In a viral 2009 TED Talk entitled ‘ The danger of a single story ’ , Nigerian feminist author Chimamanda Ngozi Adichie said, ‘ How [stories] are told, who tells them, when they ’ re told, how many stories are told, are really dependent on power . . . Power is the ability not just to tell the story of another person but to make it the de fi nitive story of that person. ’ 1

This paper presents a user/survivor researcher perspective to the debate among psychiatrists on the suggested introduction of Community Treatment Orders in Ireland. Critical questions are raised about evidence and the construction of psychiatric knowledge. Important questions include: How is this evidence created? What and whose knowledge have not been considered? Some critical issues around coercion, ‘insight’, and attributions of ‘lack of capacity’ are briefly considered. Further legal considerations are then introduced based on the United Nations Convention on the Rights of Persons with Disability. The paper concludes with a human rights-based appeal to reject the introduction of coercive community treatment in Ireland.

BACKGROUND:A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established.AIMS:To develop an understanding of individuals' experiences over the course of the involuntary admission process.METHOD:Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach.RESULTS:The 'theory of preserving control' (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: 'losing control', 'regaining control' and 'maintaining control', and a number of related subcategories.CONCLUSIONS:Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission.DECLARATION OF INTEREST:None.

Abstract In this paper, we seek to radically reframe the legal construct of consent from a disability perspective. Drawing on feminist scholarship and human rights standards around ‘free and informed consent’, we apply a concept of freedom to negotiate to laws regulating both consent to sex and medical treatment – key areas in which the legal agency of people with disabilities (especially people with cognitive disabilities) is routinely denied, restricted or ignored. We set out the essential ingredients for reframing consent: namely, legal personhood, freedom to negotiate and understanding. We also outline conditions (i.e. coercion, undue influence and power imbalances) that impede valid consent. This represents a first attempt to move beyond labelling adults with certain disabilities as lacking the ‘mental capacity’ necessary to give valid consent – in order to explore in more depth particular expressions of consent or refusal and seek new validity criteria, beyond the label of ‘mental incapacity’.

This chapter explores some of the issues that surround sexuality, gender and sexual orientation, with a view to enabling mental health nurses to respond to people’s expressions of sexuality in a more informed and sensitive manner. Evidence indicates that the impact of gender is compounded by its interrelationship with social, structural and economic determinants of health, such as income, education, housing and employment. Many of the negative experiences that expose women to mental health issues arise from their unequal position and status within society, which has led to subjugation, discrimination and violations of their rights, including sexual and reproductive rights. Gender differences are not only present in the determinants of mental distress and type of diagnosis men and women receive, but are also evident in emotional expression and patterns of help-seeking. Studies reveal gender difference in the gendered nature of treatment and care offered to men and women.

OBJECTIVES:To explore the mental health tribunal experiences of people admitted involuntarily under the Mental Health Act 2001.METHODS:Employing a qualitative descriptive study design, data were collected from 23 service users who had experienced mental health tribunals during a recent involuntary admission. Face-to-face semi-structured interviews were conducted ~3 months post-revocation of their involuntary admission order. Data were analysed using an inductive thematic process.RESULTS:The majority of participants reported mixed experiences comprising positive and negative aspects in relation to information provision, emotional support and an inclusive atmosphere. Some participants reported receiving accessible information about the tribunal process, felt emotionally supported throughout, and encountered respectful and dignifying practices during the tribunal proceedings. However, many participants described experiencing non-inclusive practices, reported feeling ill-informed regarding the tribunal process, emotionally unsupported during and after the tribunal, and distressed by what they perceived as adversarial tribunal proceedings.CONCLUSIONS:Systemic changes could ensure that the positive experiences encountered by the minority of participants in this study are more consistently experienced. Ongoing education and training of stakeholders in the provision of inclusive tribunal practices, and the provision of accessible information and emotional support to service users through the stages of the involuntary admission process appear likely to be beneficial. Service users should automatically be offered the option of having a support person of their choosing present during tribunals.

OBJECTIVE:The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland.METHODS:In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process.RESULTS:Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters.CONCLUSIONS:This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being.

There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment.

OBJECTIVES:To evaluate and compare the opinions of key stakeholders involved in the involuntary admission and treatment of patients under the Mental Health Act (MHA) 2001 regarding their views towards the operation of the legislation.METHODS:We employed a descriptive survey design. A questionnaire was distributed to stakeholders involved in the operation of the MHA 2001 (except service users, whose views were explored in a separate qualitative study) via paper or online versions evaluating their opinions regarding the operation of the MHA 2001 in relation to assessment, care, rights, transfer and information available.RESULTS:Stakeholders agreed that in their opinion that patients generally benefit from the care they receive (79%) and that the MHA 2001 ensures an independent and fair review of the person's detention (65%). However, only 23% of stakeholders were satisfied with the process of transferring patients to hospital and with the clinical assessment procedures therein (37%), with the greatest levels of dissatisfaction amongst Gardai (Police), general practitioners (GPs) and family members.CONCLUSIONS:While the introduction of the MHA 2001 has assisted delivery of care to patients with improved adherence to international human rights frameworks applicable at the time of its enactment, substantial dissatisfaction with the implementation of the MHA 2001 in practice is experienced by stakeholders particularly at the distressing phase of clinical assessment and transfer to hospital.

In this paper we set out the context in which experiences of mental distress occur with an emphasis on the contributions of social and structural factors and then make a case for the use of intersectionality as an analytic and methodological framework for understanding these factors. We then turn to the political urgency for taking up the concept of recovery and argue for the importance of research and practice that addresses professional domination of the field, and that promotes ongoing engagement and dialogue about recovery as both a personal and social experience. To this end, we describe a unique project that sought to deepen our understanding of how recovery is being thought about and applied in the current context of mental health care in Vancouver, BC, with a specific focus on how, and whether, people are taking up and addressing dimensions of power that we see as critical to the operationalization of recovery within a social justice framework. Emerging from our research and discussion is a set of critical questions about whether or not the political moment in Canada with respect to re-invigorating recovery should be embraced, versus a rejection of the concept of recovery as too limiting in its scope and too vulnerable to professional co-optation.