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Khalily MT, Rehman AU, Bhatti MM, Hallahan B, Ahmad I, Mehmood MI, Khan SH, Khan BA. Stakeholders' perspective on mental health laws in Pakistan: A mixed method study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101647. [PMID: 33246231 DOI: 10.1016/j.ijlp.2020.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
The present study explored awareness and opinions pertaining to mental health legislation in Pakistan in the context of the United Nation Convention on Rights of People with Disabilities (UNCRPD) through a mixed method research design. In the quantitative arm of the study, a structured questionnaire examined awareness and opinions of key stakeholders pertaining to national mental health legislation. In the qualitative arm, face-to-face interviews further elaborated stakeholders perspectives pertaining to these topics with thematic analysis conducted. Stakeholders demonstrated a good awareness of legislation pertaining to guardianship (83.0 %) appointment of property managers (89.7%) and salary or pension entitlements (89.2%). Compared to other stakeholders, patients had less understanding of processes pertaining to involuntary admission (χ2 = 20.54, p = 0.02) and appointing a guardian (χ2 = 34.67, p < 0.01). High consensus across stakeholders was noted for processes of involuntary detention (83.5%) and appointment of guardians or property managers (80.0%) albeit patients demonstrated less agreement on these topics (p <0.01). Minimal support was noted for an involuntary patient to be discharged solely on a psychiatrist's recommendation (25.4%). Thematic analysis indicated fifteen emergent themes: 1) Alienation/ Seclusion; 2) Capacity building; 3) Communication Gap; 4) Conflict of interests; 5) Discomfort at hospital; 6) Economic burden; 7) Government's liability; 8) Family involvement; 9) Imbalance; 10) Acceptance of Legal Incapacity; 11) Legal reforms; 12) Patient centred environment; 13) Quality assurance; 14) Under developed infrastructure and 15) Potential unethical practices. This study advocates for increased patient involvement in collaborative decision making with mental health professionals and the creation of more appropriate inpatient treatment environments.
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Affiliation(s)
| | - Aziz Ur Rehman
- Department of Law, International Islamic University, Islamabad, Pakistan
| | - Mujeeb Masud Bhatti
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Irshad Ahmad
- Department of Psychology, International Islamic University, Islamabad, Pakistan.
| | | | - Shamsher Hayat Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Bilal Ahmed Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
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Voluntary and involuntary psychiatric admissions in a suburban area: comparison with national rates, diagnosis and other correlates of involuntary admission status. Ir J Psychol Med 2017; 34:243-249. [DOI: 10.1017/ipm.2017.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ObjectivesTo establish if the relatively low rate of involuntary psychiatric admission in a suburban area between 2007 and 2011 was maintained in 2014/2015, and explore key correlates of involuntary status.MethodsWe used existing hospital records and data sources to extract rates and selected potential correlates of voluntary and involuntary admission in south west Dublin (catchment area: 273 419 people) over 18 months in 2014/2015 and compared these with published national data from the census and Health Research Board.ResultsThe rate of involuntary admission in the suburban area studied between 2007 and 2011 was 33.8 involuntary admissions per 100 000 population annually, which was lower than the national rate (48.6). By 2014/2015, the rate of involuntary admission in this area had risen to 46.8 involuntary admissions per 100 000 population annually, similar to the national rate (44.9). Nevertheless, the overall (voluntary and involuntary) admission rate in the suburban area (346.7 admissions per 100 000 population annually) was still lower the national rate (387.9), owing to a lower rate of voluntary admission in the suburban area (299.9) compared to Ireland as a whole (342.9). Multi-variable testing demonstrated that diagnosis was the strongest driver of involuntary admission in the suburban area: this area had 28.5 involuntary admissions per 100 000 population annually with schizophrenia or related disorders, compared to 18.9 nationally. Schizophrenia and related disorders accounted for 60.9% of involuntary admissions in the suburban area compared to 42.1% nationally.ConclusionsSchizophrenia is the strongest driver of involuntary admission in the suburban area in this study.
