原創：一個Social Justice Warrior對於英國心理疾病歧視的看法

利益相關和背景介紹：有輕度抑鬱傾向，白左社民人士，英國自民黨支持者，英國衛報和獨立報忠實讀者，Social Justice Warrior, 在英國Top大學學習人文學科（其實我覺得可以自稱已經融入西方社會了），正在學習英美文學和西方政治。經歷過同學的心理崩潰事件，正在規劃給英國衛報寫信揭露英國社會對心理疾病患者的文化偏見。

英國在維持社會公平正義這方面總體上來說是做得很好的，哪怕是保守黨(the conservatives), 本身也不像美國共和黨那麼費拉不堪，它是一個中右政黨，並且也比較致力於維護LGBT權利等。我個人覺得#metoo 的集體反性騷擾活動效果和反響很不錯，如果這一點能夠應用在反對心理疾病的歧視，偏見和社會性污名化上，就會更好。

自從上個世紀以來西方的民權運動開始，西方的人權活動家就一直致力於反對針對心理疾病及其患者的污名化，偏見和歧視，以及制度性壓迫。現在在英國已經很少有人敢聲稱心理疾病患者是瘋子了，並且平等法案 (Equality Act) 也制度性禁止對心理疾病患者的歧視，但是文化上和心理上仍然存在大量關於心理疾病及其患者的誤解，錯誤應對，這經常導致災難性或者虐待性的後果，這一點NHS研究報告和BBC新聞也報道比較多。

在一位NHS研究官員Graham Thornicroft的著作《Shunned: Discrimination Against People with Mental Illness》（逃避：針對心理疾病患者的歧視）》的前言中寫道：

「.......and in the 1970s I became part of what was then called the mental patients liberation movement. Those of us who had experienced the system first-hand saw clearly that our basic rights as human beings and citizens had been violated by the very process of psychiatric diagnosis, labelling and treatment, and we worked to change those conditions. It is important to note that our campaign was NOT one (merely) against stigma, but instead was part of the broad-based anti-discrimination movement that insisted our basic rights for ethnic, gender and sexual identity groups that were marginalized within the dominant culture.」

我去年認真看完了這本書，覺得這本書說得挺準確。它揭露了西方社會中仍然存在的偏見和歧視，從以下幾個角度（摘自目錄）：

1， Close to Home: Family, housing and neighbors (主要是心理疾病患者個體在家庭中遭受的偏見，虐待性對待，在購房過程中受到的歧視，以及鄰居的歧視等）

2, Getting Personal: Friendships, intimate relationships and childcare （心理疾病患者在人際關係中遭受的歧視和偏見）

3, Its not working: Discrimination and Employment （心理疾病患者在職場和職業領域遭受的歧視，包括動不動出現的解僱威脅，職場對患者極度不友好，同事和老闆的歧視等）

4, By a process of exclusion: Discrimination in civil and social life

5, Harmful Helpers: （這一點就要注意了，這是心理疾病患者在西方社會中遭受歧視的一個主要而關鍵的方面，NHS系統，司法和警察系統對心理疾病患者的偏見和錯誤對待往往對於患者本身是虐待性和災難性的，我想英國人 @Lightwing 這方面也應該看過BBC的一些報道）Discrimination in health and social care

6, Profiting from Prejudice: Mental Illness in the media

7, Danger or disinformation: The facts about violence and mental illness （根據NHS的一項調查（抱歉我搞忘連接了，好奇的同學可以去google scholar找關鍵詞查查）現在仍然有大量英國人認為心理疾病和病人的暴力傾向有聯繫）

8, "Why Try?"-Self Stigmatization and anticipated discrimination

9, From Stigma to ignorance, prejudice and discrimination

10, What works to reduce discrimination? Challenge for service users.

11, What Works to Reduce Discrimination? Challenge for everyone.

除此之外，我要講一個案例。我有一個英國朋友，有抑鬱傾向，會自殘，遭遇過非常糟糕的對待。

第一次是她當眾情緒崩潰，然後用小刀自殘，被英國警察當眾帶上手銬然後拖進救護車。這次事情發生以後，她被當成「破壞集體紀律和秩序的人」被校方警告和勸退威脅。

第二次是她當眾在學校大廳裡面哭了出來，然後被好奇的圍觀群眾團團圍住，拉扯，一個人不顧她的反對和抗議叫了4個真刀真槍的警察來把她控制住，並且強迫她進救護車。此後她的這次情緒崩潰被學校當成紀律事件處理。

自從目睹了這種極端惡劣的事件以後，我就已經開始策劃給英國衛報揭露事實的文章了。

順便給你們看幾篇文章。

Psychiatric services need better support, not more legal scrutiny （英國衛報）

There is an automatic review at six months, but they can lodge a challenge via the mental health tribunal or the hospital managers (or both) from day one. It is misleading to talk of the act giving 「the state」 the power to detain. The act empowers clinicians to do this, and two professionals have to agree. One must be a trained psychiatrist, the other an 「approved mental health professional」 (usually a social worker) charged with exploring alternatives and safeguarding the patient』s rights. The law already requires compulsion to be used only as a last resort and only when there is obvious risk. The section papers require an explanation of why effective treatment cannot be achieved without it.

