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Removing references to forced treatment, seclusion and post-traumatic stress disorder, and links to patient blogs describing experiences of poor care, is to reduce a piece on coercion in psychiatry to a sanitised grumble about poor food, thin curtains and the wrong type of tea.

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This afternoon, I was informed by the British Medical Journal that, despite us having worked on the piece (commissioned by the BMJ) since September, it would not be published in the 7 November issue without the following deletions:

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DELETION 1

“… and avoid being assaulted. I was repeatedly medicated by force. I have since been diagnosed with post-traumatic stress disorder.”

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DELETION 2

“I was repeatedly subjected to forced treatment, as a first resort. I was locked in seclusion with no water, no food, no access to a toilet and no contact with the outside world, without even my glasses or shoes.”

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DELETION 3

“If patients can’t go elsewhere for medical advice because they are locked up and the law gives staff the right to use force, there’s no need to hone these skills.”

[The skills referred to in the preceding sentence are “engagement with patients and persuasion”]

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DELETION 4

Ref 1. – Smoking and psychiatric wards – Georgia Rambles blog, Dr Georgia Belam @GeorgiaBelam (30 September 2014) https://georgiarambles.wordpress.com/2014/09/30/smoking-psychiatric-wards/

DELETION 5

Ref 3. – Do you remember your first time? – Sectioned UK blog (16 November 2014) https://sectioneduk.wordpress.com/2014/11/16/do-you-remember-your-first-time/

DELETION 6

Ref 4. – A smoking ban for mental health workers in the workplace – Nurse With Glasses blog, @nurse_w_glasses (15 November 2013) http://20commandments.blogspot.co.uk/2013/11/a-smoking-ban-for-mental-health-workers.html

DELETION 7

Ref 5. – Smoking – Wardipedia, a World of Ward Knowledge, @WardipediaNews http://www.wardipedia.org/21-smoking/

DELETION 8

Ref 6. – How can psychiatric wards become better, healthier places? – Sectioned UK blog (26 October 2015) https://sectioneduk.wordpress.com/2015/10/26/how-can-psychiatric-wards-become-better-healthier-places/

DELETION 9

Ref. 7 – On the ward – abuse in the mental health system – Schizoaffected3 blog, @schizoaffected (27 June 2015) https://schizoaffected3.wordpress.com/2015/06/27/on-the-ward-abuse-in-the-mental-health-system/

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My piece is about coercion in psychiatric care. The The BMJ would only permit me to refer to my experience as a psychiatric inpatient in the following terms:

“I am very much in favour of making psychiatric wards healthier and bringing about sustainable improvements to patients’ health. When I was fragile and detained, the ward environment was toxic. Food with no fibre, poor sleep hygiene measures, no access to exercise or fresh air, no therapy and nothing to do except sit round eating biscuits and drinking coffee [DELETION 1] [DELETION 5] There was no smoking reduction or cessation help avaiable. There is a great deal of scope for psychiatric hospitals to make wards healthier.” The BMJ would permit me to say, “Patients experience wards as coercive, not therapeutic.” However, the link to the blog post of @schizoaffected (reference 7) in which she describes her experience of a psychiatric ward, was to be deleted.

I was told I could not mention my personal experience of forced treatment unless the staff involved had been prosecuted. That’s akin to telling someone who’s been sexually assaulted that they cannot detail their own experience unless their attacker has been prosecuted. Expecting psychiatric patients harmed by poor services to prosecute staff before they can detail their own experiences is too high a bar for most of us to ever reach.

Removing the reference to use of forced treatment; removing the reference to post-traumatic stress disorder; removing the reference to having been held in seclusion with no food or water, no access to a toilet and no contact with the outside world, without even my glasses or shoes; removing links to two patient blogs describing our separate experiences of poor care; is to reduce a piece on the coercion that runs through psychiatry like words through a stick of rock to a sanitised grumble about poor food, thin curtains and the wrong type of tea.

To strip out a referenced blog piece written by a London psychiatrist; a piece by a community psychiatric nurse about a smoking reduction course; a well-known ward resource for inpatient psychiatric wards; and a collation of tweets where patients share how wards could be made better; is farcical. It smacks of inexperience, laziness or stultifying caution.

The justification for these deletions is that, the BMJ claims, I will be identifiable at the Maudsley public debate; that staff on the ward where I was detained may be in the audience; that they may recognise me all these years later; and that the NHS trust responsible for the ward where I was detained could sue the BMJ for libel. To try to accommodate those concerns, I offered a number of different forms of alternative wording. I offered, in place of the deletions, the phrase “BMJ legal advice says I may not refer in this article to other experiences on ward or the impact it has had on me.” I offered to sit on the panel wearing a face mask. I offered to sit in the room next door to the lecture theatre – the room where a patient can sit if their case is presented to doctors or medical students and speak via video link – and participate in the debate via video link with my back to the camera. BMJ refused. It was the deletions in their entirety, or nothing.

As a result of the BMJ refusal, my piece will now not be published in the upcoming issue. Happily, however, within half an hour another journal had agreed to publish my piece (slightly edited for length), as well as invite me to comment on an upcoming editorial on a related topic. Writing the piece has forced me to think well in advance about the issues I should focus on at the debate and has hence been good preparation. It has not been wasted effort.

However, it has been an upsetting episode. I was shaking with anger earlier. It has felt as I were being silenced; as if my own descriptions – brief as they were – of what was done to me under the guise of “care” – were being sanitised from the scene, buried, denied. As if coercion in psychiatric care is so entrenched as to be unmentionable. Reflecting on what I was told of the legal advice given to the BMJ and the BMJ’s refusal to consider my suggestions, it seems clear to me that stigma and prejudice against people with mental health problems has played a part. People with mental health problems are often considered unreliable witnesses to our own experiences. We are not believed. The more we insist something is so, the more extreme our experience seems to be, the more – as in this case – it appears to deviate from the accepted picture of what care on a hospital ward should be like, the more our credibility with others appears to be undermined. Tell an extraordinary tale as a mental health patient and it will be seen as a tall tale. The BMJ and the barrister they consulted didn’t, it seem, consider they would have any defence in the unlikely event they were sued: after all, I’m just a mental patient.

As I wrote in this piece, it seems that, on the one hand, professionals want to be seen to be listening to diverse voices; and yet, on the other, they aren’t prepared to make any accommodations that would make invitations meaningful. Write like a doctor. Fit in this square expert-by-profession-shaped hole even if you’re very much an expert-by-experience round peg. Don’t frighten the horses with your personal experience of brutalising inpatient hospital care. The BMJ will not be shining a light on the realities of coercion in psychiatry for the benefit of a diverse range of doctor readers. I wonder what will appear on those two pages instead.

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Click on the pictures below to link through to the blog posts or Storify stories of tweets

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Banned by the BMJ (1)