A new clinical guideline to improve sedation safety in patients transferred under the Mental Health Act from remote parts of Western Australia

OBJECTIVE

Clinicians dealing with referrals under the Mental Health Act in rural and remote parts of Australia face the difficult task of providing safe sedation whilst transferring the patient to an appropriate authorized facility. This paper reviews the efforts to overcome these challenges in the remote north-west of Australia.

METHODS

Senior medical staff undertook a review of sedation practice in the region. A search was made of the medical literature to determine whether evidence based treatment may exist elsewhere and this information was used in conjunction with consensus opinion to devise a new guideline.

RESULTS

Scant literature exists in the field of sedation and aeronautical evacuation of patients with acute mental health presentations in remote areas. Issues and challenges were identified and a new clinical guideline based on local expert consensus of good practice was developed.

CONCLUSIONS

Standardizing the approach to managing agitated patients who are transferred under the Mental Health Act is essential in order to mitigate medical morbidity that may arise from sedation related complications. The sedation guideline developed by our service has been well received by staff, seems practical and feasible to implement and has the potential to reduce sedation related morbidity.

Perspectives on the Mental Health Act 2014 (Vic)

OBJECTIVE

This article will consider the potential impact of Victoria's new Mental Health Act 2014 (Vic) from the perspectives of consumers, careers and members of the treating team. This article will examine how some of the more drastic legal reforms will impact clinical processes, procedures and decision making.

CONCLUSIONS

The new Act takes significant steps towards empowering consumers. However, its practical application will take some time to appraise. Only time will reveal how the Mental Health Tribunal handles its newfound powers, whether consumers will benefit from a more collaborative approach to clinical decision making and ultimately whether the Act will empower consumers.

Mental capacity and mental health acts part 3: deprivation of liberty

Following the introduction of the deprivation of liberty safeguards, the courts initially insisted that a deprivation of liberty for the treatment of a mental disorder was authorised under a section of the Mental Health Act 1983 as it had primacy in matters concerning mental disorder (GJ v The Foundation Trust [2009]). The courts later refined that approach to primacy and accepted that, where appropriate, decision makers could use either the Mental Health Act 1983 or the Mental Capacity Act 2005 deprivation of liberty safeguards to authorise a deprivation of liberty for the treatment of a mental disorder. In this third article on the interface between the Mental Health Act 1983 and Mental Capacity Act 2005, the author considers when it would be necessary to detain an adult who lacked capacity under the Mental Health Act 1983 instead of the Mental Capacity Act 2005 deprivation of liberty safeguards.

When the mandatory second opinion fails to approve compulsory treatment

OBJECTIVES

To examine situations in which compulsory treatment was not approved by the second opinion required under New Zealand's Mental Health Act.

METHODS

Qualitative and quantitative analysis of 11 index cases where full approval of treatment was not given and of 33 matched controls.

RESULTS

The reasons for non-approval of treatment were diverse. Following non-approval, intensive consultation occurred, reflecting significant disagreement between clinicians. The process of resolution included discharge from the Act, patients consenting to treatment and alternative treatment plans. Compared with controls, index cases had significantly lower rates of being mentally well in the community over the subsequent year.

CONCLUSIONS

Non-approval marks a group of patients with very poor clinical outcome. Explicit processes are needed to manage non-approval of compulsory treatment plans.

Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health (Care & Treatment) (Scotland) Act 2003

Compulsory psychiatric treatment is highly contested, and little research has focused specifically on direct experiences. The Mental Health (Care & Treatment) (Scotland) Act, 2003 introduced new roles and provisions including community treatment orders, and was designed to increase participation, ensure treatment was beneficial and was the 'least restrictive' alternative. This article draws on findings from semi-structured interviews with 49 individuals, who had experienced compulsion under this new legislation during 2007-2008, that were part of a broader cohort study. Interviews with service users were conducted at two stages with 80% agreeing to be interviewed twice. The sample included people on a variety of compulsory orders from four Health Board areas, some of whom had been detained for the first time, while others reported 'revolving door' experiences. Peer researchers who were mental health service users carried out the interviews in partnership with professional researchers. The findings suggest that legislation had a limited impact on participation in the process of compulsion. Consensus was that although service users felt there was increased opportunity for their voices to be heard, this was not matched by having increased influence over professional decision-making, especially in relation to drug treatments. According to people's direct experiences, the passing of the legislation in itself had done little to change the dominant psychiatric paradigm. While providing a foundation for improving the process of compulsion, the findings suggest that as well as legislative reform, fundamental shifts in practice are needed both in terms of the nature of therapeutic relationships, and in embracing more holistic and recovery perspectives.

Characteristics of the Detained and Informal Child and Adolescent Psychiatric In-Patient Populations

BACKGROUND

This project surveyed the use of the Children Act and the Mental Health Act in in-patient child and adolescent mental health services in England and Wales.

METHODS

Data were collected as a day census from child and adolescent psychiatric inpatient units, questionnaire forms completed by consultant psychiatrists or key-workers. Returns were received from 71 of the 80 units.

RESULTS

One hundred and twenty-seven of the 663 patients had been admitted formally, the great majority under a section of the Mental Health Act. Compared with those admitted informally, those admitted formally were older, contained a higher proportion of males and had 'adult-type diagnoses', mainly schizophrenia, mood disorders and personality disorder. The clinical and psychosocial characteristics of formal and informal patients were consistent with these differences.

CONCLUSIONS

This study provides a timely and useful snapshot of the use of the Acts in this population.