If any of you want to help out at your school or work with children or vulnerable adults, you will need to go through a Criminal Records Bureau (CRB) check here in the UK (I don’t know what the corresponding test in the UK is – any feedback gratefully received).

The CRB is a government body which has been set up to help organisations in the public, private and voluntary sectors by identifying candidates who may be unsuitable to work with children or other vulnerable members of society. Given the number of high profile cases where sex offenders or other criminals have ended up working with children, the Government has issued guidance to schools and care homes, to ensure that they conduct proper checks on applicant’s backgrounds to determine whether or not they should be working with children and vulnerable adults.

A reader of this blog has said that, because she was sectioned by the police under the Mental Health Act, that she is afraid that it will show up on her CRB check. Because she works with children, she is now afraid that she won’t be able to work with them.

If any of you have ever been sectioned by the police, does this mean that it would show on your CRB check?

I have now researched this and, so far, my research says that being sectioned in relation to a non-criminal act will not show up on a CRB check because merely being sectioned is not a “crime” or an “criminal offence”. The fact that the police were involved does not make you a criminal.

If, however, your sectioning was as a result of a criminal act, then it may well show up. If that’s the case then you need to determine what type of offence it was as there are varying degrees of severity and varying types of offence. So, for example, if it was any kind of sexual offence, then clearly that will be far more serious then a lesser offence. If you have any questions or doubts about your rights, you can go on the CRB website and it will tell you.

On a personal note, I do not have any criminal records, although I was arrested once when I was a University student – the details are at the end if you want a laugh! Nothing to do with any criminal act on my part, I hasten to add.

the worst I have ever done was when I was a University student, in Oxford. My crime was to try and reason with a policeman who was then trying to arrest my drunken Rugby playing boyfriend following a Rugby team strip tease at a friends 21st birthday party – not unusual behaviour for Rugby players or for undergraduates but the local police were not amused! The policeman’s wife had been offended by the sight of so many bottoms (she was driving behind the bus containing the Rugby team) that she insisted on them being arrested!). I told the policeman that he couldn’t arrest my boyfriend unless he could identify him in court; given that my boyfriend’s bottom was the only part of him that his wife had seen, the police would never have been able to identify him!!! The policeman got so cross when I was telling him the law, that he arrested me and threw me in a cell for the day to teach me a lesson!!! I hadn’t sworn, nor threatened, nor touched him but I had told him the law and clearly that didn’t impress him…….

So, apart from that, I’ve never been a criminal, so my CRB check should be clear.

What is really annoying me about this whole Bipolar thing is that I might not even have the wretched illness!! For all I or anyone else knows, I could have been misdiagnosed. My friends and family and others who meet me are all still adamant that I don’t have the condition as I don’t exhibit any of the symptoms. Even my partner, who is himself Bipolar, does not think that I have the condition as I am “too well”.

This makes it very difficult to accept the fact that my children have been told that I am not capable of looking after them full time. If I don’t have this condition, then presumably I’m capable of looking after them. It would also clear my medical records enabling me to find work and drive without all the scrutiny that I am currently subjected to.

So, I’ve been doing some research about whether there are other tests available to prove or disprove the presence of any Bipolar condition that I may have. If I do have it, then it may indicate the severity or mildness of it. If I don’t have it, them I’m off back to court to challenge the decision.

The following paragraphs are based on various articles that I have read but I haven’t attributed them as they were wrong in places so I have edited them eg they state that “all Bipolar sufferers have extreme and severe mood shifts from mania to depression.” As you and I all know, that is simply not true for all of us sufferers who experience a very individual set of symptoms. Anyway, do read on….

Bipolar Disorder and the Brain

Bipolar disorder and the shifts in mood that come with it can ruin lives. It often goes unrecognized as an illness and people can suffer for years before it’s properly diagnosed and treated. Now, however, new research that analyzes the bipolar brain could lead to better diagnostic techniques and improved treatment. Recently researchers discovered that abnormalities in certain brain areas that govern emotion can occur in those with the ailment. These findings and others may eventually provide researchers with new tools to diagnose and treat the ailment earlier and more effectively.

More than 2 million Americans and around 1 million Britons have bipolar disorder and the shifts in mood that come with it. Those with the illness in its most severe form (Bipolar 1) can cycle between episodes of manic highs and severe depression that can damage relationships and job or school performance. Those with the less severe form (Bipolar 2) have fewer marked mood shifts but they too can benefit from treatment.

People with bipolar disorder can suffer for years before their illness is properly diagnosed and treated. This may soon change, however, thanks to new research that analyzes the bipolar brain. The findings are leading to a better understanding of the cause of bipolar disorder.The development of biology-based diagnostic techniques that could identify the disorder early and provide insights into how to improve treatment.Currently, bipolar disorder cannot be identified biologically with a simple blood test or brain scan. Instead, a diagnosis is made primarily on the basis of symptoms discussed in the doctor’s office. The disorder often goes unrecognized as an illness for years, but once diagnosed many people with bipolar disorder can be treated with medication. Commonly doctors prescribe drugs that stabilize mood, such as lithium, along with drugs that ease depression.To help speed detection and improve treatment, scientists recently began to scrutinize the bipolar brain and uncover biological signs of the disorder. Some research reveals abnormalities in areas that govern emotions. For example, techniques that imaged the brain indicated that emotional areas deep inside, known as the amygdala and hippocampus, can be smaller in both adolescents and adults with bipolar disorder. This suggests that brain changes are an early feature of the disorder. Other studies that examined brain anatomy and brain activity indicate that those with bipolar disorder can have abnormalities in areas toward the front of the brain that process emotions, including the orbitofrontal cortex and the anterior cingulate. In other work, researchers uncovered some early insight into the roots of these abnormalities by studying genes. Our genes guide the production of proteins that run brain development and function. One study found evidence that a variation of gene, known as BDNF, which produces a factor involved in the development of brain structures like the ones found to be abnormal in bipolar disorder, may increase a person’s risk of developing the illness. Researchers also are examining possible links to many other genes involved in cell survival and development. With continued study, this research may help scientists find ways to detect bipolar disorder earlier and intervene earlier. For example, researchers imagine that in the future they will be able to develop a simple brain scan that identifies suspect brain alterations or devise a blood test that signals that brain changes exist. And perhaps once the genes behind the disorder are clarified, a test could be developed to detect them early.The discoveries surrounding the biological contributors of bipolar disorder also highlight where to focus new treatment development and could help doctors modify existing therapy regimens to match an individual’s particular abnormality. In the end, the research may translate into more peaceful days and longer lives for many.

Research reveals that people with bipolar disorder can harbor abnormalities in brain areas that govern emotions, including the orbitofrontal cortex, which lies behind the eyes and aids complex emotional thinking. In one imaging study, researchers examined brain activity while people with bipolar disorder and healthy individuals conducted a task that tests thinking ability. In general, the activity in the area was abnormal in bipolar patients compared to the healthy participants. Researchers also found that when patients were experiencing depression the activity was abnormally high, shown by the yellow and red coloring at the top of the left brain image. When patients were experiencing manic highs the activity was abnormally low, shown by the blue and purple coloring in the right brain image.

For any of you going to Court over the finances of your divorce, consideration of your fitness to work as a Bipolar sufferer will be a top priority.

80% of people with mental health disabilities are unemployed. This doesn’t mean that 80% are unemployable; it means that:

• there are many employers (4 out of 10) who won’t employ someone with a mental health illness
• there are insufficient flexible working opportunities for those who suffer to enable them to work in a way that they can manage their condition effectively
• there are those who are so discouraged by their condition that they “self stigmatise” ie they believe so strongly that nobody will want them, that they don’t even apply for work
• there are those who are worried that, if they apply for work, they will lose their incapacity benefit
• there are many who worry that they will be subjected to hostile/negative/unpleasantness in the workplace if colleagues find out that they have a mental health illness.

If you are fighting with your exspouse/partner over finances, they are bound to argue that you (the Bipolar sufferer) could go out and get a job and support yourself and therefore you shouldn’t require ongoing support from your ex spouse/partner.

This is what my ex husband argued: because I am a qualified lawyer and used to work in a top 10 City law firm, I should be perfectly able to go back to such a highly paid environment and support myself and our three children and therefore he should not have to pay me any maintenance.

