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Psychiatric hospitalization in Korea, 2011-2020: the impact of the Mental Health Act revision of 2017 in consideration of the COVID-19 pandemic. Asian J Psychiatr 2022; 68:102934. [PMID: 34894432 PMCID: PMC8610568 DOI: 10.1016/j.ajp.2021.102934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was performed to examine the changes in psychiatric hospitalization in Korea after the mental health law revision of 2017 with consideration of the COVID-19 pandemic. METHODS The data were obtained from National Health Insurance and Medical Aid statistical yearbooks of 2011-2020. The changes in the inpatient and outpatient utilization for schizophrenia from 2011 to 2020 were compared with those for other psychiatric disorders and the general population. With difference-in-differences analysis, the changes in utilization of inpatient and outpatient care for schizophrenia after the law revision of 2017 were analyzed with two comparison groups. RESULTS While the number of inpatients and inpatient days for schizophrenia decreased between 2017 and 2019, the number of outpatients and outpatient visits for schizophrenia increased during the period. Inpatient care utilization in two comparison groups increased during the same period. Whereas the COVID-19 pandemic of 2020 led to a general decrease in health care use among the population including inpatient care for schizophrenia, the number of outpatients for schizophrenia increased slightly after the pandemic. Difference-in-differences analysis showed that the law revision was associated with the decrease in the use of inpatient care for schizophrenia after adjustment for the effect of the COVID-19 pandemic. CONCLUSIONS The mental health law revision in Korea led to a significant decrease in hospitalization for schizophrenia. However, the limited effect of revision on the Medical Aid beneficiaries suggests that the revision was not followed by the provision of the proper alternatives which can replace hospitalization of the most vulnerable population.
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Guaiana G, Barbui C. Trends in the use of the Italian Mental Health Act, 1979–1997. Eur Psychiatry 2020; 19:444-5. [PMID: 15504654 DOI: 10.1016/j.eurpsy.2004.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Revised: 06/02/2004] [Accepted: 06/08/2004] [Indexed: 11/27/2022] Open
Abstract
AbstractItalian statistics on psychiatric bed availability, voluntary and compulsory admissions were examined from 1979 to 1997. Although the number of psychiatric beds dropped by 62.5%, the absolute number of compulsory admissions has remained substantially stable. The proportion of all admissions that were compulsory decreased from 17.1% to 11%. This study shows that a shift to community care was not associated with an increase in compulsory admissions in Italy.
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Affiliation(s)
- Giuseppe Guaiana
- The University of Hull, Hertford Building, Cottingham Road, Hull HU6 7RX, UK.
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Abstract
In 1978 Italy implemented Law Number 180, the reform law that blocked all new admissions to public mental hospitals. After 40 years without mental hospitals, we aim at understanding the consequences of the Italian reform in terms of mental health care facility and staff availability. We compared the organization of the Italian mental health system with that of countries belonging to the Group of 7 (G7) major advanced economies. Italy has nearly 8 psychiatrists, 20 nurses, 2 social workers and less than 3 psychologists per 100,000 population, while for example in France there were 22 psychiatrists, in Japan 102 nurses, in the United States 18 social workers, and in Canada and France more than 45 psychologists per 100,000 population. In terms of inpatient facilities, no beds in mental hospitals were available in Italy, while in the other G7 countries mental hospital beds ranged from 8 in the United Kingdom to 204 in Japan per 100 000 population. In Italy there were fewer beds for acute care in general hospitals but more beds in community residential facilities than in the other G7 countries. Service use data showed variability in the provision of mental health care throughout the country. Soon after the implementation of the Italian reform the absolute number of compulsory admissions progressively declined, from more than 20,000 in 1978 to less than 9000 in 2015. Alongside the progressive decline of psychiatric beds imposed by Law 180, the age-adjusted suicide rate remained stable, ranging from 7·1/100,000 population in 1978 to 6·3/100,000 population in 2012. The population of psychiatric patients placed in Italian forensic psychiatric hospitals progressively declined. During the last 40 years without mental hospitals, Italy has seen a progressive consolidation of a community-based system of mental health care. We highlighted, however, reasons for concern, including a decreasing staffing level, a potential use of community residential facilities as long-stay residential services, a still too high variability in service provision across the country, and lack of national data on physical restraints. At a national level, the resources allocated to mental health care are lower in Italy than in other high-income countries.
