Lecture: Disabling Legal Barriers – The inaugural lecture of Professor Oliver Lewis, KCL MA Medical Ethics and Law alumnus

28 September 2016


3rd November 2016, 5pm

Moot Court Room
Liberty Building
School of Law
University of Leeds

This lecture will review the impact of strategic human rights litigation as a tool that can expose and demolish barriers that prevent people with mental health issues or learning disabilities from enjoying equality, inclusion and justice. Oliver will draw on fifteen years work in central and eastern Europe with the Mental Disability Advocacy Centre, an international NGO that collaborates with the University and offer students an opportunity to engage with its litigation and advocacy.

Dr Oliver Lewis was called to the Bar in 2000 and is an associate barrister at Doughty Street Chambers, London. He is the Executive Director of the Mental Disability Advocacy Centre, an international NGO that uses law to secure equality, inclusion and justice for people with mental health issues or learning disabilities worldwide. He is a recurrent visiting professor in law at the Central European University where he developed a LLM module on ‘Mental disability law and advocacy”, and a faculty member at the Indian Law Society where he teaches an international diploma on mental health and human rights law. He is a trustee of the Avon and Bristol Law Centre, and a member of PILNet’s Hungary board. He is interested in how law serves both as a barrier to social inclusion and as method of addressing injustice. His research has focused on international human rights law and mechanisms, human rights monitoring (including monitoring closed institutions such as psychiatric hospitals), strategic litigation, legal capacity, mental health law, political participation and the right to life.

He served as research director for the first disability project of the EU Agency for Fundamental Rights, and has been retained as an expert to organisations such as the Council of Europe’s Commissioner for Human Rights.

Register via Eventbrite.


Comment: Overreaction? ‘Mentally ill patients sectioned unnecessarily’

14 August 2013

The Independent lead today on a story entitled ‘Mentally ill patients sectioned unnecessarily just to gain access to a hospital bed’. To summarise, the House of Commons Select Committee on Health has uncovered ‘more than anecdotal’ evidence that the shortage of voluntary beds for mentally disordered patients has led to doctors sectioning patients under section 2 of the Mental Health Act 1983 (MHA 1983) in order to trigger (rapid) involuntary admission. Under section 2, a patient may be admitted to hospital for mental heath assessment for a period of up to 28 days on the recommendation of two doctors if:

(a)he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
(b)he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.

The Indy quote evidence from Dr Julie Chalmers ‘that, in some areas, “being detained is the ticket to getting a bed”’. Simon Lawton-Smith, from the Mental Health foundation is also states on the record that: ‘is [sic] was possible a clinician might section a patient who in the past would not have been sectioned in order to access a psychiatric unit’ (Indy’s paraphrase).

What should we make of this? Obviously, it is very concerning that there are not enough beds available for mentally disordered individuals seeking treatment. Mental health services suffer from underprioritisation, and individuals with mental health issues are subject to much undeserved stigma. People deserve better.

However, I also want to focus on the comments of Stephen Dorrell MP, the chair of the Health Select Committee, who said:

“This represents a serious violation of patients’ basic right and it is never acceptable for patients to be subjected to compulsory detention unless it is clinically necessary.”

I want to try outline how Dorrell’s response is possibly an overreaction, using the following hypothetical example:

Let’s say I’m a GP, and I have a patient, Nigel, who has possible mental health issues, but is not at present a risk to himself or others. Nigel, says that he would consent (let’s stipulate that he is able validly to consent) to mental health assessment and treatment on a voluntary basis. I explain to Nigel that there is a long waiting list in our area, and it is unlikely that he will be seen for assessment for some considerable time. I offer him the option of sectioning under section 2 MHA 1983, and explain the risks to him. In particular, I stress that discharge in involuntary detention cases is reliant on doctors’ clinical assessments, whereas voluntary patients can withdraw consent, which in principle will result in discharge (although the patient who withdraws consent runs the risk of being sectioned). Nigel consents to sectioning, and a colleague and I do the relevant paperwork.