I argued that my “ability” to work and obtain highly paid employment, is an entirely separate issue to whether I will, in reality, be offered a job given my mental health background.

I argued that, given the 80% of unemployment amongst the mentally ill, it is unlikely that I will fall within the 20% who will get work at a high level. I might get low paid and low status work, but if I do, that is likely to be insufficient to enable me to support myself and my three children adequately in the lifestyle that they are used to (eg private schooling etc).

How can you determine these issues? Well, you need expert evidence ie an expert to write a report to the Court and then come to Court, if required, to give evidence and who is willing to be cross-examined on the evidence he/she gives.

Ideally, you have 2 experts: the first should be your treating psychiatrist/doctor who can give the Court his/her assessment of your ability to work. This will include:

• a description of your diagnosis eg Bipolar 1, Bipolar 2, rapid cycling Bipolar, cyclothymia, schizo – affective disorder etc
• an explanation of the effect that your diagnosis has on your ability to work eg levels of concentration, focus etc
• an explanation of which medication you are on and how this affects your ability to work eg does your medication make it difficult for you to wake up in the mornings? Does your medication make it harder for you to concentrate?
• an assessment of which types of work you might be able to undertake eg if stress is one of your triggers, would you be able to hold down a highly stressful job?
• What are your particular triggers? eg if noise is a trigger, how would commuting to and from work on a busy/noisy train/tube/motorway affect your ability to commute?
• your longer term ability to hold down a job
• your own ability to manage your illness eg do you recognise your triggers? Do you comply with your medication regime? Have you developed good coping strategies?

This expert report will be given to the Judge so that he/she can form a view of how your own particular illness affects you and how it will affect your ability to work.

This will help the Judge decide how likely it is that you will find work, maintain work and what level of work in terms of pay and status that you are likely to achieve.

The Judge can then base any capital distribution or maintenance levels with that knowledge in mind.

If the Judge is unaware of the discrimination issues that surround the employment of the mentally ill, then it is a good idea to submit to the Court some well researched papers on the subject. For these, Google “Professor Graham Thornicroft” and you will find some very good resources on how discrimination in the workplace affects the mentally ill.

A particularly good piece of information can be found in his book “Shunned”. You can obtain this from Amazon.

The Social exclusion part of the government’s website is also helpful. Here are some useful links:

www.library.nhs.uk/SpecialistLibrarySearch/Download.aspx?resID=213004

This above link is a paper called “Actions speak Louder” and you can download this using Acrobate.

Resources for investigating the issue of Social Exclusion of the mentally ill include:

news.bbc.co.uk/1/hi/health/503876.stm

BBC news article on Social Exclusion of the mentally ill.

www.literacytrust.org.uk/Database/Exclusion.html

www.ukcap.org/getheard/index.htm

www.lga.gov.uk/lga/aio/33473

If you Google “Social Exclusion government taskforce for mentally ill” you will find a whole load of material which will inform you about the stigma of mental illness in the workplace.

Any questions about any of this stuff, please send in your comments.

Post traumatic stress disorder (PTSD) is very real for those suffering from it. My children are regularly having nightmares; my son (7) had such a bad one last week that he woke shaking and crying and so scared that I had to hold him tight in my arms all night to keep him calm. Each time I moved even slightly, he woke again and clung to me crying, pleading with me to hold on to him. He said that these awful creatures were trying to take him away from me and no matter where he ran and hid, they came to get him…..

My daughter (6) keeps having nightmares where she is being kidnapped by some stranger and I don’t come to her rescue; I am nowhere to be found even though she’s crying out for me….She dreamt that she had been thrown into an empty room and nobody came to give her food and she was in the dark not knowing where anybody was…She dreams that I have had my head chopped off. She repeatedly asks me whether anyone is going to kill me or chop my head off and is worrying about whether I am safe or not. She dreams of coffins floating down a river…she dreams of being attacked by witches, or other creatures who are nasty and scary for her.

It is clear that the children are suffering anxiety as a result of their separation from me, their mum. The children are not currently seeing a psychologist so no diagnosis has been given to them regarding any PTSD but if the symptoms are the same then I am surmising that they too are suffering with it and should be getting some help with their trauma.

Two influential psychoanalysts – John Bowlby and Donald Winnicott – have written extensively about the concept of separation and attachment. They suggested that a large proportion of anxieties and mental health problems are associated with separation between infant and mother in childhood. Their suggestion is that separation is not only distressing for a baby but can also cause anxieties in later life. They proposed that premature separation can lead to insecurity, which can lead to hostility, and that this hostility can interfere with the processes determining subsequent growth and development. All of this is said to trigger mourning at an age when a child is too young to manage such feelings, meaning that a child may be stuck in a state of despair or depression. Dreams of suffocation, separation, loss and abandonment may therefore be informative as they can tell the dreamer of an unresolved separation in their family. This is when feelings of mourning or hostility towards the parent or other family figure have not yet been explored or dealt with.

Separation anxiety occurs when we have to confront the prospect of being separated from someone who is considered essential to our physical or emotional survival. Typically, separation anxiety occurs in relation to family members or partners as these are the people with whom we normally have the closest relationships; the anxiety may often be reflected in nightmares and disturbing dreams.

Dreams of suffocation or nightmare scenarios involving the separation, death or loss of a family member or spouse are often triggered by separation anxiety and in many instances they can offer clues to help manage and resolve these feelings in waking life. [Taken from "The Element Encyclopedia of 20,000 dreams" – Theresa Cheung].

I too am having nightmares – I dream of trying to find my children, of rescuing them from danger and of being ignored or unseen by others in the dream. The children are often in great danger yet I cannot reach them in my dream. I dreamt that my son was trapped under a collapsed building which had collapsed in an earthquake. The foundations of the building are sinking on top of him and he is crying out for me in desperation. I crawl under the building, calling out to him that I’m coming to get him but I can’t quite reach him – I hear his cries and please and the fear in his voice but I can’t quite get to him.

I dream of being unseen – a ghost to all around me including the children. These are typically of me being in my ex husband’s dream new home where he lives with the dream nanny/some other woman and the children are there. When I enter the room, they don’t see me; I talk to them, walk in front of them, sit next to them but it becomes apparent to me that I am invisible to them. I wander round the house unseen and unheard trying desperately to talk to or be with the children but they can’t see me so I am ignored. When they move from one room to another, I follow them into the different room hoping that they’ll see me in the room I’ve followed them into but they still don’t so I continue to remain invisible. There are domestic scenes of the children getting dressed, playing, eating their supper, tidying away their toys, but I cannot join in. I am left feeling helpless, tremendously sad, hurt, upset and feeling so terrible that I am there with my children but completely invisible so neither they nor I can be with each other. My dream of being a ghost meant that I could spend time with them without being told that I can’t be there….

I wake from these dreams sunk into a well of despair and have often woken up crying; I have started to cry in my dream and wake with the tears still flowing. I awake in shock and disbelief that my situation isn’t a dream and that I am living in a nightmare. I wake without my children in the house, without them coming jumping into my bed in the morning and to the silence of the house. I lie in bed for a while trying to come to terms with what has happened.  This usually takes me 2-3 hours in the following morning before I can function well enough again and then it plays on my mind for weeks at a time. I cannot get the images and feelings out of my mind.

Is this evidence that I am “mad”, “unstable” etc? If so, are my children “mad” too? Or are we all just suffering from being separated from each other?

My psychiatrist says that I am suffering from PTSD (Post traumatic stress disorder) and has given me sleeping tablets at night saying that these dreams usually stop after 6-8 months. It is his view that my experience of the Children’s Act proceedings, the subsequent judgement hearing and the separation from my children have all combined to cause me significant trauma and hence the diagnosis of PTSD. The research into PTSD states that, at first the dreams are incredibly intense and disturbing, but the sufferers report that these gradually become less vivid after around 6 – 9 months.

It has now been a year exactly since the judgement was handed down by the judge and I am still having these nightmares. How long will this continue?

The dream book referred to above is very useful to help understand the meaning of many of the dreams the children have and so I involve them with this interpretation; we look up the symbols of their dreams and then we talk about what their dreams might mean. This seems to help them put the “monsters”, the “baddies” and the horrible circumstances of their dreams (eg tidal waves, cracking ice, storms, lightning etc) into a context so that they can then understand what their dream is about. This reduces their anxiety. So, for example, if they dream about being carried away to sea by a tidal wave, I can explain to them that the sea is a very powerful expression of emotions – the stronger and more turbulent the sea is in the dream, the more powerful are their emotions. Once they understand this, they can then talk about what emotions they are feeling and so the tidal wave is then understandable and not something to be frightened of. This seems to be helpful to them.