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Shen SP, Chen YC, Wu HC, Chung TC, Tsai CH, Liang WM, Huang JJ, Chou FHC. A comparison of hospital and community stay in patients who underwent compulsory admission before and after the 2007 Amendment to the Mental Health Act in Taiwan. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:87-96. [PMID: 29853017 DOI: 10.1016/j.ijlp.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/24/2018] [Accepted: 02/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The main purpose of this study was to assess the empirical findings of compulsory admission for psychiatric disorders before and after the 2007 amendment to the Mental Health Act in Taiwan. METHODS A matched case-control study design was applied. Participants were selected using the National Health Insurance Research Database (NHIRD) in Taiwan. The control and case data were collected in 2006 and 2011, and the number of compulsory admission cases was recorded with a case-control ratio of 1:4, along with information on age (±3 years) and gender. In 2006, the number of patients recruited was 9265, including 1853 compulsorily admitted patients and 7412 voluntarily admitted patients. In 2011, the number of patients recruited was 4505, including 901 compulsorily admitted patients and 3604 voluntarily admitted patients. RESULTS The data collected for the patients who underwent compulsory admission before and after the amended Mental Health Act included gender, diagnosis, Charlson Comorbidity Index Score (CCIS), length of stay in an acute hospital ward (days), hospital accreditation level, ownership, teaching hospital status, psychiatrist gender and age, and hospital location. Although the number of compulsory admission cases (1853 vs. 901) markedly decreased and the length of stay in an acute hospital ward (30.7 ± 25.0 days vs. 39.0 ± 22.6 days) increased from 2006 to 2011, the readmission rate was reduced from 52.6% in 2006 to 42.5% in 2011. CONCLUSIONS The average lengths of hospital stay and community survival time were greater for compulsorily admitted patients than those for voluntarily admitted patients. This result might be attributed to a number of changes implemented since the 2007 amendment of the Mental Health Act, including a strict review process for compulsory admissions and a new discharge planning process, which require further research for approval.
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Affiliation(s)
- Shih-Pei Shen
- Department of Public Health, China Medical University, Taichung City, Taiwan; Graduate Institute of Biostatistics, Biostatistics Center, China Medical University, Taichung City, Taiwan
| | - Yi-Chen Chen
- Graduate institute of Health Care, Meiho University, Ping-Tong County, Taiwan
| | - Hung-Chi Wu
- Department of Community Psychiatry, Municipal Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Tieh-Chi Chung
- Graduate institute of Health Care, Meiho University, Ping-Tong County, Taiwan; Hope Doctors Hospital, Miaoli County, Taiwan
| | - Ching-Hong Tsai
- Department of Child and Adolescent Psychiatry, Municipal Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Wen-Miin Liang
- Department of Public Health, China Medical University, Taichung City, Taiwan; Graduate Institute of Biostatistics, Biostatistics Center, China Medical University, Taichung City, Taiwan
| | - Joh-Jong Huang
- Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Frank Huang-Chih Chou
- Graduate institute of Health Care, Meiho University, Ping-Tong County, Taiwan; Department of Community Psychiatry, Municipal Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
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Fitzpatrick NK, Thompson CJ, Hemingway H, Barnes TRE, Higgitt A, Molloy C, Hargreaves S. Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.27.1.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.ResultsPatients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.Clinical ImplicationsOur findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.
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Wesson ML, Walmsley P. Service innovations: Sherbrook partial hospitalisation unit. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.25.2.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodNationally, a variety of community care projects are being developed to replace institution-based care. We describe an innovative system of providing mental health care in Southport, combining an extended day service with short-term hospital admission – the partial hospitalisation philosophy.ResultsDuring the first year of operation 438 assessments took place with 27% of patients being admitted to a crisis bed and a further 25% supported via attendance at the unit.Twelve per cent needed in-patient admission and 10% were deemed not to require any involvement of the mental health service.Clinical ImplicationsThe use of short-stay admission coupled with extended day care and crisis line support can provide a viable alternative to admission to the acute ward.