Community treatment orders are not linked to payment. Whether the current 5,000 per year are justified is highly questionable, given that all three published randomised controlled trials find them ineffective. There is, however, no doubt that we do not have enough beds. No mental health act is perfect.

Things are different in Scotland. Indeed, the Law Society would do well to look at the provisions of the Mental Health (Care and Treatment) (Scotland) Act 2003, which allows for an initial short-term detention of up to 28 days, which can be appealed, and any subsequent compulsory treatment order for up to six months can also be appealed, by adults and children. And legal aid is available for these appeals.

NHS patients having to be sectioned to get help, says regulator （英國衛報）

A lack of mental health services in England means a growing number of patients are having to be sectioned to get help, according to the NHS care regulator.

A review by the Care Quality Commission found that the rise in the number of detentions under the Mental Health Act was due partly to the fact that the healthcare system was 「under considerable strain」.

The number of patients sectioned has increased by 40% between 2005-06 and 2015-16, from 45,484 to 63,622.

The CQC noted that unavailability of community care support was leading to high numbers of detentions, and demand for beds also meant patients tended not to be admitted on a voluntary basis.

Dr Paul Lelliott, the lead for mental health at the Care Quality Commission, said: 「Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the act can be influenced by gaps in support and provision in the system.」

He added: 「This includes limited hospital bed availability, which means that people cannot easily be admitted as voluntary patients early in the course of their illness.」

Mental health crisis takes huge and increasing share of police time （英國衛報）

UK police are spending as much as 40% of their time dealing with incidents triggered by some kind of mental health issue, against a backdrop of severe cuts in social and health services, the Guardian has learned.

Research by the Guardian shows that the overall number of incidents recorded in police logs as being related to mental health rose by a third between 2011 and 2014, a trend that looks set to continue.

It comes after warnings that a perfect storm is gathering over already overstretched police forces as they try to cope with the knock-on effects of cuts to mental health services.

Police say they are becoming emergency mental health services （英國衛報）

Police say they are being relied on as an emergency mental health service and that cuts in psychiatric provision are probably to blame, the Guardian has learned.

Officers point to an increase of more than 50% in a decade in the use of powers to detain people under section 136 of the Mental Health Act. It allows police to remove someone from a public place and take them to a place of safety.

On Monday police chiefs begin new initiatives to help officers cope with the mental health crisis being played out on Britain』s streets. Alex Marshall, head of the College of Policing, said: 「There is a real risk the high number of cases that frontline police deal with is because the police are stepping in where other agencies would have provided the support.」

Deaths in custody: police urged to stop holding mentally ill in cells （重點文章，也是來源於英國衛報）

Other reforms and findings include:

• There should be an end to police officers conferring after custody incidents, but before they make their statements.

• There is evidence of racial disproportionality in police restraint deaths.

• Video cameras should be used in every police van used to transport a prisoner and on every frontline officer.
• The police watchdog should robustly challenge discrimination where there is clear evidence.

• Mental health training should be given of the same standard across all 44 forces in England and Wales for officers and recruits, plus refresher training.
• The introduction of 「drying-out centres」 – seen as a potential alternative to police custody or accident and emergency departments for those under the influence of drink and/or drugs and who require specialist supervision – should be reconsidered.

Families of People who died in police custody failed by system - report （英國衛報）

A long-awaited unpublished official report into deaths in police custody says families who have lost loved ones have been failed by the system and recommends far-reaching reforms to the police, justice system and health service, the Guardian has learned.

The report, ordered by Theresa May in 2015 while she was home secretary, is yet to be published, prompting warnings from some groups that the government delay risks damaging public confidence.

The report by Dame Elish Angiolini QC will say there should be a ban on those detained under mental health powers being held in police cells, and being transported in police vehicles, except in exceptional cases. It will also say that holding those believed to be suffering from mental health issues in police cells should be phased out completely.

Police Reveal "unlawful" Mental Health Detentions (BBC報道）

Police chiefs in England and Wales say they may be unlawfully detaining arrested people needing mental health care more than 2,000 times a year.

Some people have been held in police cells for several days because there is no hospital bed for them, the National Police Chiefs Council (NPCC) says.

It says an inquiry into such mental health provision is needed.

The government said the use of police custody for people detained under the Mental Health Act had fallen sharply.

Under the Police and Criminal Evidence Act 1984, officers have 24 hours after an arrested person arrives at a police station to release or charge them.

But data gathered by the College of Policing, and shared with BBC Radio 4s Today programme, showed 264 instances where people were held for longer when they were judged to be in need of mental healthcare after being arrested.

In one case an adult was detained for six days before a bed was identified. A child was detained for five days.

當然，如果這方面還有更多的類似文章，歡迎大家在評論區補充。