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Old 12-03-2013, 09:54 AM   #51 (permalink)
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At the time of writing, 15:40 GMT, neither the Telegraph (which first published Christopher Booker's story in its Opinion section and subsequently reworked it as a news story) nor the Independent (which also reworked the Telegraph pieces as a news story) have direct links to their pieces on their home pages. None of those pieces appears to have been updated since their original publication.

The BBC and the Guardian do have direct links on their homepages. The stories are taking the line that an Italian woman is seeking custody of her child which has been in the care of Essex Social Services, on the basis that she has recovered sufficiently from the problems that caused the child to be taken into care in the first place. Both pieces do raise the question of why the child hasn't already been placed with a member of her family and include contradictory quotes from the woman and the social service department.

Also, both the BBC and the Guardian stories do distinguish between the health care trust which was the responsible the the woman being sectioned under the Mental Health Act and for her care in hospital – which included the caesarian section – and the social services department which is responsible for the subsequent care and placement of the child.

Perhaps someone familiar with the British tabloids could report on their take on this.
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Old 12-03-2013, 09:59 AM   #52 (permalink)
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I would take 17 hours non-stop driving to get from Essex to Italy, and thats not accounting for traffic or things like driving through the mountains
See! An easy ride for any woman about to give birth.
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Old 12-03-2013, 10:02 AM   #53 (permalink)
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This is exactly the journey you want to make when you are carrying a full term baby!
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Old 12-03-2013, 10:11 AM   #54 (permalink)
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Extradition isn't, I think, a matter for either social service departments or health care trusts, and nor is illness or pregnancy a justifiable reason. (Being a pain in the arse may be one, though.)

The question that should be asked is why wasn't the woman voluntarily repatriated well in advance of her coming to term? The birth wasn't until five weeks after she was sectioned.
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Old 12-03-2013, 10:15 AM   #55 (permalink)
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Also, I don't know about the UK, but in the USA a court order is required to keep someone committed involuntarily for any period longer than 72 hours, and that commitment order must be renewed by a judge at regular intervals (although I don't know offhand how long, and it may differ by jurisdiction). I suspect that the law in the UK is similar, although I would not be surprised if it were slightly more liberal than our very limited commitment laws.
In a civil matter like this, she could be detained for up to 28 days in the first instance (section 2 of the Mental Health Act) but could have appealed to a Mental Health Review Tribunal (comprising a judge, a doctor and a lay person) at any point during the first 14 days.

Her family should have been contacted and she would also have been entitled to the advice and support of a Independent Mental Health Advocate. I don't know, but I'd be absolutely astonished if the Italian Consulate hadn't been notified of her detention, too.
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Old 12-03-2013, 10:36 AM   #56 (permalink)
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I would take 17 hours non-stop driving to get from Essex to Italy, and thats not accounting for traffic or things like driving through the mountains
Also, it's not like there's a direct train between Essex and Italy. At best it would be a two to three day trip n the scenario described earlier (ferry and train combo). That would be a great idea, send a mentally ill person a multiple day trip across four countries, with 2-3 transfers, and preferably unsupervised. Lol.
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Old 12-03-2013, 10:42 AM   #57 (permalink)
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And BTW, are we sure the woman is an Italian citizen or just a resident? The passport thing kind of gave me pause. I travelled through 15 EU countries (+ Switzerland), I've even lived for longer periods in different countries, and I never had a passport in my life. My national ID and drivers license are enough that I can pass through any border check in Europe.
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Old 12-03-2013, 10:43 AM   #58 (permalink)
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So a lot of the story is muddled, it seems the c-section was performed and THEN social services got involved, not the other way around

P (A Child) [2013] EW Misc 20 (CC) (01 February 2013)

also

Never let the facts get in the way of a good story eh? : pinktape.co.uk
Thanks, Darkley!

I strongly recommend to everyone Pink Tape's analysis of both how this case was reported by the Telegraph and others vs what we now know actually happened, and of the law on the subject.