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Bridgett C, Polak P. Social systems intervention and crisis resolution. Part 1: Assessment. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.9.6.424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Home treatment as an alternative to acute adult in-patient care is part of the National Health Service Plan for mental health services in the UK. As a form of crisis intervention, it benefits from an understanding of, and ways of working with, the social systems relevant to the patient in crisis. This article reviews relevant terminology and background theory, and considers the social factors associated with psychiatric admission.
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Hotzy F, Kerner J, Maatz A, Jaeger M, Schneeberger AR. Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland. Front Psychiatry 2018; 9:267. [PMID: 29973889 PMCID: PMC6020767 DOI: 10.3389/fpsyt.2018.00267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/31/2018] [Indexed: 01/01/2023] Open
Abstract
Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.
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Affiliation(s)
- Florian Hotzy
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jeff Kerner
- Montefiore Medical Center, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States
| | - Anke Maatz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andres R Schneeberger
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States.,Psychiatrische Dienste Graubünden, Chur, Switzerland.,Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
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Abstract
BACKGROUND The increasing rate of compulsory admission to psychiatric inpatient beds in England is worrying. Studying variation between places and services could be key to identifying targets for interventions to reverse this trend. We modelled spatial variation in compulsory admissions in England using national patient-level data and quantified the extent to which patient, local-area, and service-setting characteristics accounted for this variation. METHODS This study is a cross-sectional, multilevel analysis of the 2010-11 Mental Health Minimum Data Set (MHMDS). Data from eight provider trusts were excluded, including three independent provider trusts that lacked spatial identification codes. We excluded patients detained under sections of the Mental Health Act concerned only with conveyance to, or assessment in, a registered Place of Safety, or for short-term (≤72 h) assessment only, as these do not in themselves necessarily mean that the person will be admitted to an inpatient mental health bed. MHMDS contained reasonably complete data for a limited number of patient characteristics, namely age, sex, and ethnicity; however, several patient-level variables could not be included in our analysis because of high levels of missing data. Multilevel models were applied with MLwiN to estimate variation in compulsory admission, starting with null (unconditional) models that partitioned total variance in compulsory admission between each level in the model. The primary outcome was compulsory admission to a psychiatric inpatient bed, compared with people admitted voluntarily or receiving only community-based care. FINDINGS Data were available for 1 238 188 patients, covering 64 National Health Service provider trusts (93%) and 31 865 census lower super output areas (LSOAs; 98%). 7·5% and 5·6% of the variance in compulsory admission occurred at LSOA level and provider trust levels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than were white patients (odds ratio [OR] 2·94, 95% CI 2·90-2·98). Compulsory admission was greater in more deprived areas (OR 1·22, 1·18-1·27) and in areas with more non-white residents (OR 1·51, 1·43-1·59), after adjusting for confounders. INTERPRETATION Rates of compulsory admission to inpatient psychiatric beds vary significantly between local areas and services, independent of patient, area, and service characteristics. Compulsory admission rates seem to reflect local factors, especially socioeconomic and ethnic population composition. Understanding how these factors condition access to, and use of, mental health care is likely to be important for developing interventions to reduce compulsion. FUNDING National Institute for Health Research Health Services and Delivery Research Programme.
