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

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

Nasa Begum uses mental health services.

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