The judge's comments in the custody hearing (the first link) also provide very useful factual background, which paint a rather different picture of the events surrounding this unhappy case from that reported by Christopher Booker.
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Old 12-03-2013, 11:04 AM   #59 (permalink)
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And neither of those would have resulted in care being delivered faster than if she simply stayed in the hospital.

I don't know if it is different in the UK, but in the USA it is rare for someone to be committed for five weeks, as this woman was. Usually for someone to remain hospitalized for that long would be for situations where someone was extremely ill. Of course, it is entirely possible that she remained hospitalized longer because of the pregnancy, I suppose, but in that case it seems odd that they would keep her in a psychiatric hospital, so more likely it was due to her mental state.

Also, I don't know about the UK, but in the USA a court order is required to keep someone committed involuntarily for any period longer than 72 hours, and that commitment order must be renewed by a judge at regular intervals (although I don't know offhand how long, and it may differ by jurisdiction). I suspect that the law in the UK is similar, although I would not be surprised if it were slightly more liberal than our very limited commitment laws.
Jesus. I didn't say it was the right thing to do only that it was an alternative form of transportation.

Should have just kept my mouth shut.
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Old 12-03-2013, 11:06 AM   #60 (permalink)
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This is exactly the journey you want to make when you are carrying a full term baby!
What fun would it be if the roads were flat and straight?!? Have you ever been on a road trip through the US midwest? Talk about BO-RING!

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Old 12-03-2013, 11:10 AM   #61 (permalink)
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Anyway, I am glad the OP story is pretty much a fallacy and not a modern day human rights abhorrence.
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Old 12-03-2013, 11:12 AM   #62 (permalink)
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i dont think ive ever been on a road that stays straight for more than a mile
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Old 12-03-2013, 11:55 AM   #63 (permalink)
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i dont think ive ever been on a road that stays straight for more than a mile
So...no cruise control option on eruopean cars?
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Old 12-03-2013, 12:03 PM   #64 (permalink)
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i dont think ive ever been on a road that stays straight for more than a mile
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The rolling English drunkard made the rolling English road.
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A merry road, a mazy road, and such as we did tread
The night we went to Birmingham by way of Beachy Head.
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Old 12-03-2013, 12:57 PM   #65 (permalink)
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It is probably too much to hope that the irresponsible reporting of this case has not caused undue alarm for women with mental health difficulties who may be pregnant or trying. It is easy to imagine that the ramifications of this sort of thing might extend in unseen ways, to affect some women’s behaviour in terms of compliance with medication, a failure to report a re-emergence of symptoms during pregnancy, or reduced engagement with social work and other professionals and the consequent isolation of vulnerable mums-to-be from much needed support during and after pregnancy. I hope I’m wrong.


This is what pisses me off the most about the media coverage of this case. Mentally ill people are not likely to make rational judgements to begin with, but media coverage that continually enforces the myth that they should avoid social services, government services, treatment, etc at all costs because of the risk of abuse by authorities only contribute to their difficulties.

Mentally ill pregnant women are in an even more vulnerable situation. The hormonal changes are capable of causing psychiatric problems even for mentally stable women (ie postpartum depression/psychosis). And pregnant women may be unable to take their medication, or may be put in the very difficult position of having to choose between the potential risks of taking medication vs the unknown risks that medication might pose to the fetus.

In the USA, and presumably in much of the developed world, mentally ill people face a much higher rate of unemployment, incarceration, homelessness, poverty, and are far more likely to be the victims of violent assault and rape. For journalists to recklessly discourage mentally ill people from seeking help from the appropriate authorities, and to instill fear towards medical professionals and social workers and "the system" is just....