Maybe it should be part of any co-parenting plan that a child suffering with recurrent nightmares should be referred to a psychologist for help with the trauma. I certainly will be seeking one for my children.

As for me, I will continue to try to see them as much as I can to reassure them that I have not gone from their lives and will always be there for them as often as I am permitted.

Is there anyone else out there suffering with these kind of nightmares? I’d love to hear from you.

Post script: It is now September 2008 – 18 months after I was forced to leave my home and my children and I am still having these nightmares as are the children…..If this is PTSD, then it is obviously a serious case of it. I still have to take sleeping tablets at night together with a medication to stop me from experiencing REM sleep which, according to my psychiatrist, is the best way to avoid having nightmares. It’s not working…..

I have been researching the DVLA rules regarding whether or not you can drive if you suffer from Bipolar to determine whether or not the DVLA can refuse me a licence as I suffer with Bipolar 2. Being a parent with young kids, driving is very important; if I am forced to give up my licence it will make seeing my kids even more difficult than it is already.

I’ve continued driving whilst the DVLA are undergoing their investigations as to my fitness to drive. I know that I’m absolutely fine to drive, so I should have my licence re-issued as I pass all the tests i.e.:

• I have been well for 3 years
• I am fully compliant with my medication regime
• I do not abuse substances such as alcohol or illicit recreational drugs
• I don’t fall asleep from my sedatives whilst driving
• My judgement isn’t impaired unless its a white van driver behind me driving 2mm from my rear bumper – then there’s a slight wish to slam on the brakes and shout at him/her that I’m a crazy woman who he/she shouldn’t mess with…………………..only kidding…….

I think the following aspects of my driving should also be taken into account………………

• I don’t think that going 150 mph in a 30mph zone is ok……….
• I do think that anyone who goes 20 mph in a 30mph should be shot……well, ok shooting them’s a bit extreme…………maybe I could just through eggs at their back windscreen so that they’re forced to pull over and I can then get on my merry way………
• I do think that blasting up my favourite Killers song (Mr Brightside, for those of you who are interested) is a fantastic accompliment to my driving happiness levels. (As is Fat Boy Slim, Faithless, Primal Scream, Prodigy and loads of others as I am a musicaholic…..)
• I limit my caffeine intake whilst driving to 3 cups per hour ………………………………………………….!!!!!!!!!!!!!!!!! Is this an “illicit substance” for the purposes of the DVLA’s investigation???? Causes anxiety and mania???Affects concentration as your hands are too busy shaking so you can’t clutch the wheel properly…….
• I don’t think that I’m Jeremy Clarkson or any other celebrity who thinks that they are beyond the speed limits……………………………………………………..(PS I really like Jeremy Clarkson and would dearly love to go the speeds that he goes as I am an adrenaline junkie, but I reckon it would give the Judge too much to go on.)
• I don’t think that putting on my mascara, doing my nails or otherwise tending to my personal appearance is worth being pulled over for by the police
• I don’t yell down the phone at my ex-husband whilst not on a hands free device (although it has to be said that this affects my concentration momentarily as I imagine all the ways I’d like to throttle him……………..JOKE! I am NOT dangerous…..)
• Eating chocolate, crisps and sweeties is OK whilst driving as it increases my endorphin levels so that I am a happy bunny which means I can tolerate other people’s bad driving more easily……
• I have stopped talking to my lawyer whilst driving as this substantially increases my ability to concentrate and my anxiety levels due to the thoughts that the conversation I’m having is costing my £100 every half an hour I spend on the phone to him…………Bloody lawyers………

So, I will stick to my normal driving habits and hope that I’ll be given my new licence……….Watch this space.

There are various websites giving information about the DVLA’s rules with regards to drivers with mental health problems, including:

•  Rethink is an organisation for people suffering with a mental health illness – www.rethink.org http://www.rethink.org/living_with_mental_illness/everyday_living/driving/index.html (gives the rules but also tells you how to appeal if the DVLA refuse you a licence or revoke it.
• Open Up:Mental Health Media’s anti-discrimination toolkit project. 
  http://www.openuptoolkit.net/know_your_rights/driving.php
• MIND: The mental health charity: http://www.mind.org.uk/Information/Legal/driving.htm
• DVLA: The guidelines, “Guide to the current Medical Standards of Fitness to Drive” can be found on the DVLA website at http://www.dvla.gov.uk/ . They have produced a Form M1 which you can view and download here http://www.houlston.freeserve.co.uk/mentalhealthdvla.pdf
• DirectGov: the Government’s website giving information about Government departments: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/DG_4022415

The law can be found in the Road Traffic Act 1988 and Part VI of the Motor Vehicles (Driving Licences) Regulations 1999 together with other regulations and guidelines for medical practitioners.

 Here is what the Bipolar Organisation ~( www.mdf.org.uk) says:

Driving – DVLA

Below is the current information from the DVLA on Psychiatric Disorders and what action needs to be taken.
If you have any queries about these you should contact the DVLA directly.

If you have a medical condition which has become worse since your licence was issued or you develop a new medical condition, you must inform the Drivers Medical Group of your condition, as it may affect your fitness to drive. Failure to do so is a criminal offence and is punishable by a fine of up to £1000.

Psychiatric Disorders

GROUP 1 ENTITLEMENT
ODL CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC LGV/PCV

ANXIETY OR DEPRESSION

(without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts).
DVLA need not be notified and driving may continue. (See note about medication in appendix at end of this Chapter).
Very minor short-lived illnesses need not be notified to DVLA. . (See note about medication in appendix at end of this Chapter).

MORE SEVERE ANXIETY STATES OR DEPRESSIVE ILLNESSES

(with significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts)

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Driving should cease pending the outcome of medical enquiry. A period of stability depending upon the circumstances will be required before driving can be resumed. Particularly dangerous are those who may attempt suicide at the wheel.

Driving may be permitted when the person is well and stable for a period of 6 months. Medication must not cause side effects, which would interfere with alertness or concentration. Driving is usually permitted if the anxiety or depression is long-standing, but maintained symptom-free on doses of psychotropic medication, which do not impair. DVLA may require psychiatric reports.

NB. It is the illness rather than the medication, which is of prime importance, but see notes on medication.

ACUTE PSYCHOTIC DISORDERS OF ANY TYPE

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.

Driving must cease during the acute illness. Re-licensing can be considered when all of the following conditions can be satisfied:

• (a) Has remained well and stable for at least 3 months
• (b) Is compliant with treatment
• (c) Is free from adverse effects of medication which would impair driving
• (d) Subject to a favourable specialist report

Drivers who have a history of instability and/or poor compliance will require a longer period off driving.

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective anti-psychotic dose; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

HYPOMANIA/MANIA

NB: For cases which also involve persistent misuse of or dependency on alcohol/drugs, please refer to the appropriate section of Chapter 5. Where psychiatric illness has been associated with substance misuse, continuing misuse is not acceptable for licensing.
Driving must cease during the acute illness. Following an isolated episode, re-licensing can be reconsidered when all the following conditions can be satisfied:

• (a) Has remained well and stable for at least 3 months
• (b) Is compliant with treatment
• (c) Has regained insight
• (d) Is free from adverse effects of medication which would impair driving
• (e) Subject to a favourable specialist report

REPEATED CHANGES OF MOOD: Hypomania or mania are particularly dangerous to driving when there are repeated changes of mood. Therefore, when there have been 4 or more episodes of mood swing within the previous 12 months, at least 6 months stability will be required under condition (a), in addition to satisfying conditions (b) to (e).

Driving must cease pending the outcome of medical enquiry. It is normally a requirement that the person should be well and stable for 3 years (i.e. to have experienced a good level of functional recovery with insight into their illness and to be fully adherent to the agreed treatment plan, including engagement with the medical services) before driving can be resumed. In line with good practice, attempts should be made to achieve the minimum effective dose of psychotropic medication; tolerability should be optimal and not associated with any deficits (e.g. in alertness, concentration and motor performance) that might impair driving ability. Where in patients with established illness the history suggests a likelihood of relapse, the risk should be appraised as low (either in the treated or untreated state). DVLA will normally require a consultant report that specifically addresses the relevant issues above before the licence can be considered.