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Curley A, Agada E, Emechebe A, Anamdi C, Ng XT, Duffy R, Kelly BD. Exploring and explaining involuntary care: The relationship between psychiatric admission status, gender and other demographic and clinical variables. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 47:53-59. [PMID: 27033975 DOI: 10.1016/j.ijlp.2016.02.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Involuntary admission and treatment are features of psychiatric care in many countries, but the relationship between involuntary status and gender (among other factors) is not clear. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in a deprived area of Dublin's north inner-city over a 7-year period (2008 to 2014 inclusive). Over this period, there were 1099 admissions, yielding an annual admission rate of 504.8 admissions per 100,000 population per year. When adjusted for deprivation, this rate (387.7) was lower than the national rate (413.9). Consistent with other inner-city areas in Dublin, 14.1% of admissions were involuntary, yielding an involuntary admission rate of 71.2 per 100,000 population per year (deprivation-adjusted rate: 54.8), which is higher than the national rate (39.4). After controlling for age, occupation, marital status and diagnosis, the only independent predictors of admission status were place of origin (p<0.001) and male gender (p=0.001). These findings are consistent with studies showing associations between male gender and involuntary status in the United States, New Zealand, Netherlands, Norway, Belgium, France, and Luxembourg. In contrast, female gender is associated with involuntary status in Switzerland, Brazil, and China. These cross-national differences are likely related to differing legal traditions and different criteria for involuntary admission, possibly related to varying emphases placed on "dangerousness" as a mandatory criterion for involuntary hospitalization. This merits further, cross-national study.
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Affiliation(s)
- Aoife Curley
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Emmanuel Agada
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Afam Emechebe
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Chike Anamdi
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Xiao Ting Ng
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Richard Duffy
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght Hospital, Trinity College Dublin, Dublin 24, Ireland.
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Abstract
This article provides a brief overview of the legislation that has been enacted in Ireland with respect to mental health, in particular the 2001 Mental Health Act. Although that Act was a positive step towards developing an Irish mental health service that protects the human rights of service users, a number of concerns remain, including issues related to consent and capacity, involuntary out-patient treatment and admission, the adversarial nature and timing of tribunals, and the lack of safeguards for voluntary patients.
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Affiliation(s)
- Anna Datta
- GP Rural Track Training Scheme, Gilbert Bain Hospital, Lerwick, Shetland Islands, UK, email
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Kelly BD, Emechebe A, Anamdi C, Duffy R, Murphy N, Rock C. Custody, care and country of origin: demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 38:1-7. [PMID: 25634112 DOI: 10.1016/j.ijlp.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Involuntary detention is a feature of psychiatric care in many countries. We previously reported an involuntary admission rate of 67.7 per 100,000 population per year in inner-city Dublin (January 2008-December 2010), which was higher than Ireland's national rate (38.5). We also found that the proportion of admissions that was involuntary was higher among individuals born outside Ireland (33.9%) compared to those from Ireland (12.0%), apparently owing to increased diagnoses of schizophrenia in the former group. In the present study (January 2011-June 2013) we again found that the proportion of admissions that was involuntary was higher among individuals from outside Ireland (32.5%) compared to individuals from Ireland (9.9%) (p<0.001), but this is primarily attributable to a lower rate of voluntary admission among individuals born outside Ireland (206.1 voluntary admissions per 100,000 population per year; deprivation-adjusted rate: 158.5) compared to individuals from Ireland (775.1; deprivation-adjusted rate: 596.2). Overall, admission rates in our deprived, inner-city catchment area remain higher than national rates and this may be attributable to differential effects of Ireland's recent economic problems on different areas within Ireland. The relatively low rate of voluntary admission among individuals born outside Ireland may be attributable to different patterns of help-seeking which mental health services in Ireland need to take into account in future service-planning. Other jurisdictions could also usefully focus attention not just on rates on involuntary admission among individuals born elsewhere, but also rates of voluntary admission which may provide useful insights for service-planning and delivery.