To the extent that Nigel is not at present a risk to himself or others, Dorrell is right that sectioning is not clinically necessary. However, on the example that I have given, a) arguably sectioning is necessary, since it is the only way to access services in a timely fashion and b) it is hard to see how Nigel’s rights have been violated. On my scenario, Nigel’s interest in accessing mental health services has been promoted; he has voluntarily consented to being ‘involuntarily’ detained in order to receive the assessment and possible treatment he needs. Of course, the situation is not ideal, given the risk of actual involuntary detention once the 28 day period is up. However, if Nigel is aware and willing to accept this risk,* why should we deprive him of this option?

Of course, I have no evidence to suggest that this is what patients and doctors actually do in order to access mental health services.** Nevertheless, cases like Nigel’s may provide a plausible explanation for the some of the increase in sectioning. And if cases like Nigel’s do exist, I argue that what patients and doctors do is not wrong: they merely collude to game a dysfunctional system. If so, Dorrell (and others) should avoid making simplistic statements about people’s’ rights being violated when in fact they are being vindicated in a non ideal fashion.

*The risk might be mitigated if the treating mental health professionals are made aware that Nigel should really be a voluntary patient.

**Although Nigel’s case is perhaps analogous to those in which doctors manipulate insurance systems in order to provide care to the uninsured, for which there is substantial evidence.

Conference: Situating Mental Illness Between Scientific Certainty and Personal Narrative

20 March 2011

April 28-29th 2011, Berlin, Germany

Contemporary neuroscience reduces mental illness to brain-based operations, instantiating a division between biology and culture, mechanism and context, brain and biography. This has the effect of marginalising a richer, inner-subjective complex of individual meaning, personal history and narrative. This meeting surveys recent significant shifts in biological psychiatry methods for the assessment of mental illness and questions their validity and limitations. It also explores nuances and interstices between the regard of psychiatric disorders as neurochemical flaws and experiential conditions; the cultural history of psychopathologies; and how brain-based accounts of mental illness circulate in the public domain and are incorporated in culture.

List of Speakers: Lisa Appignanesi, Noga Arikha, Lisa Blackman, Laura Bossi, Felicity Callard, Trudy Dehue, John Forrester, Allen Frances, Stephan Schleim, Ilina A. Singh

The meeting has three main sessions:

1. Tensions of Diagnosis
The current neuroscience set of co-circulating methods including diagnostic categories, behaviour rating scales, animal models and biological markers implies a superimposition of subjective symptoms, neurochemical markers and objective endophenotypology.  What are the advantages and limitations to the introduction of biological measures in DSM-V? What are their repercussions for epidemiology, criteria of inclusion in trials and treatment? The scope of this session is to illustrate difficulties conciliating validity/reliability of measurements with respect for heterogeneity in disease manifestation, both at the biological and phenomenological level and to bring emerging evidence from clinical, epidemiological and biological research, as well as sociological analysis.

2. Voices from within
The second session will be devoted to exploring nuances and interstices between psychiatric disorders as neurochemical flaws and as experiential conditions, the former characterization now being favored due to its measurability, and thus facilitation of standardization. Attention will be given to the role of narratives and personal accounts in illustrating differences in severity and sequence of symptoms as well as values and motivations among patients behind biological interpretation of illness, and pharmaceutical treatment.

3. Neurotransmitters and psychopathology in history and culture
In the final session, we will explore the history of certain psychopathologies and how brain-based accounts of mental illness circulate in the public domain and are incorporated in culture.
What ideas and representations of ‘illness’ do biological interpretations let circulate in culture? How are they welcomed, endorsed or resisted by the general public? What scientific or commonsensical ideas do we live by to describe and explain illness, and what is their valence?

There is no conference fee. For further information and to register please contact Giovanni Frazzetto at giovanni.frazzetto(at)ici-berlin.org

Updated information will be available on the conference website.

