On misinformation, outrage and critical thinking

by Paula David

The whole country is in an uproar. The Vincentian public is being sold a David and Goliath narrative which goes something like this.  A young girl without the protections of education and powerful family connections was sent to the Mental Health Centre, pumped with drugs and sent mad through an unholy conspiracy in which the judicial system and the medical services of the country are major players.  If that story is correct, it is outrageous.  But there is so much about the story that is not correct.  Let us examine some aspects of the medieval drama being recounted.

ON MISINFORMATION The Courtroom

Act 1 Scene 1

The magistrate sent the young girl to the Mental Health Centre for observation, without a shred of evidence that she was suffering from a mental illness.

The tell tale word in that narrative is “observation”.  It is precisely because the magistrate had no evidence that the young woman was indeed mentally ill that he was obliged to send her to the mental health centre for observation.  The magistrate is not a doctor.  He is not trained to determine whether someone is mentally ill or not.  What the law requires of the magistrate is that if he has reason to suspect that a person accused of a crime is suffering from a mental illness which may compromise her ability to present her case, he must seek the intervention of the health services to determine whether she is sufficiently in control of her mental faculties to be tried.

I am setting out the relevant section of the Mental Health Act below.  I invite you to read it.  It is not hard to understand.

Mental Health Act – Chapter 294 – Laws of Saint Vincent and the Grenadines Revised Edition 2009

Section 7. Admission for report

(1) Where a court has ordered that a person charged before it who appears to be incapable of making his defence to be detained for report, he shall be admitted to a psychiatric hospital and detained therein.

(2) A person admitted under subsection (1) is a hospital order patient for the purposes of this Act.

(3) The psychiatric hospital director shall, as soon as practicable after admitting a patient under subsection (1), make such examination as he considers necessary for determining whether or not the person is suffering from mental disorder and in need of care and treatment, and he shall within twenty-one days submit a report to the court in writing as to the medical condition of the patient.

(4) On receipt of a report under subsection (3), the court may –

(a) rescind the order under subsection (1) if it is of the opinion that the person is capable of making his defence; or

(b) make an order that the person remain in the hospital for such further care and treatment as the psychiatric hospital director considers necessary.

(5) Where an order has been made under subsection (4)(b), the psychiatric hospital director shall, when he is satisfied that the patient is no longer in need of care and treatment, report such matter to the court which may thereupon rescind the order and call the person before it and deal with him as it thinks fit.

Act 1, Scene 2

Why was she allowed to plead?

Unless a person is a repeat offender, usually the first time a magistrate sees an accused person is when s/he walks into the dock.  When s/he walks into the dock, the first thing the magistrate is required to do is to read the charge to the accused person and ask him or her to say whether s/he

pleads guilty or not guilty.  Sometimes even before a magistrate asks the question, “Are you guilty or not guilty?” an accused person may demonstrate behaviours which suggest that s/he may be unable to respond coherently.  If that is the case, the magistrate’s duty is to enter a formal plea of not guilty and send the person to the Mental Health Centre for observation.  If the person responds coherently to the request to plead, but the magistrate still has reason to suspect that s/he may not be able to present his or her case due to mental illness, the magistrate is still under a duty to send the accused person to the Mental Health Centre for observation.

The Mental Health Centre

Act 2, Scene 1

A doctor, who is not a psychiatrist, prescribed and administered psychotropic drugs to the young lady.

I am not a doctor and I am not competent to make informed pronouncements on whether it is ethical for a doctor who is not a psychiatrist to prescribe psychotropic drugs.  I am, therefore, inviting any medical practitioner who may read this to offer an opinion.  I do, however, know the following:

1.  The doctor in question has been the psychiatric hospital director at the Mental Health Centre for more than a minute.  The young lady in question  is not the first patient whom she’s treated with psychotropic drugs.  Before now, I heard no expression of outrage either over the fact that a doctor who is not a psychiatrist is the psychiatric hospital director of the Mental Health Centre or that she has been prescribing psychotropic drugs to patients.

2.  Medical practitioners who are not obstetricians/gynaecologists often prescribe birth control pills for their patients.  If we take the course of reasoning being offered us to its logical conclusion, it would appear that that too is improper.

3.  I know persons in other countries (first world countries for that matter) who suffer from mental illness and are prescribed psychotropic drugs by their general practitioners.

Act 2, Scene 2

The doctor prescribed and administered psychotropic drugs in defiance of the objection of the young lady’s legal practitioner. 

As far as I know, the young lady’s legal practitioner is not a medical practitioner.  I have no reason to believe that the young lady’s legal practitioner is more competent than the doctor to determine what is best practice with respect to the medical care of a patient.

Act 2, Scene 3

The court order committing the young lady to the Mental Health Centre for observation permits observation, but it does not permit treatment.

1.  Please refer to section 7(4) of the Mental Health Act reproduced above and pay particular attention to the words “further care and treatment”.  While section 7(3) of the Act says only that the hospital director shall “make such examination as he considers necessary for determining whether or not the person is suffering from mental disorder and in need of care and treatment”, the intention of the Act is seen when one reads section 7(4) which permits the court where necessary to order that the person remains in hospital for “further care and treatment”.

2.  By logical extension, the suggestion in Act 2, Scene 3 is tantamount to suggesting that if a patient is sent to be examined for gangrene, the doctor’s duty, having determined that the patient is suffering from gangrene, is to send him or her away without treatment.

ON OUTRAGE AND CRITICAL THINKING

If I were persuaded that the powerful state apparatus, in this case, the judicial system and the health care system were combining to oppress a powerless, vulnerable citizen, I would be outraged.  But I do not for one moment believe that that is what is happening.  

The ever changing narratives of the main spokespersons ring an alarm bell.  At one time it was suggested that the magistrate had no power to send the young lady to the Mental Health Centre for observation.  Now the narrative is that we need to change the law which gave him that power. 

At one time the narrative was that the young lady should be receiving medical care.  Now the narrative is that the doctor has no authority to administer medical care.

I am outraged.  What outrages me is that an obviously vulnerable young woman is being used as a pawn to score points in a chess game which has absolutely nothing to do with her.   What outrages me is the cynical dissemination of a false narrative which has persuaded Vincentians that their judicial system and their health care services are corrupt.