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Perry BI, Champaneri N, Griffiths F, Paul M, Islam Z, Rugkåsa J, Burns T, Tyrer P, Crawford M, Deb S, Singh SP. Exploring professionals' understanding, interpretation and implementation of the 'appropriate medical treatment test' in the 2007 amendment of the Mental Health Act 1983. BJPsych Open 2017; 3:57-63. [PMID: 28316797 PMCID: PMC5322255 DOI: 10.1192/bjpo.bp.116.003939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/05/2016] [Accepted: 02/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. AIMS As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. METHOD Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. RESULTS We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. CONCLUSIONS Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implement the ATT as its designers intended. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Benjamin I. Perry
- Benjamin I. Perry, BSc, MBBS, Department of Mental Health and Wellbeing, University of Warwick, Coventry, UK; Coventry and Warwickshire Partnership NHS Trust, Nuneaton, UK
| | - Nina Champaneri
- Nina Champaneri, MBChB, MRCPsych, Department of Psychiatry, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Frances Griffiths
- Frances Griffiths, MBBS, PhD, FRCGP, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Moli Paul
- Moli Paul, MBChB, MMedSci, MRCPsych, Department of Mental Health and Wellbeing, University of Warwick, Coventry, UK
| | - Zoebia Islam
- Zoebia Islam, MSc, PhD, Department of Psychiatry, Birmingham and Solihull Mentla Health Foundation Trust, Birmingham, UK
| | - Jorun Rugkåsa
- Jorun Rugkåsa, Cand Mag, Cand Polit, PhD, University of Oxford, Oxford, UK; Akershus University, Oslo, Norway
| | - Tom Burns
- Tom Burns, MD, DSc, FRCPsych, CBE, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Peter Tyrer
- Peter Tyrer, MD, FRCP, FRCPsych, FMedSci, Centre for Mental Health, Imperial College London, London, UK
| | - Michael Crawford
- Michael Crawford, MD, FRCPsych, Department of Medicine, Imperial College London, London, UK
| | - Shoumitro Deb
- Shoumitro Deb, MBBS, FRCPsych, MD, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Swaran P. Singh
- Swaran P. Singh, MD, MBBS, FRCPsych, Department of Mental Health and Wellbeing, University of Warwick, Coventry, UK
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Raveesh BN, Pathare S, Noorthoorn EO, Gowda GS, Lepping P, Bunders-Aelen JGF. Staff and caregiver attitude to coercion in India. Indian J Psychiatry 2016; 58:S221-S229. [PMID: 28216773 PMCID: PMC5282619 DOI: 10.4103/0019-5545.196847] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess attitudes of Indian psychiatrists and caregivers toward coercion. MATERIALS AND Methods: The study was conducted at the Department of Psychiatry, Krishna Rajendra Hospital, Mysore, India. Staff Attitude to Coercion Scale (SACS), a 15-item questionnaire, was administered to self-selected psychiatrists across India and caregivers from Mysore to measure attitudes on coercion. Data were analyzed using descriptive statistics and investigating differences in subgroups by means of Chi-square test, Student's t-test, and analysis of variance. Reliability of the SACS was tested in this Indian sample. RESULTS A total of 210 psychiatrists and 210 caregivers participated in the study. Both groups agreed that coercion was related to scarce resources, security concerns, and harm reduction. Both groups agreed that coercion is necessary, but not as treatment. Older caregivers and male experienced psychiatrists considered coercion related to scarce resources to violate patient integrity. All participants considered coercion necessary for protection in dangerous situations. Professionals and caregivers significantly disagreed on most items. The reliability of the SACS was reasonable to good among the psychiatrists group, but not in the caregiver group (alpha 0.58 vs. 0.07). CONCLUSION Caregivers and psychiatrists felt that the lack of resources is one of the reasons for coercion. Furthermore, they felt that the need on early identification of aggressive behavior, interventions to reduce aggressiveness, empowering patients, improving hospital resources, staff training in verbal de-escalation techniques is essential. There is an urgent need in the standardized operating procedure in the use of coercive measure in Indian mental health setting.