Seminars: On mental disorder

20 January 2011

Upcoming seminars in the Centre for the Humanities and Health, King’s College London:
Wednesday 26 January 2011
Dr Hanna Pickard, University of Oxford
“Responsibility without Blame: Empathy and the Effective Treatment of Personality Disorder”
6.00 – 7.30pm
S-1.29, Strand Campus, King’s College London

Wednesday 2 February 2011
Professor Grant Gillett, University of Otago, New Zealand
“Reflections on the real nature of mental disorders from “The Bacchae””
6.00 – 7.30pm
K3.11, Strand Campus, King’s College London

Maps of the Strand Campus here.

Both events are free: no RSVP is needed. If you would like more information about these seminars, please contact me (ben.chisnall@kcl.ac.uk), or look at our website.

Conference: Making sense of mental illness: biology, medicine and society

12 December 2010

The European Molecular Biology Organization and the European Molecular
Biology Laboratory are pleased to announce the 12th EMBO/EMBL
multidisciplinary conference on Science & Society, which will take place at European Molecular Biology Laboratory, Heidelberg, Germany, on the 4th and 5th November 2011.

Please check the conference website for more information.

The conference will address the often-challenging issues surrounding neurological and behavioural disorders and attitudes towards them. Experts from a wide range of disciplines will explore the ethical and social implications of mental illness and will explain the latest scientific knowledge on their causes and treatment. The conference will also debate a number of difficult topics including the definition of mental disorders, financial interests in their diagnosis and treatment, and controversial therapies. The tradition of this conference series is to promote dialogue between a wide range of professionals and members of the public.

Following a scene-setting Keynote Lecture by UK social scientist Nikolas
Rose, the conference is organized in four sessions: Session I: Impact and definition of mental illness Session II: The biology of mental illness Session III: Pills, sofas and surgery – ways of treatment Session IV: Society and mental illness.

Registration will open in February 2011

If you have any questions, please do not hesitate to contact Sandra Bendiscioli: scisoc@embo.org

Lecture: How mental health law discriminates unfairly against people with mental illness

11 November 2010

15 November 2010, 1pm at Barnard’s Inn Hall, Gresham College

Speaker:   Professor George Szmukler, Institute of Psychiatry, King’s College London

Mental health legislation in most jurisdictions (including England and Wales) discriminates against people with a mental illness. When it comes to involuntary treatment, it fails to respect – without adequate justification – the ‘autonomy’ of people with a mental illness, in stark contrast to the treatment of people with a physical illness.  It further discriminates against persons with a mental disorder by allowing a form of preventive detention on the basis of ‘risk’, without any offence having been committed.  Mental health legislation thus carries underlying assumptions that people with mental disorders are not fully self-determining and that they are inherently dangerous.  It is possible to frame a law based on impaired decision-making capacity, from whatever cause (whether due to a mental or physical disorder), that would counter such discrimination.

Free and open to all.

Conference: Madness: Probing the Boundaries

2 February 2010

3rd Global Conference

Tuesday 14th September – Thursday 16th September 2010
Oriel College, Oxford

Call for Papers
This inter-disciplinary research conference seeks to explore issues of madness across historical periods and within cultural, political and social contexts. We are also interested in exploring the place of madness in persons and interpersonal relationships and across a range of critical perspectives. Seeking to encourage innovative inter, multi and post disciplinary dialogues, we warmly welcome papers from all disciplines, professions and vocations which struggle to understand the place of madness in the constitution of persons, relationships and the complex interlacing of self and other.

