Parents 'should go abroad to avoid family courts'

[ScrambledSmegs]

www.bbc.co.uk/news/education-25641247

Yep, that's the BBC. Currently trending as one of the most read pages on the site.

I know they've tried to make this balanced by referencing CAFCASS, but it doesn't feel like much balance when the headline is something as scaremongering as that. It feels quite irresponsible.

Yes, I know that they're trying to drum up interest in their Panorama program, but I think they'd have been better off not publicising JHMP and his ramblings. Unfortunately, he's dangerous. Ridiculous and foolish, but dangerous.

Funny, the comment talking about MH patients not having a say in their treatment implying that that is Always A Bad Thing.

Last time my mother was in the grip of a psychotic episode, the doctors refused to speak to me about her treatment and asked my mother who was psychotic what drugs she wanted them to treat her with. Funnily enough, she wasn't best placed to make that decision. She couldn't make that decision. But still, they pushed her to make it - even when she asked doctors to speak to me and became upset.

It resulted in my mother, when she was better, giving me Power of Attorney, in an attempt to avoid a repeat.

Stats can be used to 'prove' anything. Sometimes, when you're actually dealing with the situation first hand, things that appear to be a good idea, aren't.

'Strapped down'?? In approx 15 episodes of severe mental health crisis including psychosis, delusions, hallucinations and mania lasting weeks and months at a time, (in fact, one might term her stark raving mad if you had absolutely zero empathy or sense) my mother has never been strapped down.

As for anyone arguing about the state of mental health provision in the UK or anywhere else. If you don't have experience in this area of some sort, you don't know anything in my (very black and white, granted opinion). It is very different from what the media and/or government would have you believe. Stats will spin things and people - without experience - will comment without the benefit of having 'been there, done that'.

Therefore if you decide not even to allude to your experience/credentials in this area and 'hide' behind the veil of 'confidentiality' (whilst posting anonymously on an Internet forum) then I guess you need to understand that people (me for 1) will doubt you have any experience at all. Still fine for you to have an opinion, of course, but it's not one I'll consider too carefully.

Redding:

It says when the FIRST application was made in the precursor to the hearing transcript. It was 4:16pm on 23 Aug 2012, also the same night as the hearing only giving him hours not days or weeks to go over all the info provided.

More than enough time for an experienced judge.

"The mother in the Pakistan case fled to the UK because she was effectively being held prisoner." In this sentence the only association you give for her being imprisoned is Pakistan. If you were to actually give context it might make sense, otherwise it reads as Pakistan holding her prisoner.

No, it doesn't. You claim to have read the original report. If you had, you couldn't possibly derive that interpretation from what I said. Unless, of course, you wanted to misrepresent it.

In RE:C it was not in the best interest to save the man's life? Also you don't mention the legal test devised from this exercise. Where is it stated that the proper legal test were applied in the hearing?

You do know, don't you, that the Re C case you cited is about treating a child for anorexia? I suspect what you mean is Re C (Adult: Refusal of Treatment) [1994] 1 WLR 290 - which doesn't help your argument at all because the man in question was found to have the requisite mental capacity to form an informed decision about refusing treatment. It is trite law that anyone with capacity is entitled to refuse treatment even if it would save their lives.

@nenny

So you are saying the judge had more than enough time to run all legal test (which are never mentioned in the hearing), examine every last bit of info, and cite all relevant case law in the span of a couple hours?

From the uk gov website

Capacity should not be confused with a healthcare professional’s assessment of the reasonableness of the person’s decision. Under the Mental Capacity Act and the common law, a person is not to be treated as unable to make a decision merely because they make an unwise decision. A person is entitled to make a decision which may be perceived by others to be unwise or irrational.

The Mental Capacity Act also requires that all practical and appropriate steps are taken to enable a person to make the decision themselves. These steps include the following:

Providing relevant information. For example, if there is a choice, has information been given on the alternatives?
• Communicating in an appropriate way. For example, could the information be explained or presented in a way that is easier for the person to understand?
• Making the person feel at ease. For example, are there particular times of the day when a person’s understanding is better?
• Supporting the person. For example, can anyone else help or support the person to understand information and to make a choice?