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Affiliation(s)
- Brendan D Kelly
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Afam Emechebe
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Chike Anamdi
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Richard Duffy
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Niamh Murphy
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Newcastle Road, Galway, Ireland.
| | - Catherine Rock
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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Attitudes and experiences of nursing staff to the Mental Health Act 2001: lessons for future mental health legislation. Ir J Psychol Med 2014; 31:83-87. [DOI: 10.1017/ipm.2014.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ObjectivesThe Mental Health Act 2001 was implemented in 2006 to bring Ireland into line with international practice and United Nations Conventions on Human Rights. Previous studies have reported some practical difficulties for the professionals involved. We wished to examine the experiences of nursing staff and the impact of the Act on clinical nursing practice since its implementation.MethodThis cross-sectional survey was conducted by questionnaire. It contained questions examining training in and attitudes to the Act, and any resultant changes in nursing practise.ResultsA total of 317 questionnaires were returned. Of the nurses, 92% reported having received training in the Act, and 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative, with increased paper work, lack of clarity and an excessive focus on legalities being the most common difficulties reported.ConclusionsNursing staff have shown mixed attitudes to the Mental Health Act 2001, but many of the difficulties encountered are similar to those experienced by other professionals.
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Ramsay H, Roche E, O'Donoghue B. Five years after implementation: a review of the Irish Mental Health Act 2001. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:83-91. [PMID: 23274178 DOI: 10.1016/j.ijlp.2012.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The Mental Health Act 2001 (MHA 2001) was implemented in November 2006. Since that time, there has been considerable research into its impact, including the impact on service provision, use of coercive practices and the perceptions by key stakeholders. Our objective is to present a summary of research into the MHA 2001 since its implementation in the Irish state in the context of international standards and practice. METHODS We reviewed the literature presented on Medline and Google Scholar, directly assessed relevant journals and sought abstract information from the College of Psychiatry of Ireland. RESULTS There has been a small decrease in the rate of involuntary admission since implementation but there has been no change in the representativeness of diagnoses of individuals admitted involuntarily. Mental Health Tribunals were held for 57% of those admitted involuntarily and 46% of service users found that the Mental Health Tribunal made the involuntary admission easier to accept. One year after discharge, 60% of service users reflected that their involuntary admission had been necessary. Professional groups have expressed concerns regarding workload, training time for junior doctors and paperwork. CONCLUSIONS The MHA 2001 has brought the practice of involuntary admission further into line with international standards. However, five years after the implementation of the Act international guidelines and practice have highlighted areas in need of further reform, including capacity legislation and consideration of advance directives and community treatment orders. Further research is also lacking on caregivers' or family members' perceptions of the MHA 2001.
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Affiliation(s)
- Hugh Ramsay
- Lucena Clinic, Orwell Road, Rathgar, Dublin 6, Ireland.
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Ng XT, Kelly BD. Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:317-326. [PMID: 22560406 DOI: 10.1016/j.ijlp.2012.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Individuals with mental disorders can, under specific circumstances, be detained and treated against their wishes. In 2009, there were 1633 involuntary admissions in Ireland, accounting for 8.1% of all psychiatric admissions. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in Dublin's north inner-city over a retrospective three-year period. The overall admission rate was 450.5 admissions per 100,000 population per year (deprivation-adjusted rate: 345.7), which is lower than the national rate (476.3). The involuntary admission rate was 67.7 (deprivation-adjusted rate: 51.9), which is higher than the national rate (38.5). Fifteen per cent of admissions were involuntary (for all or part of the admission), which is higher than the national proportion (8.1%) but the same as that reported in another inner-city psychiatry service (15.7%). The proportion of admissions that was involuntary was higher amongst individuals from outside Ireland (33.9%) compared to those from Ireland (12.0%) (p<0.001). Country of origin was, however, related to diagnosis: 53.2% of admissions of individuals from outside Ireland were with schizophrenia, compared to 18.5% of admissions of individuals from Ireland (p<0.001). Diagnosis was, in turn, related to admission status: 37.5% of admissions with schizophrenia were involuntary compared to 15% overall (p<0.001). On multi-variable testing, diagnosis was the only independent predictor of admission status (p=0.01) (R(2)=35.2%); country of origin was not an independent predictor of admission status. Deprivation accounts for part, but not all, of the high rate of involuntary admission in Dublin's inner-city. Diagnosis accounts for one third of the variance in admission status between individuals. Further study is required to determine what factors account for the remaining two thirds (e.g. symptoms, insight) and to clarify better the relationships between admission status, diagnosis and country of origin. There is a strong need for enhanced focus on the mental health needs of individuals from outside of Ireland, especially in Dublin's north inner-city.
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Affiliation(s)
- Xiao Ting Ng
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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