John Hunt (psychiatric patient)
Encyclopedia
John Hunt an Irish citizen, is a writer, artist and an involuntarily detained
Involuntary commitment
Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....

 psychiatric patient. The conditions of Hunt's detention have been the subject of a sustained campaign by his former partner and mother of his child Gráinne Humphrys. He was committed as an involuntary psychiatric patient in 2005 and was detained at a secure psychiatric unit in Cork
Cork (city)
Cork is the second largest city in the Republic of Ireland and the island of Ireland's third most populous city. It is the principal city and administrative centre of County Cork and the largest city in the province of Munster. Cork has a population of 119,418, while the addition of the suburban...

 until August 2011 when he was transferred to the Central Mental Hospital, Dundrum
Dundrum
Dundrum is the name of several places:in Ireland:*Dundrum, Dublin, a suburb of Dublin city.**Dundrum Town Centre, a shopping centre*Dundrum, County Tipperary** the Dundrum meteorite of 1865, which fell in Munster, Ireland...

, Dublin. Until 2010 he was not granted leave for any temporary release from the Cork facility to visit his family. As a result of the campaign of his former partner that year the Cork hospital allowed Hunt six hours unsupervised leave every two weeks. However, following a violent altercation with a psychiatric nurse this leave was rescinded and Hunt was transferred to the main Irish forensic
Forensic psychiatry
Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...

 psychiatric unit in Dundrum.

Early life

At the time of Hunt's birth, his family lived in the small, coastal town of Greystones
Greystones
Greystones is a coastal town and small seaside resort in County Wicklow, Ireland. It is located on Ireland’s east coast, south of Bray and south of Dublin , with a population in the region of 15,000....

 in Wicklow
Wicklow
Wicklow) is the county town of County Wicklow in Ireland. Located south of Dublin on the east coast of the island, it has a population of 10,070 according to the 2006 census. The town is situated to the east of the N11 route between Dublin and Wexford. Wicklow is also connected to the rail...

, Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

. His father was a violent alcoholic and his mother had few supports in raising her children. His four year old brother drowned when he was eleven years old. Thereafter, Hunt began getting into fights and taking drugs. Humphry's attributes these behaviours to his history of trauma
Psychological trauma
Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...

 and low self-esteem. His first breakdown occurred shortly after the end of his relationship with his first long-term girlfriend.

Humphrys has observed in relation to Hunt's history that, 'trauma and loss, amongst other factors, form the bedrock of John’s problems — his so-called attachment disorder
Attachment disorder
Attachment disorder is a broad term intended to describe disorders of mood, behavior, and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood, resulting in problematic social expectations and behaviors...

 and paranoid schizophrenia.'

Involuntary committal

John Hunt is an artist and writer and a resident of Cork
Cork (city)
Cork is the second largest city in the Republic of Ireland and the island of Ireland's third most populous city. It is the principal city and administrative centre of County Cork and the largest city in the province of Munster. Cork has a population of 119,418, while the addition of the suburban...

, Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

. In 2005 he experienced a breakdown while his then partner, Gráinne Humphrys, was pregnant with their child, Joshua. Frightened for his safety, Hunt's mother, Marion Hunt, instigated committal proceedings against her son. As he was deemed a danger to himself, this led to his involuntary committal
Involuntary commitment
Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....

 at the Carrig Mór Centre, a Psychiatric Intensive Care Unit (PICU) in Shanakiel, Cork. Subsequent to his admission, he received a variety of diagnoses including drug-induced psychosis, bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

 and schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. He remained an involuntary in-patient of this facility until August 2011 under the legal provisions of the Mental Health Act 2001
Mental Health Act 2001
The Mental Health Act 2001 sets out the legal procedures for admissions and treatment in approved centres. It aims to protect the rights of everyone using the mental health services. It aims to ensure the patient's best interest is the most important aspect of mental health...

 when he was transferred to the Central Mental Hospital, Dundrum.