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Affiliation(s)
- B N Raveesh
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad
| | - S Pathare
- Co-ordinator, Centre for Mental Health Law and Policy, Indian Law Society, Pune
| | - E O Noorthoorn
- Head of research GGnet Community mental Health Centre, PO Box 2003, 7230 GC Warnsveld, the Netherlands and main researcher of the Dutch Information Centre for Coercive Measures, Stichting Benchmark GGZ, Bilthoven, Netherlands
| | - G S Gowda
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru
| | - P Lepping
- Honorary Professor (Bangor University and Mysore Medical College and Research Institute, India), Consultant Psychiatrist (BCULHB), Centre for Mental Health and Society, N Wales, UK
| | - J G F Bunders-Aelen
- Professor of Biology and Society, Vrije Universiteit, Amsterdam, Netherlands
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Esfahani MN, Mirsepassi G, Atef-Vahid MK. Development of mental health law in Iran: work in progress. BJPsych Int 2015; 12:68-70. [PMID: 29093861 PMCID: PMC5618927 DOI: 10.1192/s2056474000000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A brief account of the three stages of development of a new mental health law in Iran is given. At each stage, the expert opinions of mental health professionals and lawyers interested in the rights of psychiatric patients were obtained. The final draft of the law consists of six sections and 50 articles. It has been submitted for ratification by Parliament.
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Affiliation(s)
- Mehdi Nasr Esfahani
- Associate Professor of Psychiatry, Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad-Kazem Atef-Vahid
- Associate Professor of Clinical Psychology, Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
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Weich S, McBride O, Twigg L, Keown P, Cyhlarova E, Crepaz-Keay D, Parsons H, Scott J, Bhui K. Variation in compulsory psychiatric inpatient admission in England: a cross-sectional, multilevel analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes.ObjectivesTo quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places.DesignCross-sectional analysis using multilevel statistical modelling.SettingEngland, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services.Participants1,287,730 patients.Main outcome measureThe study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period.Data sourcesThe Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers.ResultsA total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models.ConclusionsThis was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- School of Psychology, University of Ulster, Londonderry, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Patrick Keown
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan Scott
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Singh SP, Islam Z, Brown LJ, Gajwani R, Jasani R, Rabiee F, Parsons H. Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- SP Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Z Islam
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - LJ Brown
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - R Gajwani
- School of Psychology, University of Birmingham, Birmingham, UK
| | - R Jasani
- Humanitarian and Conflict Response Institute (HCRI), University of Manchester, Manchester, UK
| | - F Rabiee
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Birmingham, UK
| | - H Parsons
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
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15
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Keown P, Weich S, Bhui KS, Scott J. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study. BMJ 2011; 343:d3736. [PMID: 21729994 PMCID: PMC3130113 DOI: 10.1136/bmj.d3736] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced. DESIGN Ecological analysis. SETTING England, 1988-2008. DATA SOURCE Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre. MAIN OUTCOME MEASURES Association between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified. RESULTS The rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation -0.60, 95% confidence interval -1.06 to -0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds. CONCLUSION The annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.
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Affiliation(s)
- Patrick Keown
- Tranwell Unit, Queen Elizabeth Hospital, Gateshead, UK.
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16
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Lay B, Nordt C, Rössler W. Variation in use of coercive measures in psychiatric hospitals. Eur Psychiatry 2011; 26:244-51. [PMID: 21296560 DOI: 10.1016/j.eurpsy.2010.11.007] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/12/2010] [Accepted: 11/15/2010] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels. METHODS Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals. RESULTS Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics 'size of the hospital', 'length of inpatient stay', and 'work load of the nursing staff' were only weak ('bed occupancy rate' was not statistically significant). CONCLUSION The significant variation in use of coercive measures across psychiatric hospitals needs further study.
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Affiliation(s)
- B Lay
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Militärstrasse 8, PO Box 1930, 8021 Zurich, Switzerland.
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17
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Trends in the Mental Health Act Review Tribunals: A Welsh experience 2004–2008. J Forensic Leg Med 2009; 16:375-7. [DOI: 10.1016/j.jflm.2009.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 03/30/2009] [Indexed: 11/20/2022]
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18
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Wierdsma AI, Mulder CL. Does mental health service integration affect compulsory admissions? Int J Integr Care 2009; 9:e90. [PMID: 19777114 PMCID: PMC2748183 DOI: 10.5334/ijic.324] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 08/06/2009] [Accepted: 08/17/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. METHODS In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. RESULTS Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. CONCLUSIONS Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.
