Eleanor Roosevelt, 1958

'Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person... Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.' Eleanor Roosevelt, 1958

The Small Places has moved...

The Small Places has moved to a new home here, including all the old posts. Any posts after 6th March 2014 will appear on the new website, but old posts are preserved here so that URLs linking here continue to work. Please check out the new site.

Sunday, 24 February 2013

A guide for litigants in person in the Court of Protection (and some news)

Those fantastic folk at 39 Essex Street have done it again.  Court of Protection barrister Victoria Butler-Cole has produced a guide to the Court of Protection for litigants in person (or self-represented litigants, or, in plain English, folk without a lawyer).  You can find it at their Court Guides blog.  I had a look through, and it looks brilliant - really clear, simple language, but covers the questions you won't find answered anywhere else online.  It also includes links to further resources (like their online case law index).  If you have any suggestions for questions you'd like to see answered in the guide, I'm sure they'd be more than happy to consider it for later revisions.  Spread the word!

And, in other news, I'm scribbling this post whilst waiting for a flight to Ireland... where I am about to take up a six month postdoctoral position with the fantastic Centre for Disability Law and Policy at NUI Galway.  The CDLP is, of course, the home to many fantastic researchers and campaigners on legal capacity, mental health law and disability rights issues, and I am really looking forward to being a part of that team and learning from them.  I will be working on projects relating to legal capacity and access to justice, amongst other things, so watch this space for many more posts on Article 12.

Oops, there's the call for my flight!

Ps. If you're trying to get hold of me, my Exeter email should continue to work for the next few months, but you might get a nasty shock when you check your bill if you phone my mobile.

Thursday, 21 February 2013

Capacity, care and the chemical cosh

Researchers at Queen's University Belfast have published a study in the Journal of the American Geriatrics Society which casts light on the use of antipsychotic medications for older people (Maguire, A.; Hughes, C.; Cardwell, C. & O'Reilly, D. (2013) 'Psychotropic Medications and the Transition Into Care: A National Data Linkage Study', Journal of the American Geriatrics Society 61(2) p 215-221.).

It has been known for some time that antipsychotic medications are used to excess upon people with dementia.  In 2009 Professor Sube Banerjee wrote a report for the Department of Health in which he reported that they brought no benefit to patients in 80% of cases, and estimated that:
...we are treating 180,000 people with dementia with antipsychotic medication across the country per year. Of these, up to 36,000 will derive some benefit from the treatment. In terms of negative effects that are directly attributable to the use of antipsychotic medication, use at this level equates to an additional 1,620 cerebrovascular adverse events, around half of which may be severe, and to an additional 1,800 deaths per year on top of those that would be expected in this frail population.
The study published this month is important because, for the first time, it has demonstrated that overprescribing of antipsychotic medications is not a problem for people with dementia per se, but for older people being admitted to residential care.  By auditing prescriptions for the over 65's in the UK, they were able to show that:
Psychotropic drug use was higher in care homes than the community; 20.3% of those in care homes were dispensed an antipsychotic in January 2009, com-pared with 1.1% of those in the community. People who entered care had higher use of psychotropic medications before entry than those who did not enter care, but this increased sharply in the month of admission and continued to rise. Antipsychotic drug dispensing increased from 8.2% before entry to 18.6% after entering care...
So the use of this non-beneficial, sometimes lethal, 'chemical cosh' is somehow linked to institutional care.

Monday, 11 February 2013

Medical and social work students' knowledge of the law

If you're involved in teaching medical or social work students I really recommend you get your hands on a paper called 'Exploring UK medical and social work students’ legal literacy: comparisons, contrasts and implications' by Michael Preston-Shoot and Judy McKimm, published in the journal Health and Social Care in the Community.  It tracks the legal knowledge and skills of medical and social work students during their studies, measuring their knowledge and confidence in those areas of law which impact upon their work.  It's a very interesting read.  A few findings stood out to me, which say a lot about the way law is taught to these students and how their perceptions of it change:

Friday, 8 February 2013

The new playing field

I have been thinking about relational autonomy quite a bit lately. It comes up more and more in writings on legal capacity. In England and Wales there are, with a few honourable exceptions, two distinct literatures around legal capacity: a literature about the Mental Capacity Act 2005 (MCA) - how progressive and empowering and autonomy promoting it is - and a more international literature connected with the UN Convention on the Rights of Persons with Disabilities (CRPD) – and in particular Article 12 – about how dreadful laws like the MCA are, how regressive, disempowering, autonomy-denying. These literatures seem to have evolved quite separately, almost always cheerfully ignorant of each other’s concerns, and interestingly – both increasingly pray in aid ideas connected with what philosophers call ‘relational autonomy’. 

Relational autonomy is an idea which emerged in feminist philosophy over the last couple of decades. In debates about the MCA and the CRPD, autonomy is often used as a kind of analogue to the legal concept of ‘capacity’ – the ability to make decisions for oneself. Scholars of legal capacity who make reference to relational autonomy, therefore, are simply arguing that our ability to make (legally recognisable) decisions is somehow connected to our relationships with others. Unfortunately, most scholars of legal capacity simply stop there – as if the consequences of this are simply obvious