You claim that they did take AP's thoughts and wishes of the procedure into account. May I ask how when they were able to do so without informing the person of said procedure?

The Pakistani woman must not have been too bothered by her detention as she did not file any charges.

An assessment of a person’s capacity must be based on their ability to make a specific decision at the time it needs to be made, and not their ability to make decisions in general. A person is unable to make a decision if they cannot do one or more of the following things:

• understand the information given to them that is relevant to the decision
• retain that information long enough to be able to make the decision
• use or weigh up the information as part of the decision-making process
• communicate their decision – this could be by talking or using sign language and includes simple muscle movements such as blinking an eye or squeezing a hand.

Yet none of this much less whether any assessment at the time of the hearing was carried out.

Also try reading the St.George's case in which the NHS trust lied to the court about the woman's capacity. The guidelines specifically created from that case were ignored in this one.

If you have read any of the legal blogs that discuss the c-sect hearing you would know how sloppy the hearing was.

@nenny

You were looking at RE:C(minor) about a girl with anorexia, try reading RE:C(adult) about an adult male with gangrene.

@nenny

Though it is very disturbing that you don't know the difference between minors and adults, or men and women.

@nenny

jme.bmj.com/content/30/5/427.full#xref-ref-2-1

THE RE C TEST
Mr C was a patient in a psychiatric secure hospital who had chronic paranoid schizophrenia with grandiose delusions of being a world famous doctor. He developed gangrene in his right foot. He refused to consent to amputation of his right leg below the knee. He sought an injunction to restrain his doctors from amputating the leg without his express consent. In granting the injunction, Justice Thorpe held that C sufficiently understood the nature, purpose, and effects of the proposed amputation, and that he retained capacity to consent to, or refuse, medical treatment. Justice Thorpe laid out the criteria for capacity, which were subsequently cited in other cases, and have become generally known as “the Re C test”.4

There you go a link, as you are incapable of finding on your own.

Redding:

So you are saying the judge had more than enough time to run all legal test (which are never mentioned in the hearing), examine every last bit of info, and cite all relevant case law in the span of a couple hours?

Not necessarily a couple of hours. Potentially over 7 hours. He didn't have to 'cite' all case law: as an experienced judge in that court most would have been familiar to him, and the relevant cases would have been presented by counsel.

You claim that they did take AP's thoughts and wishes of the procedure into account. May I ask how when they were able to do so without informing the person of said procedure?

I expressly preferred to her previously expressed wishes. Is it really inconceivable that at some point during her pregnancy at least one medical professional may have discussed her wishes about the birth with her and recorded her answers in her medical notes? I don't know whether they did, because unlike you I am not claiming to have in-depth knowledge of everything that happened before, during and after the court case, but that is one answer to your question.

The Pakistani woman must not have been too bothered by her detention as she did not file any charges.

Evidence for that contention? And how many people do you know who are "not too bothered" by being detained would go to a lot of trouble to escape and leave the country?

Yet none of this much less whether any assessment at the time of the hearing was carried out.

Evidence?

The guidelines specifically created from that case were ignored in this one.

Evidence?

You were looking at RE:C(minor) about a girl with anorexia, try reading RE:C(adult) about an adult male with gangrene.
Though it is very disturbing that you don't know the difference between minors and adults, or men and women.

This is totally bizarre. It is you who cited Re C (A minor): see your post at 18.30 on 21st February. It was I who pointed out your error and cited the correct authority in my post at 11.10 today. So perhaps you should direct your slightly sad attempt at sarcasm at yourself.

Interesting that you have now started misrepresenting your own posts as well as other people's.

Any chance that you will direct your mind at some point to that question about what motive you think all the social workers, and medical and legal professionals involved had for this conspiracy you seem to be contending for?

@nenny

I do apologize I did cite the wrong case in by posting minor instead of adult.

Evidence for that contention? And how many people do you know who are "not too bothered" by being detained would go to a lot of trouble to escape and leave the country?

Same evidence you used to say that AP wasn't upset by her own detention since she hasn't filed charges against it.