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Affiliation(s)
- André I Wierdsma
- University Medical Center Rotterdam, Department of Psychiatry, O3 - Mental Health Care Research Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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19
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Keown P, Mercer G, Scott J. Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996-2006. BMJ 2008; 337:a1837. [PMID: 18845592 PMCID: PMC2565753 DOI: 10.1136/bmj.a1837] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse the number of voluntary and involuntary (detentions under the Mental Health Act 1983) admissions for mental disorders between 1996 and 2006 in England. DESIGN Retrospective analysis. SETTING England. MAIN OUTCOME MEASURES Number of voluntary and involuntary admissions for mental disorders in England's health service, number of involuntary admissions to private beds, and number of NHS beds for patients with mental disorders or learning disabilities. RESULTS Admissions for mental disorders in the NHS in England peaked in 1998 and then started to fall. Reductions in admissions were confined to patients with depression, learning disabilities, or dementia. Admissions for schizophrenic and manic disorders did not change whereas those for drug and alcohol problems increased. The number of NHS psychiatric beds decreased by 29%. The total number of involuntary admissions per annum increased by 20%, with a threefold increase in the likelihood of admission to a private facility. Patients admitted involuntarily occupied 23% of NHS psychiatric beds in 1996 but 36% in 2006. CONCLUSIONS Psychiatric inpatient care changed considerably in the decade from 1996 to 2006, with more involuntary admissions to fewer NHS beds. The case mix has shifted further towards psychotic and substance misuse disorders, which has changed the milieu of inpatient wards. Increasing proportions of involuntary patients were admitted to private facilities.
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Affiliation(s)
- Patrick Keown
- East Community Mental Health Team, Molineux Street NHS Centre, Newcastle upon Tyne NE6 1SG.
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20
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Mulder CL, Uitenbroek D, Broer J, Lendemeijer B, van Veldhuizen JR, van Tilburg W, Lelliott P, Wierdsma AI. Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000-2004. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2008; 31:331-336. [PMID: 18667238 DOI: 10.1016/j.ijlp.2008.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND In England, rates of involuntary admissions increased in subgroups of patients. It is unknown whether this is true in other European countries. AIMS To establish whether the increase in emergency commitments was uniform across subgroups of patients and dangerousness criteria used to justify commitment in The Netherlands. METHOD National data on all commitments in the period 2000-2004. RESULTS Commitments increased from 40.2 to 46.5 (16%) per 100,000 inhabitants. Controlling for population changes in age and sex, relatively large increases were found in patients over 50 years (25-40% increase), in patients with dementia (59%), 'other organic mental disorders' (40%) and substance abuse (36%). 'Arousing aggression', increased most strongly as a dangerousness criterion for commitment (30%). CONCLUSION Changing patterns of commitments in The Netherlands and England might indicate a wider European shift in diagnoses and reasons for admission of committed patients.
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Affiliation(s)
- C L Mulder
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry and BavoEuropoort, Rotterdam, The Netherlands.
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21
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Hiroeh U, Kapur N, Webb R, Dunn G, Mortensen PB, Appleby L. Deaths from natural causes in people with mental illness: a cohort study. J Psychosom Res 2008; 64:275-83. [PMID: 18291242 DOI: 10.1016/j.jpsychores.2007.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/24/2007] [Accepted: 09/25/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate natural-cause mortality risk in people with psychiatric admission histories in a national population-based cohort. To estimate risks in relation to psychiatric diagnostic categories and for specific causes of death. METHODS We studied a 21-year cohort (1973-93) of 4.1 million Danish adults with linkage to national psychiatric and mortality registers. Person years were stratified by psychiatric diagnostic category and age-standardized mortality ratios (SMRs) were estimated versus the general population. RESULTS Risks of death by natural causes were higher across a range of psychiatric illnesses in both sexes. We observed SMRs greater than 200 in men and women with alcoholism, drug abuse, organic psychoses, dementia, and learning difficulties. Alcoholism and drug misuse in particular were important causes of premature mortality. The highest cause-specific SMRs were for nervous system diseases, gastrointestinal diseases, lung diseases, and "all other natural causes"; the lowest were for neoplasm. The greatest excess, in terms of absolute numbers, was for circulatory disease mortality. CONCLUSION Adults experiencing a range of psychiatric illnesses are more likely to die at any age, and also prematurely, from natural causes. The consistency of elevated risk across psychiatric diagnoses and causes of death indicates an important health inequality. Those involved in planning and providing mental health services should address the heightened need for physical health care in psychiatric patients.