Appendix

PSYCHIATRIC NOTES

• The 2nd EC Directive requires member states to set minimum medical standards of fitness to drive and sets out the requirements for mental health in broad terms
• The Directive makes a clear distinction between the standards needed for Group 1 (cars and motorcycles) and Group 2 (lorries and buses) licences, the standards for the latter being more stringent due to the size of vehicle and the greater time spent at the wheel during the course of the occupation
• Severe mental disorder is a prescribed disability for the purposes of Section 92 of the Road Traffic Act 1988. Regulations define “severe mental disorder” as including mental illness, arrested or incomplete development of the mind, psychopathic disorder or severe impairment of intelligence or social functioning. The standards must reflect, not only the need for an improvement in the mental state, but also a period of stability, such that the risk of relapse can be assessed should the patient fail to recognise any deterioration
• Misuse of or dependency on alcohol or drugs will require the standards in this chapter to be considered in conjunction with those of Chapter 5 of this publication.

MEDICATION

• Section 4 of the Road Traffic Act 1988 does not differentiate between illicit or prescribed drugs. Therefore, any person who is driving or attempting to drive on the public highway, or other public place whilst unfit due to any drug, is liable to prosecution
• All drugs acting on the central nervous system can impair alertness, concentration and driving performance. This is particularly so at initiation of treatment, or soon after and when dosage is being increased. Driving must cease if adversely affected
• The older tricyclic antidepressants can have pronounced anticholinergic and antihistaminic effects, which may impair driving. The more modern antidepressants may have fewer adverse effects. These considerations need to be taken into account when planning the treatment of a patient who is a professional driver
• Anti-psychotic drugs, including the depot preparations, can cause motor or extrapyramidal effects as well as sedation or poor concentration, which may, either alone or in combination, be sufficient to impair driving. Careful clinical assessment is required
• The epileptogenic potential of psychotropic medication should be considered particularly when patients are professional drivers
• Benzodiazepines are the most likely psychotropic medication to impair driving performance, particularly the long acting compounds. Alcohol will potentiate the effects
• Doctors have a duty of care to advise their patients of the potential dangers of adverse effects from medication and interactions with other substances, especially alcohol
• Drivers with psychiatric illnesses are often safer when well and on regular psychotropic medication than when they are ill. Inadequate treatment or irregular compliance may render a driver impaired by both the illness and medication.

CONFIDENTIALITY

When a patient has a condition which makes driving unsafe and the patient is either unable to appreciate this, or refuses to cease driving, GMC guidelines advise breaking confidentiality and informing DVLA. [GMC Confidentiality Handbook] PATIENTS UNDER SECTION 17 OF THE MENTAL HEALTH ACT

Before resuming driving, drivers must be able to satisfy the standards of fitness for their respective conditions and be free from any effects of medication, which will affect driving adversely.

Here is some advice from the following link on the Flesh and bones website: http://www.fleshandbones.com/readingroom/viewchapter.cfm?ID=994
 Do I have to inform the DVLA that I am taking antidepressants?
Straightforward anxiety and depression does not need to be notified to the DVLA. If there are problems relating to memory, agitation or suicidal thinking, then this needs to be notified. If the condition may make the driver dangerous, this must be notified, and the DVLA may then make  enquiries to decide whether the licence should be withdrawn. There is no obligation to notify the DVLA if you are taking antidepressants, providing you are aware that all medication can impair alertness, concentration and driving performance especially within the first month of starting medication  or increasing the dose. If you experience any problems then you should not drive. Sedative antidepressants are more likely to cause drowsiness, and antidepressants can interact with other drugs and tranquillizers as well as alcohol. In general, drivers with depression are safer when well and on regular antidepressant medication than when ill. If in doubt about your fitness to drive you should not drive and should notify the DVLA. It is the illness and the general condition that you suffer from that is the most important thing rather than the medication that you are taking.

I also found an article that said that the DVLA was setting up an independent review to look into the way medical conditions are assessed and their effects on an individual’s ability to drive.

In 2000 the Department for Transport set up a research programme into “Medical Fitness to Drive” with a number of important studies, including the attitudes of healthcare professionals towards giving advice. Areas of concern include the effects or side effects of medication. This was due to be completed in November 2005. I will look further into the results of this and post them on a separate post…………..

Well, there you go. Are there any readers who have had any experiences regarding their ability to drive and their encounters with the DVLA? Please do comment so that we can all see what the issues are and then how we may be able to address them.

 Thanks.

P.S. Any other music recommendations for driving to? No “air guitar” suggestions please as I try hard to keep my hands on the wheel at all times, even when gesticulating madly to my lawyer who can’t see what I’m gesticulating…………………

Well, somehow I knew it was going to happen – the continuing excuses as to why my husband still thinks I shouldn’t be able to see the kids………

In April,I was forced to leave the family home following my husbands Occupation Order to get me out on the basis that my presence in the house was causing the children “significant harm”. I didn’t agree that it was my “continuing presence” that was causing them harm, but the arguing and bickering was distressing for them. My own view though was that it would be even more distressing for them if I left, especially without another home to go to and for them to call their own too. But I was advised by my lawyers that the Judge would force me to go so, rather than spending another £20,000 of wasted legal fees, I was told I should go. So I did, very unhappily. Not surprisingly the children were terribly upset. They told me they kept going into my empty room and couldn’t believe that I was gone………..and so was my bed that they cuddled up to me in.

However, I have Shared Residency Order which states that the children are to live with me for half the holidays and every other weekend during term time, and another afternoon or possibly two each week for the mother as agreed between the parties. So my solicitors wrote to his, suggesting that the kids and I should see each other every Tuesday and Thursday afternoon after school – an arrangement which the Judge had said in the Court Order that she would “welcome” but it would have to be with agreement by both parents.

However, I thought at the time the Order was made that the reality was that my husband wouldn’t agree to it and, sure enough, he is still refusing to agree to an afternoon after school so that the kids and I can see each other. His reasons are still the same as they were 6 months ago: “the children need routine and stability.” Well, surely the same afternoon each week for contact is “routine”. Surely the children will feel more “stable” if they see their mother once a week? “The children have a very important year ahead of them at school.” Oh, and not seeing their mother is going to help them with that??

Where are the children’s rights here? Or their Human Right to have a family life (one of the Rights set out under the Human Rights Act). Or my “mother’s rights”…..Who says there are any such things???

Herein lies one of the biggest problems with a Court Order in Family Law which leaves any kind of extra time with either parent to the agreement between them: it was so obvious to me that my husband wasn’t going to agree to any extra time. When he and his barrister both made oral promises to the Judge that he would definitely encourage and facilitate as much time as possible with me, I could see through his charm, but the Judge was convinced by him. The Judge, however, didn’t go as far as to enshrine any right of the kids to see me mid-week so my requests for more time will continue to be met with refusal.

(To give him his due, he did allow the kids and I to celebrate my birthday together last Thursday which was absolutely brilliant! They got me a Scooby Doo birthday cake with more candles than space on his vast face………yes, I’m ancient……Best birthday I’d had in a very long time. Just me and the kids. Bliss). But that is one rare occasion of “extra” time.

What can I do about it?

I will keep asking, just keep writing, keep writing, keep writing with the same request hoping that he will eventually realise that it isn’t kind to either the kids or me to keep us separated from each other.

The only other option is to go back to the Judge and ask her to adjudicate again on the issue of these after school times. My husband must surely be expecting that I will have to do this; he can’t think that I wouldn’t want to keep asking to see them or that the kids won’t keep asking to see me?  It makes so much more sense though to just be sensible rather than going back to Court again. That would be distressing for all of us, but maybe not as distressing as the continuing absence of my children and I being able to spend time together. 

The thing is, my Bipolar is completely under control and has been ever since before the Court hearing started; I have repeatedly been given the all clear by my psychiatrist who says I am perfectly stable. So it’s not like I’m manic or hypomanic or severely depressed or alcoholic or abusive or anything else – I’m just a really decent, loving mum who wants to see her kids and, most of all, give them loads of love and hugs………..I’ve even told him that he can insist on making me have a psychiatric assessment of my mental health every 6-8 weeks if he needs any reassurance, so why’s he refusing to take me up on it?