Carraig Mór Centre

The Carraig Mór Centre is a two-storey building that was formerly part of the now defunct Our Lady's Hospital (Cork District Mental Hospital). It has a small, gated, overgrown garden to its rear and is situated adjacent to a golf course. The first floor, containing twenty-one beds, is occupied by long-stay patients who were transferred from the old mental hospital. These patients, ranging in age from thirty to seventy-eight years, were in 2010 all voluntary patients. No patient has been admitted to this ward since the early 1990s.

The ground floor, where Hunt was detained, is a secure psychiatric unit under the management of a forensic psychiatric
Forensic psychiatry
Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...

 team. It has eighteen beds. The people resident there are all involuntary patients and are deemed to have behavioural difficulties arising from their mental condition. The use of benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...

s has been recorded as high in this unit, polypharmacy
Polypharmacy
Polypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....

 is common and a significant number of patients are on high dose antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...

 medicine. The unit lacks a clinical psychologist
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...

 and, according to a 2010 report on the facility by the Inspector of Mental Health Services, 'This was a serious defect in a forensic service and a psychiatric intensive care unit'. The inspectorate also stated in relation to this matter that, 'The decision by the Health Service Executive
Health Service Executive
The Health Service Executive is responsible for the provision of healthcare providing health and personal social services for everyone living in Ireland, with public funds. The Executive was established by the Health Act, 2004 and came into official operation on January 1, 2005...

 not to have a psychologist on a forensic team and in a PICU where behavioural problems are common is incomprehensible and short sighted and not in keeping with best practice'. While noting that the staff of the facility did their best to provide rehabilitation
Psychiatric rehabilitation
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and usually simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual who has a psychiatric disability...

 services, the inspectorate was critical of the absence of 'a step-down unit and adequate rehabilitation' for patients'. 'It was obvious', noted the inspectorate, that these deficiencies resulted in residents 'staying longer in Carraig Mór than was necessary'.

PICUs are intended as short stay, secure units for patients with disturbed behaviour during acute phases of illness. Conversely, the guidelines issued by the UK's Department of Health state that the appropriate therapeutic setting for patients experiencing chronic behavioural disturbance is a low secure unit.

In July 2011, the Junior Minister with responsibility for Mental Health and Labour Party
Labour Party (Ireland)
The Labour Party is a social-democratic political party in the Republic of Ireland. The Labour Party was founded in 1912 in Clonmel, County Tipperary, by James Connolly, James Larkin and William X. O'Brien as the political wing of the Irish Trade Union Congress. Unlike the other main Irish...

 T.D.
Teachta Dála
A Teachta Dála , usually abbreviated as TD in English, is a member of Dáil Éireann, the lower house of the Oireachtas . It is the equivalent of terms such as "Member of Parliament" or "deputy" used in other states. The official translation of the term is "Deputy to the Dáil", though a more literal...

, Kathleen Lynch, announced that the Carraig Mór Centre would eventually be shut down. She stated that this would be in compliance with government mental health policy as outlined in the 2006 policy paper, A Vision for Change, which foresees the closure of all large psychiatric in-patient facilities. However, she conceded that there were "no plans as of yet" for the centre's closure but added that "that's not to say that there won’t be".

Treatment

Since his committal Hunt has been forcibly medicated
Involuntary treatment
Involuntary treatment refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections...

 with a diverse range of psychoactive drug
Psychoactive drug
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...

s including the typical antipsychotic
Typical antipsychotic
Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis...

s Clopixol
Zuclopenthixol
Zuclopenthixol , also known as zuclopentixol, is a typical antipsychotic drug of the thioxanthene class...

 and Largactil
Chlorpromazine
Chlorpromazine is a typical antipsychotic...

, the atypical antipsychotic
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...