In particular papers, workshops, presentations and pre-formed panel proposals are invited on any of the following themes:

1. The Value of Madness or Why is it that We Need Madness?
~ Critical explorations: beyond madness/sanity/insanity
~ Continuity and difference: always with us yet never quite the same
~ Repetition and novelty: the incessant emergence and re-emergence of madness
~ Profound attraction and desire; fear of the abyss and the radical unknown
~ Naming, defining and understanding the elusive

2. The Passion of Madness or Madness and the Emotions
~ Love as madness; uncontrollable passion; unrestrainable love
~ Passion and love as a remaking of life and self
~ Gender and madness; the feminine and the masculine
~ Anger, resentment, revenge, hate, evil
~ I would rather vomit, thank you; revulsion, badness and refusing to comply

3. The Boundaries of Madness or Resisting Normality
~ Madness, sanity and the insane
~ Being out of your mind, crazy, deranged … yet, perfectly sane
~ Deviating from the normal; defining the self against the normal
~ Control, self-control and the pull of the abyss
~ When the insane becomes normal; when evil reins social life

4. Lunatics and the Asylum or Power and the Politics of Madness
~ The social allure and fear of madness; the institutions of confining mad people
~ Servicing normality by castigating the insane and marginalizing lunatics
~ Medicine, psychiatry, psychology, law and the constructions of madness; madness as illness
~ Contributions of the social sciences to the making and the critique of the making of madness
~ Representations, explanations and the critique of madness from the humanities and the arts

5. Creativity, Critique and Cutting Edge
~ Madness as genius, outstanding, out of the ordinary, spectacularly brilliant
~ The art of madness; the science of madness
~ Music, painting, dance, theatre: it is crazy to think of art without madness
~ The language and communication of madness: who can translate?
~ Creation as an unfolding of madness

6. Unrestrained and Boundless or The Liberating Promise of Madness
~ Metaphors of feeling free, unrestrained, capable, lifted from reality
~ Madness as clear-sightedness, as opening up possibilities, as re-visioning of the world
~ The future, the prophetic, the unknown; the epic, the heroic and the tragic
~ The unreachable and untouchable knowledge of madness
~ The insanity of not loving madness

7. Lessons for Self and Other or Lessons for Life about and from Madness
~ Cultural and social constructions of madness; images of the mad, crazy, insane, lunatic, abnormal
~ What is real? Who defines reality? Learning from madness how to cope with reality
~ Recognising madness in oneself; relativising madness in others
~ Love, intimacy, care and the small spaces of madness
~ Critical and ethical implosions of normality and normalness; sane in insane places and insane in sane places

Papers will be accepted which deal with related areas and themes.

The 2010 meeting of Madness will run alongside our project on Villains and Villainy and we anticipate holding sessions in common between the two projects.  We welcome any papers considering the problems or addressing issues of Mad Villains, Madness and Villainy and related themes.

Papers will be considered on any related theme. 300 word abstracts should be submitted by Friday 26th March 2010. If an abstract is accepted for the conference, a full draft paper should be submitted by Friday 13th August 2010.

300 word abstracts should be submitted to the Organising Chairs; abstracts may be in Word, WordPerfect, or RTF formats, following this order:

a) author(s), b) affiliation, c) email address, d) title of abstract, e) body of abstract
E-mails should be entitled: Madness Abstract Submission

Please use plain text (Times Roman 12) and abstain from using any special formatting, characters or emphasis (such as bold, italics or underline). We acknowledge receipt and answer to all paper proposals submitted. If you do not receive a reply from us in a week you should assume we did not receive your proposal; it might be lost in cyberspace! We suggest, then, to look for an alternative electronic route or resend.

Organising Chairs

Gonzalo Araoz
University of Cumbria, Cumbria, United Kingdom
E-mail: Gonzalo.Araoz@cumbria.ac.uk

Maria Vaccarella
Hub Leader, Making Sense Of: and Marie Curie Research Fellow, King’s College, London
E-mail: maria.vaccarella@inter-disciplinary.net

Rob Fisher
Network Founder and Network Leader, Inter-Disciplinary.Net, Freeland, Oxfordshire, United Kingdom
E-mail: mad3@inter-disciplinary.net

The conference is part of the ‘Making Sense Of:’ series of research projects. The aim of the conference is to bring together people from different areas and interests to share ideas and explore various discussions which are innovative and exciting. All papers accepted for and presented at this conference are eligible for publication in an ISBN eBook. Selected papers may be invited to go forward for development into a themed ISBN hard copy volume.

Further details about the project here.
Further details about the conference here.