His latest reasons are that I have been “turning up at the kids schools and this has distressed them.” What I have, in fact, been doing, is to attend every single school event that I can so that I get to look at the kids even if I can’t hug them or talk with them. So I go to all the school masses, services, sports events, coffee mornings, kids parties etc. I am fully legally entitled to go to these, so I’m not just “turning up”. Also the kids want me there at their sports matches, their masses, concerts etc. The only reason they are distressed is because they’re not seeing enough of me, not because I’m there!

He then cites the fact that on around 3-4 ocasions, I have dropped the children back between 15mins – 1 hour late on a Sunday night after my long drive back up to Kingston through Sunday afternoon, London-bound traffic. This is “proof” that I am unreliable and irresponsible……………..clearly.

So, I just have to keep asking. Most importantly, the kids keep asking me why they can’t see me more often and they ask me to ask him. So I do. And he says no. So I ask again. And he says no. When the children ask me why he says no, I simply have to say “I don’t know why, you’ll need to ask him yourself.” What else can I say?

My eldest daughter (frighteningly mature and perceptive for her age) said: “Mummy, you have to stand up to him. If you don’t, he’ll just keep treating you badly and ignoring you. If you let him get away with it, he’ll carry on doing it. You can’t let him carry on like this.”

Well, that may be the truth and I want to stand up to him for her and my sake. But just how do you stand up to a parent who is determined to put you down and stamp on you? I can only think that I have to be as level headed as possible and appeal to his legal/rational mind. So I keep writing to him.

Unfortunately, due to the incredibly strategic manner in which my husband ran his case (he’s the head of a litigation department, so he knows all the tactics), I have learnt to ensure that there’s a paper trail of correspondence so that he can’t claim that I haven’t requested time with the kids.  I send the emails with the “Read receipt” and “Delivery report” option so that he can’t say that he didn’t receive it (which he has said in the past about emails that he’s denied receiving). When he doesn’t answer, I just keep forwarding the email asking him to reply. If this goes back to Court then I will have all my requests documented that I have continually asked to see the kids and he is persistently refusing. By asking him to reply by email, he has to put his reasons down in writing. Which of course are then also documented so there is no way that he can argue that he didn’t give the reasons that he has, in fact, given. Our whole relationship has always been plagued with the “you said “x”" , “no I didn’t – I said “y”", “no you didn’t” etc. We even discussed this in our 2 and a half years at Relate: how can 2 people sharing a conversation remember totally different things about what was said, in what tone, with what expression etc? Even before we divorced, we agreed that we would write things down in emails to send to each other so that we had a record of what each of us had said in a vain hope of avoiding rows about who said what. Clearly it didn’t work, hence the divorce……..!

Oh, and I forward all the emails and the replies to my lawyer for safe keeping in case there’s any denial that these requests were ever made……………….

However, I am no longer able to afford to instruct a barrister to represent me; therefore I am a “litigant in person”and don’t have to pay any more legal fees. That being the case, any correspondence or further Court applications won’t cost me any more money so I don’t have to worry about the fees. I think my husband will still be paying for his though……

Any other parents out there also having similar problems? Did any of you manage to find a clever way of solving this issue?

Please let me know or just keep hoping for me……………

As my readers will know, I’m an English mother with Bipolar who also happens to be a lawyer, but I’m NOT a family or mental health lawyer. Nor am I an expert in American Family law or mental health law. However, I am continuing to research much of the law governing mental health in the context of parenting children whilst suffering from Bipolar.

As such, whenever I find some useful information, I shall post it on the site and hopefully, the site will become increasingly informative and useful as a source of knowledge sharing with other sufferers and their families.

So here goes: Wikepedia’s explanation of the Californian Welfare and Institutions Code:

5150 is a section of California’s Welfare and Institutions Code which allows a qualified officer or clinician to involuntarily confine a person deemed a danger to himself, herself, and/or others^[1] and/or gravely disabled. A qualified officer, which includes any California peace officer, as well as any specifically designated county clinician, can request the confinement after signing a written declaration. When used as a term, 5150 can informally refer to the person being confined or to the declaration itself.

//

 The process

Confinement under section 5150 lasts for up to 72 hours from the time the declaration is written. WIC 5151 requires an assessment prior to admission to the facility in order .. to determine the appropriateness of the involuntary detention. During the period of confinement a confined individual is evaluated by a mental health professional to determine if a psychiatric admission is warranted. Confinement and evaluation usually occurs in a county mental health hospital or in a designated Emergency Department. If the individual is then admitted to a psychiatric unit only a psychiatrist may rescind the 5150 and allow the client to either remain voluntarily or be discharged.

On or previous to the expiration of the 72 hours the psychiatrist must assess the client to see if they still meet criteria for hospitalization. If so the client may be offered a voluntary admission, if it is refused then another hold (the 5250) must be written to continue the involuntary confinement of the client. If the 72 hour timeframe has elapsed before the client is offered a voluntary admission or placed on the 5250 then the client must be immediately released.

A 5150 written by a peace officer is valid in any county in California, therefore a client could be moved from one county to another according to available resources. When written by a designated clinician the hold is only valid in that county. The designated clinician is also only able to write a 5150 while working in the facility they are employed at unless they work as part of a Psychiatric mobile response team.

Contesting the hold

The person under a 5150 hold has a limited ability to contest the legality of the hold. While the person has the right of demanding a writ of habeas corpus, it is up to the county public defender whether to file it or not. Since such a writ may take a day or two to file, the public defender usually chooses not to as the hold would expire before the anticipated court date.

 5150 criteria

The criteria for writing requires probable cause. This includes danger to self, danger to others together with some indication, prior to the administering of the hold, of symptoms of a mental disorder, and/or grave disability – as noted below. The conditions must exist under the context of a mental illness and the person must be refusing psychiatric treatment.

1. Danger to self – the person must be an immediate threat to themselves, usually by being suicidal. Someone who is severely depressed and wishes to die would fall under this category.
2. Danger to others – the person must be an immediate threat to someone else. A person hearing voices telling them to kill someone would fall under this category.
3. Gravely disabled
   1. Adult – the person (over 18 years old) is unable to provide for their food, clothing, and/or shelter – and there is no indication that anyone is willing or able to assist them in procuring these needs. This does not necessarily mean homeless, as a homeless person who is able to seek housing (even in a temporary shelter) when weather demands it would not fall under this category.
   2. Minor – the person (under 18 years old) is unable to provide for their food, clothing, and/or shelter – even if these are supplied directly.
4. Mental disorder Undefined by statute or regulation. On page 14 of the LA County LPS Designation Manual it is stated that The initiator must be able to articulate behavioral symptoms of a mental disorder either temporary or prolonged (People v. Triplett,(1983) 144 Cal. App. 3d 283.)

Required documentation

There are two legal documents, the 5150 application itself and the patient advisement form (5157(c)). The LA County LPS Designation Manual stipulates that, prior to the completion of the 5150 application, the initiator must conduct and document a face-to-face interview with the patient. On the 5150 application, the initiator is required to ..give sufficiently detailed information to support the belief that the person for whom the is in fact a danger to others, a danger to himself/herself and/or gravely disabled. The 5150 Application contains the words …as a result of a mental disorder.. but does not stipulate documentation of evidence of ..behavioral symptoms of a mental disorder….., defined in People v. Triplett (1983) as a necessary part of probable cause. The 5150 Application requests no explicit documentation of the required face-to-face interview.

 Patient rights while under section 5150

Patients admitted under section 5150 retain all rights under the Lanterman-Petris-Short Act. With the exception of being able to freely leave the facility they are placed in, patients have all rights accorded to a voluntarily admitted client. This includes the rights to:

• humane care
• religious freedom and practice
• participate in publicly supported education
• be free from abuse or neglect
• refuse medications except in emergency situations where danger to life is present; or by court order where the patient is found to lack the capacity to give or refuse informed consent via either a Riese hearing or via conservatorship.
• wear their own clothes
• visitors
• writing materials (including sending mail though they may be charged for postage)
• safe storage and access to their personal property
• have access to private phone conversations (though may be responsible for toll charges)
• speak with a Patient’s Rights Advocate
• go outside for exercise and leisure (usually in a fenced area)
• access their money in amounts for small purchases (vending machine, etc.)
• be free from discrimination

Good cause

Denying any of the patient’s rights requires good cause. Good cause being defined as the belief of the professional in charge of care for the client that the specific right would cause:

1. a danger to self or others; or
2. a serious infringement on the rights of others; or
3. serious damage to the facility;

and that there is no less restrictive measure that would protect against those occurrences.