 Solian
Amisulpride
Amisulpride , is an atypical antipsychotic used to treat psychosis in schizophrenia and episodes of mania in bipolar disorder. In small doses it is also used to treat depression. It was introduced by Sanofi-Aventis in the 1990s.-Pharmacology:Amisulpride functions primarily as a D2 and D3 receptor...

, benzodiazepines and sleeping tablets. The use of liquid Largactil has contributed to the decay of his teeth. Humphrys, describing the effects of the medication, has stated that, 'Sometimes he is yellow in the face from all the meds and he is now incontinent. He's completely over-medicated'. This medical regime led to a serious decline in his physical health and it is reported that both his kidneys and liver have been affected. Former Green Party
Green Party (Ireland)
The Green Party is a green political party in Ireland. It was founded as the Ecology Party of Ireland in 1981 by Dublin teacher Christopher Fettes. The party became the Green Alliance in 1983 and in 1987 was renamed to its current title in English...

 Senator, Dan Boyle
Dan Boyle (politician)
Dan Boyle is an Irish Green Party politician and party chairperson. He was a Teachta Dála for Cork South Central from 2002–07 and was a member of Seanad Éireann from 2007–11.-Early life and education:...

, visited Hunt at the Carraig Mór facility in the summer of 2010. Senator Boyle acknowledged that he was 'physically cared for' but expressed concern 'about the overriding culture of excessive medication there'. He also noted that Hunt 'was only allowed minimum contact with the outside world' and that he did not have access to a rehabilitation programme.

Humphrys argues that Hunt's treatment at the facility damaged him mentally and physically and she has characterised the mental health system as punitive and fostering dependency in patients. She has also alleged that her former partner suffered in the facility as he has been perceived as non-compliant.

Detention

The hospital authorities at Carraig Mór considered Hunt a 'chronic' patient and 'suitable' for long-term hospitalisation. His prolonged psychiatric detention has been against the express wishes of his family. Up to the summer of 2010 he had not been allowed outside of the Cork psychiatric centre since his attendance at his son's christening four years previously.

Three days after Senator Boyle's visit to Hunt he called for a debate in the Seanad
Seanad Éireann
Seanad Éireann is the upper house of the Oireachtas , which also comprises the President of Ireland and Dáil Éireann . It is commonly called the Seanad or Senate and its members Senators or Seanadóirí . Unlike Dáil Éireann, it is not directly elected but consists of a mixture of members chosen by...

 on 'the culture of mental health and psychiatric care services' in Ireland. In his address Senator Boyle referred to his visit to the Cork psychiatric hospital and the fact that Hunt had only seen his son outside of that institution once in the previous four years. He also referred to a twenty-six year old female patient that he had met on the same visit. She had, he said, been in detention for five years ("and I will define it as detention") and, he continued, 'One of the reasons for her continued detention is some person medically defined her as being in danger of becoming promiscuous if she ever lived in the outside world'.

Visiting conditions

Family visits at Carraig Mór were carried out in a small room at the facility that has been described as "cramped" and "uninviting". The room was constantly by a closed circuit television system and often other families were present during their visits. Referring to these conditions in interviews conducted in 2010 Humphrys stated that, "We have been forced to have our family relationship in this small room for four years now". She also said that, “The room has surveillance cameras all around it and there is no such thing as privacy there. You often find you are stuck in the same room as other families trying to visit their loved ones. It’s heartbreaking for Josh who really pines for his father and all John wants is the chance to get his life back in shape in normal surroundings.”

Campaign: 'The Incarceration of John'

In 2007 Humphry's mounted a campaign seeking to free Hunt from 'from his chemical straitjacket' and to challenge coercive practices and forced treatment in psychiatry. She advanced the campaign through new and traditional media and established an online petition in support of her cause. In 2010, following the campaign's expanded media presence and Senator Boyle's visit to Carraig Mór, Hunt was granted day release without supervision. Hunt was allowed a six hour pass every two weeks and, according to Humphrys, this reconnection with the world outside of the secure psychiatric hospital
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

 gave him 'new hope for his future'.

