeks at a time when taking antipsychotics. This is a particular problem for me as I am diagnosed with schizoaffective disorder, a mixture of psychosis and mood disorder, so while the antipsychotics are aimed at improving the psychosis, in other words dampening down thoughts, the mood disorder is made much worse as I am unable to get on with any kind of life. They have left me feeling suicidal at times.)
One good thing that some people on CTOs experience is that where they would normally be given no care or attention, even when in desperate need, when on a CTO they are assured of receiving some kind of attention from their care team on a regular basis. That people have to submit to this chemical assault on their bodies to be given even the most basic emotional support is a measure of how dire the provision of psychiatric care is.
One last point, in a slightly different vein: in order to obtain the welfare benefits that people with mental distress need to survive, many of us are taking drugs we do not want to take, that are harming us physically, mentally, emotionally, and even making it impossible for us to have children and a social life.
Were it not for our need for welfare benefits, many of us living with mental distress would be very happy to walk away from the psychiatric system altogether and seek appropriate care elsewhere.
Denise McKenna, Mental Health Resistance Network