I guess it would be nice if some of the journalists who claim to care about the mentally ill would stop using them as pawns for their own petty ideological agendas.
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Old 12-03-2013, 01:02 PM   #66 (permalink)
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On that subject, journalist Judith Warner looked at the topic of the disparity between medical consensus and journalism reporting on mental health problems and medication in children a few years ago. Her book is especially interesting because she initially intended to write a very different book, one that Mr. Booker probably would have enjoyed. Instead, after talking to real physicians and real experts and real parents, she began to see how her own profession was drastically misunderstanding and misreporting on these issues.



Amazon.com: We've Got Issues: Children and Parents in the Age of Medication eBook: Judith Warner: Kindle Store

Near the end of the book she discusses the fact that when news media discuss mental health issues, they're usually not really talking about mental health issues but using them as a proxy for completely different political and ideological concerns.
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Old 12-03-2013, 06:40 PM   #67 (permalink)
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The question that should be asked is why wasn't the woman voluntarily repatriated well in advance of her coming to term? The birth wasn't until five weeks after she was sectioned.
Not knowing the medical history of the woman, obviously we can't say anything for certain, but if you have dealt with a person that has had a severe mental break, you know that five weeks isn't very much time in terms of recovery. I imagine that is further complicated by her lack of consent, medication, and her advanced state of pregnancy. The priority of her doctors was not to get her back home so she could have her baby. Their priority was her health and safety. It would probably have been much easier to shuffle her back to her own country and wash their hands of her. Instead, they appear to have done what is expected of ethical medical professionals: treated their patient.

Again, I have no way to know how extreme her case was, but it's highly likely that providing stability for her was more important than what side of international lines she was on.
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Old 12-03-2013, 06:54 PM   #68 (permalink)
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Not knowing the medical history of the woman, obviously we can't say anything for certain, but if you have dealt with a person that has had a severe mental break, you know that five weeks isn't very much time in terms of recovery. I imagine that is further complicated by her lack of consent, medication, and her advanced state of pregnancy. The priority of her doctors was not to get her back home so she could have her baby. Their priority was her health and safety. It would probably have been much easier to shuffle her back to her own country and wash their hands of her. Instead, they appear to have done what is expected of ethical medical professionals: treated their patient.

Again, I have no way to know how extreme her case was, but it's highly likely that providing stability for her was more important than what side of international lines she was on.
She was clearly very seriously ill and for some time. It's not clear exactly when "At this stage" was, but it seems, from the context, to have been no earlier than mid-October:

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By that stage it was being asserted by the treating doctors that the mother had regained capacity under the relevant test. I have to say that when the mother appeared before me at that time she did not appear to be at all well, and I am surprised that it was being claimed that she had legal capacity . I am critical of the doctors because it appears to me that she was despatched (in deed escorted ) from the UK with undue haste simply because she wished to go back to Italy. I was led to believe that the mother was in a good state and a good frame of mind but frankly nothing could have been further from the truth, because if one looks at the reports of the admitting Doctors in italy , it is clear that the mother when she arrived in Italy was in a very poor state .She should in my view have been assisted here to participate in these proceedings. I know she wanted to go to Italy but by going to Italy any realistic prospect of P returning to her care was diminished substantially. It is for that reason it seems to me that it was a most ill-advised thing to have occurred. I was critical at the time and I remain critical to this day.
P (A Child) [2013] EW Misc 20 (CC) (01 February 2013) para 9
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Old 12-03-2013, 06:58 PM   #69 (permalink)
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Ah. So it was five weeks to do barely enough to get her to the point where they could shuffle her off. Okay, so they were just responsible "enough." But still, the point is that five weeks wasn't really that much time to get her well and home. And, really, shuffle her off is probably a bit unkind. I'm not sure how much progress you can make with a patient who feels they're being kept against their will in a foreign country.
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Old 12-03-2013, 07:11 PM   #70 (permalink)
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Ah. So it was five weeks to do barely enough to get her to the point where they could shuffle her off. Okay, so they were just responsible "enough." But still, the point is that five weeks wasn't really that much time to get her well and home. And, really, shuffle her off is probably a bit unkind. I'm not sure how much progress you can make with a patient who feels they're being kept against their will in a foreign country.
I'm getting confused about the five weeks. According to Judge Newton's summary of the events in this case (para 7), she was originally admitted on June 17th under section 2 (compulsory observation) and subsequently section 3 (compulsory treatment) of the Mental Health Act. So she was actually in hospital here for about 4 months, and must have been receiving treatment for her condition for at least three of them.

