Involuntary psychiatric admission: Comparative study of mental health legislation in Brazil and in England/Wales

Involuntary Admission From the Perspective of RNs and Nursing Assistants at a Mental Health Facility

The current qualitative research study was performed in a psychiatric hospital in São Paulo, Brazil. The study aimed to identify RNs' and nursing assistants' (NAs) (N = 21) knowledge regarding different types of admission to psychiatric hospitals established by Brazilian legislation. Data were collected through semi-structured interviews and analyzed through content analysis resulting in the following theme: Gaps in the Knowledge of RNs and NAs Regarding the Rules for Admission; and five subthemes: voluntary admission and the requirement of having a responsible person during admission; involuntary admission occurring when the family is the one to hospitalize the patient; involuntary admission is the same as compulsory admission; is there involuntary admission?; and the role of the public attorney in involuntary admissions. Results showed deficits in knowledge about the different types of admissions to psychiatric hospitals. Therefore, policies to promote awareness of the legal framework concerning psychiatric treatment should be developed to enable mental health nurses to support patients' autonomy during involuntary admissions. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 42-50.].

Middle-income country perspectives on global mental health

PURPOSE OF REVIEW

Despite being a relatively new discipline, global mental health (GMH) has made substantial advances, paying particular attention to optimising the provision of mental health services in low- and middle-income countries (LMICs). Much of the work done in GMH has focused on low-income countries (LIC), but middle-income countries (MIC) such as Brazil, China, India, and South Africa, have particular characteristics that may impact the nature of this work. Here we examine key GMH issues, including mental health legislation, burden of disease, task-sharing, and mental health clinical and research capacity-building, in the MIC context.

RECENT FINDINGS

In MICs there is particular concern about an increase in non-communicable diseases, including mental disorders. MICs have more resources than LICs, but the treatment gap in these settings remains significant. MICs are better equipped than LICs to mobilize task-sharing programs, and these can potentially include more high educated community health workers. In MICs there have been important advances in mental health, but more is needed regarding their implementation and the promotion of human rights. Clinical and research capacity-building initiatives in MIC contexts are easier to establish and have potential to be more ambitious in scope.

SUMMARY

GMH has developed important universal principles that apply across low-, middle-, and high-income countries. Nevertheless, particular issues in MICs may require moulding of more general GMH frameworks.

The rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital

The aim of this study is to analyze the exercise of rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital in an inner city from the state of São Paulo, Brazil, from the perspective of patients. This is a cross-sectional qualitative research study. Data were collected by interviewing 20 patients in the process of being discharged from the studied hospital who agreed to participate in the investigation. The guiding instrument of this interview was based on the WHO QualityRights interview tool and the obtained data were processed by means of thematic and content analyses. Results showed that the legal processes resulting from the Psychiatric Reform did not ensure the full exercise of the human rights of people with mental disorders admitted at general hospitals. Participants generally did not know about their rights to have access to their information and referred that they received information about their own health or these were given to their representatives.

Intégration des droits humains dans la pratique du personnel infirmier faisant usage de coercition en santé mentale : recension systématique des écrits et méta-ethnographie

Introduction and background : The last decade has seen a steady and rising use of coercion in mental health care, as well as an increase in the number of forms it takes. The application of these measures frequently relies on the work of nurses, but few studies have analyzed the human rights issues raised by these practices.Aim : To produce a qualitative synthesis of how human rights are integrated into the practice of nurses who use coercion in mental health care.Methodology : A systematic review of qualitative scientific literature published between 2008 and 2018 was conducted and supplemented by a meta-ethnographic analysis.Results : The analysis of the forty-six selected studies revealed four distinct themes : coercion in mental health care as a socio-legal object, issues of recognition of human rights in mental health care, role conflict experienced by nurses, and the conceptualization of coercion as a necessary evil or a critical incident.Discussion and conclusion : Further research is needed to understand the specifics of the continuum of support and control that characterizes the coercive work of psychiatric nurses.

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

Background.

Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

Methods.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

Results.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

Conclusions.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.