Patient rights can not be denied as a condition of admission nor as part of a treatment plan such as being labeled a privilege or as punishment. Any time a right is denied under good cause it must be documented in the patient’s medical record and explained to the patient. The denial must be reviewed regularly and must be removed once good cause no longer exists.

References

1. ^ 5150 and You. Retrieved on October 3, 2006.Frequently asked questions about section 5150 at the Fresno County, California, Human Services System.

• (Revised April 2004) Rights for Individuals in Mental Health Facilities. California Department of Mental Health. 

External links

• California Welfare and Institutions Code, Sections 5150-5157
• contrast/compare with Rogers Law, concerning involuntary treatment/commitment in Massachusetts
• Los Angeles County LPS Designation Manual. This is a guide to procedures only. Accepted practice may vary significantly from these guidelines.

I will endeavour to comment on these pieces of legislation once I have researched them further. In the meantime, if any of you wish to add your own comments or experience relating to the Californian Code, please do so so that we can all share our knowledge.

 Thanks.

DIGG This
A Mum First and Foremost
[digg=http://digg.com/health/Bipolar_Mother_loses_Children_in_Vicious_Custody_Battle_at_the_High_Court]

The Story:

This is a story of a Bipolar mother who has been in a custody battle over her three children due to her Bipolar. This is the result of my ex-husband’s application to the Court for an Sole Residency Order seeking an Order that he alone should look after the children with me only having supervised “contact” with them. The reason cited for his application is that I am “incapable” of looking after the children due to my Bipolar.His application asked for me to only have supervised contact with them.

A 17 month battle ensued resulting in a 10 day hearing in the High Court in the Royal Courts of Justice. Despite hearing evidence from 3 experts in psychiatry and psychology  all of whom gave evidence to the Judge that I am perfectly capable of looking after the children, the Judge decided that, because of my Bipolar, I should not be allowed to be the main carer of the children. She ordered that the children should be the subject of a Shared Residency Order ie that their care should be shared between me and their father with  them having homes with both of us. Legally, that puts us both on equal footing when it comes to our legal parenting rights. However, the Judge decided that their main carer should be their father on the basis that he doesn’t have the illness and can therefore provide greater stability than I can. He was not put through any psychological or psychiatric assessment to determine whether he was capable, despite the fact that he has been violent to both me and the children. The children’s nanny has had not psychiatric or psychological testing and yet has been allowed to take over their care in preference to me. Their main carer is therefore my husband’s nanny as, the reality is, that he is at work most of the time that he should be there looking after them. He heads up a City law firm litigation department (he’s an ex barrister) and is therefore rarely at home before their bed time.

I was thrown out of our marital home by my Husband who succesfully applied for an Occupation Order, claiming that my presence in the house was causing “significant harm” to the children. The Judge who heard this application was the same judge who heard the Children’s Act custody dispute. She came into court saying that she hadn’t had time to read the papers for the application but that she didn’t need to as it was obvious that my staying at the home would damage the children. She sought to evict me without consideration as to my financial means. I had no capital with which to buy or rent another home until the matrimonial home was sold. My husband was fighting my maintenance claim saying he couldn’t afford to pay me any maintenance out of his £450,000 earnings. My work was not producing enough income to fund a rented property. She gave no consideration for the effect that evicting me from my home was going to have on me and my mental health.

I was given 2 days to pack all my stuff and leave. I had nowhere to go other than to my brother’s house. I have been living there for 18 months in his spare bedroom where me and my three children have to share a bed when they come to stay with me. Yet the Shared Residency Order means that the children are to have HOMES with both me and my husband. I was specifically advised that, under the Matrimonial Homes Act, there would be no inequality between my financial situation for me and the kids when they are with me and those of my husband when the kids are with him.

The reality is stark. I am without my own home at all whilst my husband continues to live in our 7 bedroomed matrimonial home. He has been left with 80% of his salary whilst I have been awarded 20% of his salary as maintenance for me and the children. This maintenance will stop in 5 years time. I have incurred debts of £450,000 which has now bankrupted me given the fall in the housing market. I have no capital left with which to buy a home for the children.

The judge considers all this to be a fair outcome!

My children’s thoughts and feelings:

The children’s thoughts and feelings were simply not taken into account. They did not give direct evidence to the Judge either orally or verbally – a point I discuss further below. They are devastated by the decision and miss me terribly. They do not understand the Judge’s contention that I am not well enough to look after them nor do they agree – they all think that I am a good mother who is perfectly able to parent them and indeed they desperately want me to be parenting them far more regularly. My daughter wants to come and live with me and yet no-one is listening to her; she has resigned herself to the fact that, eventually, she will be able to “vote with her feet” and that eventually her view will count.

They cannot understand why they are not allowed to see their mummy very often and don’t understand why nobody has listened to what they want. They keep telling me that they want to live with me and that they are heartbroken without me. My youngest said “Mummy, there’s no love in my heart when you’re not here with me”. She is regularly having nightmares and is wetting and soiling herself regularly. She is convinced that I no longer love her despite all my assurances that I do. She’s clingy and demands my constant attention when I am with her. Relatives observing her say that she is clearly suffering. My son (8) tells me he is often crying himself to sleep and now talks to me and others through his favourite soft toy. He follows me everywhere, (even into the loo!), not letting me out of his sight. I have nicknamed him “my little shadow”. He cries on the car journey to drop him back to his father, pleading with me not to let him take him away from me. My eldest child, 10 , still asks to sleep in bed with me when she is with me and cuddles me for dear life. She keeps asking when the Court will listen to her views and when she is allowed to “vote with her feet”. She has asked me to get her her own solicitor so that she can be listened to.

They all need their mummy – that much is clear. They love me regardless of my condition and tell me that they don’t believe that I am doing anything wrong to them or harming them in any way. They simply cannot understand it all.

Me and my Bipolar:

I was the children’s main carer for the 9 years leading up to this Judgement, some of this time I was the sole carer at home, some of the time I had nanny help.

I suffer from Bipolar 2 and have therefore never experienced a manic episode. I do not suffer from delusions,nor have I ever been psychotic. I am told that I have the mildest form of Bipolar and it is on the borderline of a diagnosis which is why it went undiagnosed for 16 years!

I have only been in hospital twice, both of which were voluntary admissions – I have never been sectioned. The first admission was for depression, during which time I was diagnosed with depression only. The second time was because the psychiatrist changed his diagnosis to Bipolar and wanted me to be in hospital for the introduction of Lamotrigine and because he was concerned that I might be going hypomanic on the anti-depressants. I was not manic according to me and to the admission notes.

I have never abused the children. I have no substance abuse problems, nor have I ever had any substance abuse problems) and don’t even smoke. I have no criminal record. I have a full, clean driving licence and have never been convicted of any driving offences.

I am fully medication compliant and my condition is fully stable with no relapses since I started on medication 4 years ago. I have been through 2 years of intensive Cognitive Behavioural Therapy (the recommended treatment for Bipolar). During the 6 years leading up to my hospitalisation and diagnosis, I was the children’s main carer and was being their mum without being on any medication or treatment as I hadn’t yet been diagnosed. Yet, I was still managing to look after them. The children were thriving at school with good school reports and the schools reported them to be well-adjusted, highly intelligent, popular, lovely children.

I have experienced 4 depressive episodes (no manic ones) since I was 22 (I’m now in my 40s), each of which followed a major life trauma. I experienced the first during my degree – I still graduated with an honours degree, went through my military training at Sandhurst, became an Army officer and rowed for my university, winning the National Polytechnic rowing regatta, so the depression didn’t hamper my functioning. I experienced my second episode at Law school, but still graduated and became a lawyer. I experienced my 3rd after the birth of my second child, but still carried on parenting my two children (aged 2 and newborn) whilst managing my third pregnancy whilst my son was only 6 months old. During this time, I oversaw the building works in our house and worked part-time.