She seems, if I properly understand the judge's summary, to have been re-admitted to an Italian mental hospital immediately on arrival there. He clearly regrets having allowed her to leave, since he apparently had grave misgivings at the time but allowed himself to be swayed by the doctors' advice.
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Old 12-03-2013, 07:52 PM   #71 (permalink)
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I'm getting confused about the five weeks.
Ah, you're right. Sorry, I was just responding to the notion that five weeks was enough time to treat her and get her home. I hadn't checked the timeline. So even after months of treatment it was unlikely she was ready to be released and sent home.

Maybe I misunderstood KT's question at the end of her post.
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Old 12-04-2013, 03:58 AM   #72 (permalink)
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If this had happened in the USA, she might have been committed for 72 hours. I highly doubt that it would have lasted beyond that. Then she would have had the complete freedom to refuse a C-section and die during childbirth. The USA is a world leader when it comes to psychiatric research and diagnostic guidelines, which is why the APA's DSM is often used around the world in place of the WHO's ICD for psychiatric diagnoses. But at the same time, we're one of the worst of the developed nations in terms of the legal options available to the most severely mentally ill who refuse treatment and who often do not believe that they are mentally ill.

In most cases even a 72 hour hold cannot happen unless the person presents an imminent danger to themselves or others. In most cases they are released after 72 hours regardless of whether they are stabilized. In many states a committed patient cannot be forced to take medication unless it is considered medically required for their own safety (realistically this means that they can't be made to take medication unless they are acting violent and aggressive. Sleeping on the floor in their own shit does not count). Once released, it is almost impossible to ensure that the patient continues to take their medication. A few states have passed laws like Kendra's Law in NY and Laura's Law in CA to allow court-mandated assisted outpatient treatment, where patients are regularly tested to ensure that they are complying with their medication, but this usually only occurs in the context of the criminal justice system where the patient's mental illness has already reached the point where they have been arrested and charged with a crime.

So in many ways this woman was very lucky that she was travelling to the UK and not to the USA when this happened.
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Old 12-04-2013, 05:13 AM   #73 (permalink)
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I think that releasing after 72 hours whether they're stable or not generally happens with the uninsured which unfortunately many of the mentally ill are. But, in cases where there is insurance they'll hold the person until the insurance runs out.
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Old 12-04-2013, 06:04 AM   #74 (permalink)
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This is exactly the journey you want to make when you are carrying a full term baby!
Just as a small anecdote. We were once heading home by car from a trip to Slovenia. At the time, Slovenia didn't have highways yet except for the ring roads surrounding the capital (they only built their first international highway in 2008). So we drove from Slovenia to Italy over roads like that. At 3 AM.

One spot just inside Italy, the roads were exactly this winding, but instead of a gently sloping hill, we were dealing with an actual rock-like mountain. After driving like that for two-three hours, the driver suddenly goes like "Oh shit"...

The road was already only just wide enough, and at that point, a rock had fallen down earlier that day, the size of a minivan. The left half of the road had been ripped away with it and became a gaping hole. >_> Had to drive in reverse through that pass for an hour before we passed a spot wide enough to turn the car, then until late morning before we found an alternative route. >_>
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Old 12-04-2013, 06:17 AM   #75 (permalink)
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Ah, you're right. Sorry, I was just responding to the notion that five weeks was enough time to treat her and get her home. I hadn't checked the timeline. So even after months of treatment it was unlikely she was ready to be released and sent home.

Maybe I misunderstood KT's question at the end of her post.
I was thinking in terms of transfer to a hospital in Italy, and I was thinking that her condition would make such a move a very bad idea.
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