Is it really inconceivable that at some point during her pregnancy at least one medical professional may have discussed her wishes about the birth with her and recorded her answers in her medical notes?

If they had done so why not cite this in the hearing? It would have cleared any confusion. Always assuming procedure has been followed without any evidence to back it up is unwise.

St.George's case

www.globalhealthrights.org/wp-content/uploads/2013/03/EWCA-1998-Regina-on-application-of-S-v.-Louize-Collins-and-Ors..pdf

If there is a problem the capacity of the patient to accept or refuse treatment must be assessed as a priority. The issues should be addressed if possible by a consultant psychiatrist approved under section 12(2) of the Act, who should also assess whether the patient is incapable of managing her property and affairs by reason of mental disorder as defined in the Act. If so the patient will not be able to instruct a solicitor and will require a guardian ad litem. Potential medical witnesses should be made aware of the criteria laid down in Re C and Re MB and the Department of Health guidelines provided to the hospital.

If these legal test were carried out why are they not noted?

In problematic cases and if there is a real doubt as to capacity the issue should be resolved by the court and the hospital should seek legal advice as soon as possible. It will be desirable in such cases for a declaration to be sought from the High Court, as soon as possible so as to avoid the necessity for an emergency hearing. Oral evidence will generally be preferable to affidavit evidence and should reduce delay and the possibility of further adjournments.

Obviously this didn't happen as it was delayed until it became an urgent emergency.

nennypops Thu 20-Feb-14 08:04:41

If you think the authorities didn't comply with the law on sectioning people and deprivation of liberty, do produce your evidence, and tell us why Ms Pacchieri's lawyers don't seem to have done anything about it.

Tell me why the Pakistani women and her lawyers haven't filed a claim against her detention in Pakistan.

Redding:

Same evidence you used to say that AP wasn't upset by her own detention since she hasn't filed charges against it.

Except, yet again, I didn't say that.

If they had done so why not cite this in the hearing? It would have cleared any confusion. Always assuming procedure has been followed without any evidence to back it up is unwise.

For the umpteenth time, how do you know it wasn't? Quite rightly, the statements and documents filed with the court have not been publicised.

If these legal test were carried out why are they not noted?

How do you know they weren't?

Obviously this didn't happen as it was delayed until it became an urgent emergency.

The important phrase quoted by you is "If there is a real doubt as to capacity"; the only person who suggests there was was AP herself. It is unfortunately the case that people with her diagnosis do tend to think they are well when in fact they are extremely ill. In a situation where a woman with capacity for whom a natural birth might be dangerous for her and the baby nevertheless wants to try for a natural birth, both the medics and parents will normally keep trying right up until the point when it is clear that it really is too dangerous. In AP's case, it does rather look as if that was the thinking of her obstetricians - there is an account of a discussion with her doctor who had clearly given thought as to whether a natural birth might be a possibility, and had ultimately discounted it because her mental state was such that she might mask the symptoms of uterine abruption or make it extremely difficult for them to monitor for this. It may be that they left it late in the hope that her mental condition would recover sufficiently for them at least to try to accommodate her previously expressed wishes. That's possibly unfortunate, but not evidence of the dastardly plot for which you still haven't produced any motive.

@nenny

The guidelines from St.George's case state that if a pregnant woman has lost capacity, they are required to seek a court order ASAP in order for the court validate the concerns. This did not happen or perhaps 10 weeks is the amount of time it takes to get an emergency hearing?

@nenny

So NHS hopes for the best and doesn't bother to prepare for the worst. Believe it or not you can get a court ordered c-sect in advance and not have to use it unless it is deemed necessary. There is no reason to delay the court order further endangering the patient from lack of action.

@nenny

Thinking that the patient will magically get well without meds is ignorant at best, down right dangerous at worst.

In problematic cases and if there is a real doubt as to capacity the issue should be resolved by the court and the hospital should seek legal advice as soon as possible. It will be desirable in such cases for a declaration to be sought from the High Court, as soon as possible so as to avoid the necessity for an emergency hearing. Oral evidence will generally be preferable to affidavit evidence and should reduce delay and the possibility of further adjournments.