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Affiliation(s)
- Urara Hiroeh
- Centre for Suicide Prevention, Division of Psychiatry, University of Manchester, Manchester, United Kingdom
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22
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Lorant V, Depuydt C, Gillain B, Guillet A, Dubois V. Involuntary commitment in psychiatric care: what drives the decision? Soc Psychiatry Psychiatr Epidemiol 2007; 42:360-5. [PMID: 17396204 DOI: 10.1007/s00127-007-0175-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychiatric commitment laws have been reformed in many European countries. We assessed the relative importance of the different legal criteria in explaining involuntary commitment under the Belgian Mental Health Act of 1990. METHOD Psychiatric assessments were requested for 346 patients living in Brussels who were randomly selected from a larger group and were being considered for involuntary commitment. A retrospective study of these patients' files was carried out. RESULTS More than half of the requests for involuntary commitment were turned down. The lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment. Alternative forms of care were more likely to be unavailable for psychotic individuals, foreigners, and patients not living in a private household. CONCLUSION Involuntary commitment is mainly due to the inability of the mental health care system to provide more demanding patients with alternative forms of care.
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Affiliation(s)
- Vincent Lorant
- Public Health School, Faculty of Medicine, Université Catholique de Louvain, Louvain, Belgium
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23
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Bauer A, Rosca P, Grinshpoon A, Khawaled R, Mester R, Yoffe R, Ponizovsky AM. Trends in involuntary psychiatric hospitalization in Israel 1991-2000. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2007; 30:60-70. [PMID: 17141875 DOI: 10.1016/j.ijlp.2006.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 11/21/2005] [Accepted: 02/24/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject. AIMS To identify trends in first IPH to all inpatient psychiatric settings in Israel. METHOD The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry. RESULTS A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis. CONCLUSIONS These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.
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Affiliation(s)
- Arie Bauer
- Forensic Psychiatry Unit, Mental Health Services, Ministry of Health, Jerusalem, Israel
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25
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Salize HJ, Dressing H. Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 2004; 184:163-8. [PMID: 14754830 DOI: 10.1192/bjp.184.2.163] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the tendency for harmonisation of strategies for mental health care delivery, rules and regulations for involuntary placement or treatment of mentally ill persons still differ remarkably internationally. Rapid European integration and other political developments require valid and reliable international overviews, sound studies and profound analyses of this controversial issue. AIMS To give an overview of compulsory admission data from official sources across the European Union (EU). METHOD Data on the legal frameworks for involuntary placement or treatment of people with mental illness and their outcomes were provided and assessed by experts from all EU member states. RESULTS Total frequencies of admission and compulsory admission rates vary remarkably across the EU. Variation hints at the influence of differences in legal frameworks or procedures. Time series suggest an overall tendency towards more or less stable quotas in most member states. CONCLUSIONS Further research is greatly needed in this field. Common international health reporting standards are essential to the compilation of basic data.
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Affiliation(s)
- Hans Joachim Salize
- Mental Health Services Research Unit, Central Institute of Mental Health, Mannheim, Germany
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Hotopf M, Wall S, Buchanan A, Wessely S, Churchill R. Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996. Br J Psychiatry 2000; 176:479-84. [PMID: 10912226 DOI: 10.1192/bjp.176.5.479] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. AIMS To explore changes in the use of the Act since its introduction. METHOD The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data. RESULTS Formal admissions rose from 16,044 in 1984 to 26,308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s. CONCLUSIONS Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.
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Langley GE. Work of mental health review tribunals is increasing faster than detentions. BMJ (CLINICAL RESEARCH ED.) 1999; 319:920. [PMID: 10506064 PMCID: PMC1116739 DOI: 10.1136/bmj.319.7214.920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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