to think that Human Rights has a lot to answer for in this obesity related death.

[meyesmyeyes]

A lot people are saying, Well why were people getting him that food? Why weren't they saying No? and why weren't the 'Carers' refusing to give him his takeaways etc.... OK, he would have sworn at them, but he couldn't get out of bed, so wouldn't have been able to harm them for not getting him his junk food.

the human rights act allows him to do what he wants if carers do not comply they are in the wrong and are liable to lose their jobs psychiatrists have to prove they do not have the capacity -- very few people come under this sadly

So surely, this poor man was failed miserably by a system that was supposed to help him?

People should have been in a position where they were able to say 'no' to him. But because of a flawed human rights system, this man has lost his life.

hackmum The want in itself is not an illness. The excess eating arguably is. I agree that there seems to be one rule for anorexics and another for the obese, when indeed the problem comes down to eating, or lack thereof. However, if the UK implemented some sort of programme to keep an eye on the obese, we'd probably end up bankrupt before midnight.

elementofsurprise You made a similar point r.e anorexia and over-eating but your caps-lock shock at having never heard of different 'levels' of sectioning is rather astonishing. Perhaps I should have used the term 'circumstantial' but I wasn't contributing to the discussion to play semantics. There is no one-size-fits-all model of sectioning. There are many layers in the process, including but not limited to: consent to treatment, supervised community treatment, private premises (section 135 warrant) or indeed public place (Section 136 warrant), non-emergencies, (SOAD) service safeguards the rights of patients or even MHT. It's not simply a case of 'Section and be done with it.'

im sorry but i feel when the person has got to the stage when they can no longer get out of bed due to overeating (and not due to anything else) then someone should be able to intervene and refuse to buy the unhealthy shite they want when they can move they can go to the shop themselves and buy it

but why in gods name should any carer on minimum wage assist someone in a slow drawn out suicide because that is what it is really isn't it? suicide by food and we dont believe in assisted suicide in this country so does that mean carers should be prosecuted for helping him dig his grave with a knife and fork? (obviously no)

yes it sounds ignorant and simplistic but i dont feel carers should buy people ciggies and booze either well maybe the small odd bottle
my great nan was an alcoholic she couldnt get out so she asked people to buy her the odd bottle to help her sleep so the nurse would bring her one my aunt my nan the neighbor the lady down the road her carer the list was endless addicts will go to any lengths to get what they want so maybe a clear policy on what carers can get you and what they cant is in order?

Online shopping? It's not always the carers who buy the stuff!

Some people can have 24 hour chefs, personal trainers and dietitians yet they will still choose to eat themselves to death. It doesn't matter how 'high up the chain' you can, you still cannot force an individual to change.

In most cases, it's actually not the carers who buy the food. It's usually family, friends or online shopping.

According to the article I've just read in the Fail, the owner of his local takeaway had a key to his flat.

yes it sounds ignorant and simplistic but i dont feel carers should buy people ciggies and booze either Unless we totally ban cigarettes and alcohol for everyone in this country then people unable to go for themselves should ABSOLUTELY have the right, as we all do, to buy crap that isn't good for them. Just because someone has need of a carer does not mean they are a child and in need of paternalistic, controlling, rigid boundaries.

Support to abstain to reduce substances should be available but people with disabilities aren't in prison and shouldn't be treated as if they are. I'm quite horrified, actually.

Not the HRA....fortunately we are lucky to have the mental capacity act.one of the principles making an unwise decision doesn't mean u lack capacity. This man chose what we ate and rightly so. Who are the carers to override his decision ?

The Mental Health Act allows sectioning for assessment and treatment of psychiatric conditions alone whereby the condition is putting the life of the patient or others at risk. It does not allow for any other treatment (eg for a physical problem). So a person with schizophrenia may be sectioned for treatment of their delusions that for example, is causing them to wander onto train tracks. They could not be treated for a physical problem under this act. So a person with schizophrenia refusing to have their appendix removed would be assessed under the Mental Capacity Act. If they could demonstrate that they understood and believed all the medical information given and still did not want the operation it is entirely possible they would be found to have capacity.

In the case of anorexia extreme low weight contributes to a delusional outlook. Therefore a woman with severe anorexia could potentially be force fed as part of the treatment of delusions. Regaining of weight is a necessity in the treatment of the psychiatric condition.

By contrast a person with extreme obesity may have a psychiatric problem. However, the obesity is a consequence of this rather than the cause of a psychiatric condition. I do not think it could be demonstrated that forcing a diet on someone is treating a severe psychiatric condition. The only other recourse would be the Mental Capacity Act. As this man understood the consequences of eating as he was again treatment could not be forced on him.

While this may seem a matter of semantics to some it is very important we maintain the strict definitions of the Mental Health and the Mental Capacity Act for all of our protection.

MoonriseKingdom But what we are trying to get to the bottom of here is why by contrast extreme over-eating and therefore weight gain is considered differently than extreme anorexia.

In your argument:

In the case of anorexia extreme low weight contributes to a delusional outlook. Therefore a woman with severe anorexia could potentially be force fed as part of the treatment of delusions. Regaining of weight is a necessity in the treatment of the psychiatric condition. By contrast a person with extreme obesity may have a psychiatric problem. However, the obesity is a consequence of this rather than the cause of a psychiatric condition

Why is it that extreme obesity is a consequence rather than a cause whilst anorexia operates reversely? Why can't obesity be considered "a delusional outlook"? Surely it's delusional to think you can get away with eating all that food without any adverse effects to your health.

