Vulnerable to coercion?

I think most people have heard the term Vulnerable adult and most will have some idea about what that means but I wonder how many people would say they were a vulnerable adult?

It’s taken me a long while to accept and really I’m not all that happy with the definition, I don’t feel I’m vulnerable, I certainly don’t think most people see me as vulnerable… and yet if I take a more objective view of my choices over the years I wonder how much I have been influenced unduly by my peers and my family. But does that make me vulnerable to coercion or have been coerced? And can I tell?

Most would say no, my family would certainly say I was far too stubborn but I am still vulnerable and I would say on reflection far too amenable to the will of others particularly when it comes to my health. Put me in a room with authority and I cave, like you would not believe and sadly I feel this is very common. How often have I heard stories from people about being forced to, having no choice …

It is a sad fact that coercion is used all too often by people to get what they want regardless of what the other person wants. In business and in person lives it is the method of choice for many so what about the medical profession? Do they have too much power? Or do they ignorant of the effect what they are doing has on the vulnerable?

Well there are certainly some who would abuse their own granny, so to speak but these are not the people I’m talking about, it’s the do gooders, the ones who want to help, the ones who sadly feel, we, the vulnerable don’t know what’s good for us because we don’t have all the facts. These are the people who may well pigeon hole us and use blanket rules for everyone in their care or with a certain diagnosis. These are the people who with a little thought and a bit of time would be great nurses, doctors, social care workers and yet sadly fall very far from the mark because they haven’t spent the time to listen, think and understand.

To the abusers I hope you get caught and banged to rights, to the others please take a little more time to consider a few things. For instance the current adverts on TV with the person watching what’s going on their own life through a window with the tag line, ‘If you could see yourself would you see abuse?’ What about looking at your own practises with patients and re-evaluate.

Think about how many times you’ve told a patient here’s you meds, now take them, and insisted that they do.

Look at how you would react when having voluntarily submitted to being in ward try to leave and find the door locked and no instructions on how to get out. What would you think… would you search for someone to ask?

• 84% of mental health wards were found to be locked. Care quality Commissions report into the mental health act (CQC)
•    of voluntary patients on mental health wards 23% are not told of their right to leave the ward …

 

Where relevant, CQC raises concerns at the lack of signage on locked doors that would explain how a voluntary patient can leave. In 2011/12, this was a problem in 88 of 481 visits where the issue was relevant – nearly one in five visits. As in the following example, this can be an indication that voluntary patients are not able to leave the ward.

 

#the explain cited was of asking a ward manager what they would do if an informal patient asked to leave the ward. They said -that she would use a holding power to stop patients leaving the ward.

Which is strictly against the NICE guidelines

and what about this

If having explained that a medication gives you lots of side effects and your doctor asks is it really a big deal?

Would you refuse? and having done so if you were told, ‘well we can’t help you then’. What would you think? What would you do?

Do you think this is coercion?

I certainly do and sadly for many years it worked with me. I also know a great number of people who feel very much the same. In this article in the guardian the writer complains bitterly about the amount of coercion and the reliance of some professionals on it’s use.

But what worries me more is that there is no way of knowing how much coercion goes on, nor it seems is there anyone looking to it or trying to change it. As the writer says it seems a necessary evil and maybe so but there comes a point were enough is enough and I feel that this country is way past that already. There are far too many people who think they know best and are not even listening to the interests and wishes of the patients they are aiming to helping.

This report only covers mental health units and does not even touch upon the outpatient services, however for these services the CQC shows that

Consent to treatment discussions (before the first administration of medication) improved in 2011/12 – 55% of records showed these, up from 46% in 2010/11. But this means that in almost half of cases there was no evidence that doctors had talked to patients about whether they consented to proposed treatment

There was better evidence of consent discussions after the first use of medication (72% of records). But still this means consent was not discussed in more than a quarter of cases.

Which is abysmal and although part of me feels that this can’t be right. There must be paperwork errors and there were discussions for some of these patients. It doesn’t seem credible to me that that is what has happened. In all likelihood people have just taken the medication that they were prescribed without ever knowing what it was for or why. And more worryingly the CQC report states

Having checked over 6,000 relevant records over the last two years, CQC has found one in 10 records where patients who have been receiving medication for three months or more while detained are prescribed medication above the legally authorised care plan.

I’m horrified as I’m sure many people are but this has got to stop. And it’s not just the medical profession, the entire country looks at what’s going on and feels that they know better, the police the social workers, the family and friends and the only people who are really suffering here are the patients.

I still don’t quite get why the world doesn’t understand why people with mental health problems don’t want to go the doctors or tell anyone when such disrespect and coercion is rife. Seriously if all you thought was that people were going to strip you of your right to choose would you do it? And yet sadly there is no other way right now but it might offer some explanation as to why so many people wait such an inordinately long time to seek help.