My fourth episode resulted in my (voluntary) admission to hospital. I had three children in three years, my two year old son developed diabetes, I was working and we had knocked down our house and I was overseeing the rebuilding works. My husband had become physically violent towards me and our marriage was crumbling and high in conflict with a husband who was rarely at home. When he was at home, he was emotionally and psychologically abusive for quite a lot of the time. He was highly critical of my parenting and of my abilities as a wife and housewife – I rarely got anything right in his eyes. I collapsed from the pressure of it all.

I tell you the following about myself only to give you an idea of what I have managed to achieve during my illness when I wasn’t even diagnosed and was on no medication. These achievements did not seem to carry much weight for the Judge and did not convince her that I was able to lead a full, productive life and be competent.

I am a qualified lawyer and still manage to work. I am a regular speaker at conferences, have been a speaker on the Radio, and have had many articles published in both the broadsheets and journals. I am an ex Territorial Army officer, having passed through Sandhurst military academy and was in the TA for over 9 years, both in command roles and in organisational roles. I am a qualified mountain expedition leader, have won sailing races with the Army, ski, run, cycle and have led an expedition team across the Yukon in Canada, leading them through 5 weeks of arduous terrain on a 250 mile trek. I gained my legal qualifications by doing a distance learning course of a law degree whilst working full time.

I have many long-standing friends, all of whom say that I have never exhibited any form of mania, nor any substantial depressive symptoms. None of them could believe that I have been given this diagnosis.

Discrimination, prejudice, ignorance and Human Rights and the Law

I will write separately in detail about the law on the Children’s Act,the Disability Discrimination Act, the Human Rights Act, the United Nations Convention on the Rights of the Child and the other pieces of legislation. Being a lawyer I can strive to effect a change in the legislation. This will take a great deal of time and energy but I feel strongly that the law is not serving the interests of the children where a parent suffering from an illness is deemed incapable. The law I discuss here is my understanding and interpretation of it; I may be challenged on this but it is my view currently.

I believe that this whole situation and judgement is as a result of ignorance and a misunderstanding of the complexities of the condition; in particular the fact that there is an entire spectrum of manifestations of the condition from the extremely mild (as in my case) to the extremely severe. There is also an ignorance of the fact that there are two types of Bipolar: Bipolar 1 which is a mix of mania and mild depression compared to Bipolar 2 which is only hypomania but more severe depression. Clearly, the manifestations of these two types of the illness are very different and result in very different sets of behaviours of the individual sufferer and therefore the effect that this has on the family and especially the children.

Discrimination:

I also think that this case falls within the realm of mental health discrimination, prejudice and stigma by the Judge, my exhusband and his witnesses. There is still a high level of prejudice surrounding mental health conditions which is pervasive throughout our society and I aim, through this blog and my legal background and skills (I am a qualified lawyer), to fight it and challenge it through both the court system and the media.

I am fighting this issue as I now know that I am, unfortunately, one of many parents with this condition who is suffering from this kind of prejudice and losing custody of their children as a result. There are now many stories both on this blog and sent to me through my private email, which are heart-rending stories of parents having their children taken away from them as a result of their mental illness. Clearly, some parents are not well and struggle to find the right medication to stabilise their condition, some have substance abuse problems and some have such a severe form of the illness that they would find it very difficult to be a full time parent. However, there are many, many others who have managed to stabilise their condition such that it no longer impacts their day to day life in a debilitating way and these parents should not have their children taken away from them simply because they have a diagnosis of a condition which is not of their making, is not “their attitude, fault or fundamental flaw of personality” but is simply a disease which they are extremely unfortunate to have got.

There are parents with epilepsy, diabetes, cancer, alzheimers, paralysis, Down’s syndrome, Autism or any other illness which can be debilitating either physically hampering the way that they can parent their children or emotionally/psychologically debilitating, yet do these parents have their children taken away from them because they are ill? There are parents who have alcohol and drug problems yet these parents don’t usually have their children taken away from them. Why should people with mental health problems be deemed to be automatically more incapable of parenting their children than these other sufferers?

My son has Type 1 diabetes (a form which is NOT the result of a poor diet), and I witness his extreme fluctuations in mood and functioning. When his blood sugar levels fluctuate, his mood fluctuates: he can become aggressive, irritable, bad-tempered, very fatigued, have headaches, feels nauseus, can’t concentrate, and at times can’t function at all. All this happens on a daily basis and yet how many diabetics have their children taken away from them on the basis that they are “incapable” of looking after their children?

They don’t, because every one would argue that that would be discriminatory and unnecessary. And yet it is allowed to happen to the mentally ill.

The United Nations Convention for the Rights of A Child.

This states clearly that all children have the right to be have their voice heard. Yet the Judge did not hear my children’s opinions at all. They did not give evidence either orally or in writing. They were deemed to be “too young” and yet there is no age stipulation in the legislation. It simply gives guidance that evidence of children will be taken into account if they are deemed to be sufficiently mature enough to understand the issues involved. What does that mean? Who makes that assessment? Who funds the children’s separate legal representation? A CAFCASS officer was the only person who heard what the children had to say.

CAFCASS: The Children and Family Court Advisory and Support Service

Apparently, the Court case was all about what was in the best interests of the children. Yet my children were interviewed by CAFCASS on only 1 occasion for approximately 50 minutes. They gave evidence to the CAFCASS officer that they want their mummy. My youngest daughter told CAFCASS that she wanted to live with me, my son said he wanted to live with both of us and my eldest daughter said she wanted to live with me but see a lot of her father. CAFCASS did not report this properly and there is no transcript taken of the interview so I cannot prove what I heard the children say when I was in the room with them when they said it. It is my word against the CAFCASS officer’s report.

The CAFCASS report was, in the judge’s own words “appalling” and highly deficient in its thoroughness and findings yet the proceedings continued, despite the fact that the Report was the only truly objective evidence on what the children wanted. The judge told the CAFCASS officer that it was the most depressing example of how badly a CAFCASS investigation could go, yet it was still admitted as evidence. He didn’t even interview the schools or my new partner or come to the home to see if the allegations of my disgusting housewifery were true.

The Judge, accountability and Appeals

Astonishingly, a Judge is exempt from the provisions of the Disability Discrimination Act when acting in their judicial capacity! I simply do not understand why a Judge should be exempt from being held to be potentially discriminatory and held accountable for that bias. I am told also that I cannot appeal this decision as there are only 2 grounds for appeal:

1. That the Judge misapplied the law: well, she didn’t because the Children’s Act is entirely silent on the point of how a Judge should assess a parent’s capability or indeed a parent suffering with mental health issues.

2. That the Judge exercised her “judicial discretion” in such a way that no other judge would have exercised it in that way!. Clearly, an individual’s subjective discretion is such a nebulous concept that it is extremely difficult to criticise it. I was also advised that judges very rarely criticise another judge’s exercise of this judicial discretion. I find this an extraordinary protection to afford judges.

You also have to have leave to appeal and this leave has to be sought from the Judge herself. In other words, the judge who made the decision that you wish to appeal, has to agree that you can appeal it! She has reserved the case to herself too, which means that if I wish to bring a fresh application under the Children’s Act for the residency issue to be re-evaluated, I will get the same Judge!

I simply fail to see how this is justice or how it prevents miscarriages of justice from happening as there seems to be little room for challenging the decisions of the judges.

Human Rights

There are also Human Rights issues in all of this. There has, in my view, been a breach of various articles in the Human Rights Act including a breach of privacy, a breach of my right to a family life and a unfair trial.

Breach of privacy:

I was ordered to make a full disclosure of ALL my medical notes, both in patient and out patient and regardless of whether they pertained to my condition. They were also allowed to see ALL my psychology session notes. My computer was gone through by my husband as were all my mobile phone calls and texts and he was permitted to give evidence on the findings of his investigations. He had me followed by a private investigator.

Right to a fair trail

Whilst all of my medical history was obtained and given in evidence, none of his medical notes had to be disclosed, nor his notes from his psychology sessions that he had been having. No medical reports were conducted on him. This meant that the Judge heard all about my medical history and nothing about his.