Letter to Carraig Mór

Reflecting on Hunt's experience of the mental health system as a patient and her own as the partner and advocate of a psychiatric patient, Humphrys wrote to the medical authorities of the Carraig Mór Centre in early 2011 outlining her grievances.

Proposed transfer to the Central Mental Hospital

Hunt's fortnightly passes were rescinded following an incident in June 2011 when he struck a male member of staff. The authorities at the Carraig Mór Centre also barred all visits to Hunt by non-family members. According to Hunt's mother, the medical authorities at Carraig Mór failed to investigate either the context of the assault or Hunt's emotional condition at that time. When the incident occurred Hunt was talking to his son on the telephone as it was his fifth birthday. He had just broken up with his partner and, according to his mother, "he was frustrated and drugged up." Another patient at the facility requested to use the telephone and a psychiatric nurse asked Hunt to end his telephone call. At this point Hunt assaulted the nurse. Humphreys has said that Hunt's behaviour was due to the regime of forced treatment and over-medication.

The authorities at Carraig Mór reported the incident to the Gardaí
Garda Síochána
, more commonly referred to as the Gardaí , is the police force of Ireland. The service is headed by the Commissioner who is appointed by the Irish Government. Its headquarters are located in the Phoenix Park in Dublin.- Terminology :...

 (the Irish police force) and also sent a report to the Mental Health Commission. The Commission subsequently directed that the incident should be addressed by a Mental Health Tribunal. This tribunal ruled that Hunt should be transferred to the Central Mental Hospital, Dundrum, which is the main forensic psychiatric facility in Ireland. Although Hunt's solicitor, Mr Eamonn Moloney who was selected by his family and is "known and liked by" Hunt, is a member of the Mental Health Commission's "tribunal legal board" he was not appointed by the Commission to attend this tribunal session. His family also were not allowed to attend the internal hearing. The family have queried why they were not consulted about the decision to transfer Hunt. Humphreys has criticised the tribunal system as "a closed shop". One week after the incident Hunt's mother attempted to visit her son at Carraig Mór but was denied entry to the facility.

The Irish Health Service Executive
Health Service Executive
The Health Service Executive is responsible for the provision of healthcare providing health and personal social services for everyone living in Ireland, with public funds. The Executive was established by the Health Act, 2004 and came into official operation on January 1, 2005...

 has responded that it is the goal of the mental health services to “work in a collaborative way with patients and their families to ensure the best outcome possible for people who need mental health services”. They also stated that, “All patients detained under the Mental Health Act have access to independent legal advice. Their detention under the mental health act is reviewed at regular intervals by an independent mental health review tribunal. This tribunal has the power to end the patient’s detention".

Prior to his transfer Humphreys stated that she and Hunt's family were apprehensive about the plan to relocate him but that they remained hopeful that better rehabilitative services would be available to him in Dundrum than were accessible at Carraig Mór. Characterising Hunt's own attitude towards his impending removal to the Central Mental Hospital, Humphreys said: "He is afraid about it, and very worried to leave Carraig Mór, as it has been home for almost six years. It is much further away from his family and visiting will be very difficult. But at the same time, he is a little bit excited about something new". Hunt was reported to be worried, however, that he might never be released following his transferral. John McCarthy, a mental health campaigner and the founder of Mad Pride
Mad Pride
Mad Pride is a mass movement of mental health services users and their allies. The first known event specifically organized as a Pride event by people who identify as psychiatric survivors/consumer/ex-patients was in Toronto, Canada when it was called "Psychiatric Survivor Pride Day", held on...

 Ireland, likened the facilities of John's detention as a form of "jail" where patients were held with "no judge, jury or release date".

See also

  • Long-term effects of benzodiazepines
  • Involuntary commitment
    Involuntary commitment
    Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....

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