The dangers of choice

    I sometimes wonder whether professionals are trying to travel so
    far down the road to Damascus they are beginning to forget what the
    original journey might have been about.

    The concepts of choice, empowerment, self-determination and
    independence are close to the heart of many service users. It is a
    much applauded shift that professionals are using values based on
    service user ideals as part of their everyday currency. We have
    achieved a significant milestone – or have we?

    During a recent difficult period of mental distress I was asked
    whether I would like to be detained under the Mental Health Act
    1983. All my previous compulsory admissions to hospital stemmed
    from the fact I was refusing to consent to treatment. Offering me a
    choice felt like it was missing the point.

    For me the notion of choice when I’m in or approaching a mental
    health crisis is problematical. The nature of my mental distress is
    such that the ability to make reasonable decisions that will keep
    me safe goes out of the window. The use of advance directives may
    seem an obvious solution so that what ought to happen in times of
    crisis is clearly set out and agreed beforehand. But I know advance
    directives do not work for me because when I’m in crisis I
    sometimes refuse what I have agreed in advance.

    At times of crisis I need my social worker to offer support and
    direction. Sometimes this means taking choice away from me and
    acting on my behalf until I’m stable again and in a position to
    make choices.

    What I find really difficult when my head is all over the place
    is workers asking me what ought to happen, what would help and do I
    want this or that. I recognise workers ask these things with a
    genuine concern to give me a real role in determining the type of
    intervention and outcome that I may want. But usually when I am
    approaching or living in crisis my best interventions with my
    social worker are when she says “you’ve got to do this or
    that”.

    I’m not suggesting professionals take control over people’s
    lives as a long-term measure, but merely offer those who need and
    want it a bit of breathing space to regain some equilibrium. Some
    may argue there is a risk of creating dependency, but we would be
    hard pushed to find any workers or service users who do not at some
    point benefit from briefly being dependent on others.

    Maybe the time has come to recognise that independence and
    dependence don’t have to be polar opposites. They can be fluid
    requirements according to the circumstances of people’s lives. On
    the road to Damascus there has to be room for accommodating the
    whole spectrum of people’s needs, including a degree of dependency,
    direction and support when service users feel they are losing their
    way.

    Nasa Begum uses mental health services.

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