This guideline does not state: "Ignore in hopes that the patient regains capacity."

Interesting comments underneath this article including the fact that it appears AP declined to go to the Italian embassy; her lawyers then did so but the Italian embassy failed to get back to her. Which accords with reports at the time that the Italian government just wasn't interested.

Comments include this one:

"As a mother with bipolar disorder who has suffered from paranoid delusions I have been horrified by the coverage of this case. To go through labour while paranoid and psychotic, unable to understand either why you are in pain or that the people around you are trying to help, would quite literally be one of the most dreadful experiences that I can imagine, and if this woman was that ill a caesarian would absolutely be the only humane way to proceed.

There seems to be a general refusal, particularly in the liberal press and blogosphere, to accept that really serious mental illness and a consequent lack of capacity exists any more, a belief that everything can be done by consent and that anything else is merely prejudice against the mentally unwell. It’s an understandable backlash against the time when we were routinely denied our rights but it does those of us who occasionally really cannot make decisions for ourselves no favours. In this case it seems from the limited information supplied that the court was definitely the appropriate places for the issue to be raised and a decision to be made in light of medical advice."

Redding:

The guidelines from St.George's case state that if a pregnant woman has lost capacity, they are required to seek a court order ASAP in order for the court validate the concerns. This did not happen or perhaps 10 weeks is the amount of time it takes to get an emergency hearing?

No, they don't. As you have in fact acknowledged in your later post, they state that this should be done if there is a real doubt as to capacity.

Thinking that the patient will magically get well without meds is ignorant at best, down right dangerous at worst.
This guideline does not state: "Ignore in hopes that the patient regains capacity."

But why do you assume that AP was not given medication? It isn't necessarily contra-indicated in pregnancy, as this article makes clear. Indeed, it includes the illuminating fact that Pregnancy and delivery often increase the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have a sevenfold higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant - which may well cast light on what happened in AP's case, despite Booker's and Hemming's suggestions that the authorities went to all of this trouble because of a mere panic attack.

www.localgovernmentlawyer.co.uk/index.php?option=com_content&view=article&id=16513:nhs-trust-issues-statement-on-role-in-caesarean-section-case&catid=52:adult-social-services-articles&Itemid=20

"On this occasion the pregnancy made it very difficult to treat Ms X as medications would have affected the unborn child.

Unless the Health Trust is lying they did not medicate AP til the c-sect. Nice try but please try harder next time.

@nenny

"Interesting comments underneath this article including the fact that it appears AP declined to go to the Italian embassy; her lawyers then did so but the Italian embassy failed to get back to her. Which accords with reports at the time that the Italian government just wasn't interested."

Really, you are going by public comments on a blog as your source of official information? Try getting official statements from people involved in the case.

www.independent.co.uk/life-style/health-and-families/health-news/pregnant-woman-with-very-severe-mental-health-problems-could-be-forced-to-have-caesarean-8998824.html

If you read this story the judge gave the go ahead for a court ordered c-sect if necessary. The important thing to remember is this was a month before the due date meaning the health trust actually did their job and sought a possible solution before it became an urgent emergency.

Sorry, not going to pretend I've been following the twists and turns of this part of the debate.

Redding, I assume you are arguing that due process was not followed in the AP case and that the reasons for this were somehow deliberate and malign?

If I am right about this, you were asked a question, much much earlier which I don't think you ever answered.

What were the MOTIVES for the doctors in forcing an operation upon a woman in this way? If they weren't genuinely acting in what they thought were her best interests WHY did they do it?

You see - and I am genuinely interested in this - the issue of 'motive' is never addressed by any conspiracy theorist, apart from the (completely ridiculous and untrue) assertion that professionals are paid a bonus to secure babies. So what IS going on in these cases?

@spero

Not so much motive as much as general incompetence and the belief that the the english court is a better at judging the fate of foreign nationals than the home countries of said foreign nationals.

Ok, fair enough. So you are not a 'full on' conspiracy theorist then?

Just updating my spreadsheets.