It seems one rule for some and another for others. If an anorexic individual can be "force fed as part of the treatment for delusions" why can't an obese person be put on a diet or regime to bring their weight into reasonable measures?

Moonrise It's medically recognised that your brain does not function at optimum capacity when undernourished and severely underweight. The reverse is not true for obesity.

Excellent post above Miscellaneous,

Yanbu. It was state sponsored suicide, what a waste of a life and a misuse of carers. If carers hadn't been sent then he'd have lost the weight, no one would have been assisting him and feeding him.

klayden - that is exactly what I am saying. Extreme low weight causes disordered thinking, there is no evidence the same is true of obesity.

been - when it comes down to it I suspect most people at the extremes of obesity know they are killing themselves, even if they are trapped by their situation.

Realistically, you could force someone to diet to a low weight but you would not actually be changing anything. Whereas with the person with anorexia you are improving their ability to think rationally.

Thank you Moonrise, I think I get it now.

I find this thread very, very odd.

Usually the people arguing against the HRA are people who want less state interference in our lives. It is strange to see it being derided for allegedly being the cause of not enough interference!

The HRA is a red herring.
This is a free society. Grown adults can make their own decisions.
The mental capacity act lays down what I feel should be a self evident starting point is that there is a presumption in law that a person has the capacity to make their own decisions unless it can be shown otherwise and that a capacitors person has every right to make an unwise decision.

The mental capacity act also lays down that being old or disabled should not lead to an assumption that you lack capacity.

I am only aware of 2 situations in which you can have your right to decide taken away in English law 1. The mental health act 2. The mental capacity act. Both have safeguards and rights of appeal. Both require that you suffer from a mental disorder.
Anorexia nerves a is a recognised mental disorder. Eating too much is not.

I get this a lot in my job. Why can't you stop my relative doing x, y, z thing that I don't agree with. Answer because they have a right to make an unwise (in your view) decision. If the tables were turned you would be outraged that a Dr or anyone else should be able to tell you what to do.

If you want your Liberty then it applies to people who you don't agree with too.

Alcohol addiction and drug addiction are also not considered 'mental disorders' within the meaning of the mental health act although many people would describe them as such.

So what you can be 'sectioned' for comes down to what the law covers not what people think intuitively is right (as people would disagree)

At the heart of it I think these people at the very extremes of obesity almost always have some deep trauma in the past. In many cases this may involve an abusive childhood. I really think we should do more to offer them psychiatric help to deal with these past traumas. Only then are they likely to be able to engage with attempts to lose and ultimately maintain weight loss. But I don't believe this can be forced on someone.

What is really needed is multidisciplinary teams including psychologists, dieticians and also bark attic surgeons - possibly some option of residential treatment. Of course this would be hugely expensive and would not be able to help everyone.

Bariatric not bark attic!

Yes, they should be offered help.
In fact in just the same way that anyone with a mental or physical illness should be offered help. The first port of call is to try to agree a treatment plan with the person. If you give people all the facts and options and support then most of the time treatment will be by consent.
The difficult times are where it cannot be agreed. When does the state have a right then to interfere in a person's choices? In the UK only in very limited circumstances of mental disorder with lots of safeguards and checks built in. It is a high bar and it should stay high unless we want a nanny state mandating all our life choices.

my reasoning as to why i feel carers should not buy ciggies booze or large quantities of bad food is this how would you feel as a carer being paid to kill someone with food or alcohol etc if your going to be an addict maintain your own addiction dont pay someone else to do it

i do remember a carer refusing to buy an alcoholic booze the family tried to get her sacked but he was a violent alcoholic when he drank he lashed out and she would get hurt the family would not deal with him and expected carers to do it instead he was a vile person when he was drinking utterly vile nmw is not enough for what they would have to deal with (the boss removed the person from the books btw companies can refuse to "care" for people who are aggressive) i think people take carers for granted when someone they care for dies it can be devastating for them when things go wrong they feel bad

What is really needed is multidisciplinary teams including psychologists, dieticians and also bariatric surgeons - possibly some option of residential treatment.

Although this supposes the individual concerned wants this intervention and help. It's very likely the man in the news today was offered multiple opportunities for help and refused them. If it is then considered that at some point somewhere in the process of being helped he crosses a line and as he is slowly killing himself he needs to be compelled to accept help for his own good - for a start, his response to the intervention is likely to be a poor one. The desire to change has not come from him, there is no choice on his part to make the huge shifts in himself and face the very uncomfortable process of unpacking himself mentally and being physically 'sorted out', and he is likely to be angry, resistant and feel assaulted by this intervention and the people offering it. And there also arise secondary problems such as does that mean someone with cancer who decides against active treatment should also be compelled to accept help for their own good since their choice is likely to kill them?

I agree with you rumble that many people in this situation would not want to make the massive life changes this would entail. However, from the experience of family members, good psychological help is like gold dust on the NHS, even where people really want to make changes. There seems to be no incentive for government (over many many decades) to invest in good mental health care.