I spent a week listening to my medical notes being taken to pieces by his barrister: excerpts from my psychology sessions, from my psychiatric assessments, from my previous medical history.I was absolutely destroyed as a person and as a mother by my husband, his witnesses and his barrister. I spent an entire week not being allowed to speak at all but having to  listen to my exhusband’s barrister ask his witnesses to explain certain behaviours and thoughts and emotions that I had as though I was completely invisible and as though they were able to understand what was going on in my head. It was deeply humiliating and degrading and very largely untrue and exaggerated. I then endured 3 days of cross-examination by a barrister who bullied and humiliated and taunted me in the most disgraceful manner about my illness, my behaviour and my emotional and psychological state. His entire aim was to make me seem like a complete danger to myself, to my children, to claim that I had a fundamental personality disorder despite having been told by the experts that I did not suffer from any personality disorder. My whole inside of my mind was taken to pieces by people who knew nothing about my illness and yet claimed that they “knew” me well enough to give evidence about my condition.

My husband’s legal team knew that the only way to ‘convince the Judge that I was the incapable, “mad” wife and mother that he said I was, was to try to focus on the period running up to and following on from my hospital admission and to assert that this was the norm. This he did with devastating success. He was able to focus the Judges attention away from all the years of my parenting prior to admission (ie 6 years) and only focus on the 4 months leading up to my admission and the 12 months following it.

I asked my legal team to include all his own bad behaviour but I was advised that we shouldn’t “sink to his level”.His violence towards me resulted in the police being called out to our home, yet no police records were brought into the trial. His drug taking in the past was not brought up, nor was his visits to places he shouldn’t have been visiting. None of this was considered important in terms of assessing his own personality and fitness to parent.

The witnesses were allowed to give evidence which was outside their realm of expertise ie they were not psychiatrists or psychologists and yet they were allowed to give evidence on my state of mind, on my personality and behaviour and were allowed to contend that I was mentally ill and that I had a personality disorder.

Law on expert evidence

The law on evidence is usually that no witness is allowed to give “expert evidence” ie evidence which should only be given by an expert in their field. So, for example, in a hearing on negligence of a construction of a building, a lay person cannot give evidence on whether or not the building had been constructed properly or not as they are not experts in construction. Yet, in a case involving Bipolar, the witnesses were allowed to give evidence on my state of mind, on my emotional background and on my thoughts. The Judge stated in her Judgement that the evidence of my neighbour was “particularly persuasive” yet my neighbour knows nothing about my condition.

This was therefore not a fair trial in my view. There was a huge disadvantage to me and none to him as he did not undergo any of the same scrutiny into his personality, his thoughts, behaviours etc yet mine were gone through in minute detail.

The Children’s Act – guidance on mentally ill parents

The Children’s Act is totally silent on the issue of parent’s with mental health conditions. It gives no guidance whatsoever to either the Judge or to CAFCASS on how to assess a parent’s capabilities when they are suffering from a mental health problem.

The Judge is given the sole responsibility for assessing any evidence. This is despite the fact that the Judge has no psychiatric or psychology training. They are given the jurisdiction to decide on issues which are beyond their training and experience.  Neither are they qualified in child psychology yet they are allowed to adjudicate on the effects of a particular parent’s illness on a child.

There is no panel of judges and experts; simply one judge.

How is this a “fair trial” and how is it justice?

“Personality v symptoms”

Because many of the symptoms of the illness can be mistaken for inherent personality traits, this is the main barrier to people being able to see the person for who they are rather than as a cluster of mistaken personality traits. The fatigue associated with depression is perceived as “laziness”, the lack of communication as “being anti-social”, the anxiety as being “over-sensitive” etc.

The mainstay of therapy for Bipolar consists of helping the sufferer develop “coping strategies” to stave off depression and minimise stress. Each sufferer has their own “triggers” ie stimuli, which will bring on either an episode of depression or an episode of mania/hypomania. During my therapy, I recognised that stress was a major trigger for me so I learnt to avoid taking on too much eg too much work, too much housework, too much organising social activities etc. I also learnt that a coping mechanism for stress was to go running, listen to music and do other pleasurable activities to bring balance back into my life.

During my recovery from my admission to hospital with depression, I was advised to “put my recovery first” for a while. This was interpretated by my husband and others as me being “selfish”, “self-absorbed” and not interested in being a wife and mother. I was “lazy”. On the one hand I was being advised by my medical team to put my recovery as the highest priority, on the other hand I was being criticised roundly by my husband and others for being “selfish” and “lazy”.  This contradiction was causing even further stress and was making my recovery harder. To have a husband who says, on the one hand that he understood and supported me and yet was highly critical when I implemented my coping strategies, was very difficult to cope with.

Noise is another trigger for me and London is extremely noisy and crowded. I therefore sought to regularly escape from the noise and crowds and travelled down to the seaside to get away. This was considered “unnecessary”, “self indulgent” “putting my own needs before my children’s”, “irresponsible”. The Judge decided that my reasons for doing this were “disingenous – as it was really for my socialising”. Yet this need to escape the noise and stress of my town was highlighted as a positive coping strategy by my psychologist.

All these symptoms and coping strategies were misinterpreted and I was condemned as a result.

My Bipolar Partner

My new partner has Bipolar 2 – a mild form like mine with no mania, delusions or psychosis but depressive episodes and anxiety. We met in hospital and formed a close bond as a result of our mutual understanding and empathy of our respective suffering and struggles to come to terms with our condition. He was diagnosed at the same time as me and he and I were the only people we each knew with the condition. We relied on each other during the first year of diagnosis to support, inform and listen to each other. He was discharged after the first week of my admission yet he came back to visit me, take me for walks and to the cinema, send me encouraging texts and so on. My husband visited me twice during my 5 weeks of hospitalisation, saying that he was “too busy” looking after the children and working to find the time to come and visit me. Not surprisingly, I came to rely increasingly on my new found fellow sufferer for support rather than my husband. After a year, I decided I wanted to leave my husband and be with someone who understood me and my condition and be fully accepting of the limitations it might impose on me.

My husband immediately issued proceedings against my new partner for a Prohibited Steps Order ie an application to the Court to prohibit my partner from seeing the children claiming that he was a danger to himself and a potential danger to the children. No supporting evidence was submitted with this application – it was based purely on my husband’s contention. This application was in place for 17 months before Judgement was handed down by the Judge.

My partner was prevented from seeing the children for this entire time simply based on  my exhusband’s  assertion that my partner had Bipolar and therefore shouldn’t be exposed to the children. He has no criminal record, no alcohol or drug abuse and has never hurt or threatened the children in any way. But he was still not allowed to see them until the Judge ruled that he could.  Unlike criminal law “innocent until proved guilty”, in these proceedings my partner was “ill and dangerous, until proved otherwise”.  This is despite the fact that the children adore him and kept asking why they couldn’t see him.

He went through hell in those 17 months; having been made a party to the proceedings he was required to be a witness and therefore be interviewed by my lawyer and prepare witness statements. He had to be examined by a psychiatrist to prepare an expert witness report, he was in the witness box for 2 days and his medical notes were trawled through in court. Unsurprisingly, he found this deeply humiliating, insulting and degrading. My husband’s barrister did everything he possibly could to depict him as unstable and incapable of being a parent.

When the Judge did hear the application, she threw it out on the basis that it was unfounded. Yet, during this 18 month period awaiting judgement, my partner was forbidden to see the children. This also meant that he was brought to trial where full disclosure of his own medical notes were ordered and he was cross examined for 2 days. He was again bullied and humiliated by the barrister cross examining him, and being told repeatedly that he was “unstable” and clearly not capable of parenting.

This was also used as a reason for my children not coming to live with me: the two of us together are clearly unable to care for children, according to the judge. But why?

• Neither of us has a criminal record.
• Neither of us has a drug or alcohol problem and never have had.
• Neither of us have abused the children in any way, nor threatened them.

Yet we are considered to not be capable of looking after the children, based on our mental health condition.

Kids need mums:

The vast majority of people believe that children need their mothers and not just on an ad hoc basis, but on a regular one with a great deal of love, nurturing and understanding of their needs on the mother’s part. The mother-child bond is fundamental, deep and irreplaceable. All the psychological studies into the importance of the role of the mother bears testament to my contentions. My children desperately want me; they are unutterably sad that I am forced to see them so rarely and are emotionally and psychologically suffering as a result.

This blog is my attempt to highlight that all parents, regardless of their illness, are needed by their children and that discrimination, ignorance, stigma and a lack of empathy is are all in the way of blocking those children from their parents.

Any comments, or offers of support would be greatly appreciated.

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