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Stephens J, Simkhada P, van Teijlingen E, Porter J, Eaton J. An analysis of Nepal's Draft Mental Health Act 2006-2017: Competing values and power. Health Policy Plan 2024:czae023. [PMID: 38590053 DOI: 10.1093/heapol/czae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 02/19/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
This qualitative study maps the process of drafting and consulting on Nepal's mental health legislation from 2006 to 2017. Fourteen people were interviewed, and interviews were analysed thematically. These themes were subsequently interpreted in light of Shiffman and Smith's policy analysis framework, as the process was found to be at the agenda-setting stage. Two groups of actors were identified with different views on appropriate policy content and how the policy process should be conducted. The first group included psychiatrists who initiated and controlled the drafting process, and who did not consider people with psychosocial disabilities to be equal partners. The psychiatrists viewed forced detention and treatment as upholding people's Right to Health and lobbied the Ministry of Health and Population (MoHP) to pass the draft Acts to Parliament. The second included the rights-based civil society actors and lawyers who saw the Right to Equality before the Law as of utmost priority, opposed forced detention and treatment, and actively blocked the draft Acts at the MoHP. There is no clear legal definition of mental health and illness in Nepal, legal and mental capacity are not differentiated, and people with mental and behavioural conditions are assumed to lack capacity. The analysis indicates that there were few favourable conditions to support the progression of this policy into law. It is unclear whether the drafters or blockers will prevail in the future, but we predict that professionals will continue to have more input into content than service users due to national policy dynamics.
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Affiliation(s)
| | | | | | - John Porter
- London School of Hygiene and Tropical Medicine, UK
| | - Julian Eaton
- London School of Hygiene and Tropical Medicine, UK
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Laing J, Dixon J, Stone K. 'I was going into it blind': Nearest Relatives, legal literacy, and the Mental Health Act 1983. Int J Law Psychiatry 2024; 94:101981. [PMID: 38513445 DOI: 10.1016/j.ijlp.2024.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
Eligible relatives are given rights and powers in the compulsory treatment of people with mental health problems in several international jurisdictions, including within England and Wales. However, little attention has been given to whether relatives feel legally literate or competent to fulfil such roles. This article examines this issue through focussing on the experiences of Nearest Relatives, who are given rights and powers during Mental Health Act 1983 (MHA) assessments for compulsory admission in England and Wales. Interviews with nineteen Nearest Relatives in England were conducted and were thematically analysed. Three themes were identified. First, NRs spoke about their awareness and knowledge of the role. They predominantly reported negative experiences in which they received no or little information. They also reported that professionals assumed they possessed legal knowledge, and their legal knowledge was largely self-taught. Secondly, NRs reported uncertainty about their own rights and powers, noting the role lacked status or informational or emotional support. Third, NRs highlighted areas for legal reform, stating that the NR role was important, but required specialist support systems for NRs. The findings of this study indicate greater attention needs to be given by law and policy makers to support relatives' understanding of their rights and powers under the MHA, if the NR role is to be effective in helping to safeguard patient rights under the European Convention on Human Rights. These include the right in Article 5 not to be arbitrarily deprived of one's liberty and the right to a private and family life in Article 8. Legislators also need to take account of these factors when considering proposals to reform mental health law in England and Wales.
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Affiliation(s)
- Judy Laing
- University of Bristol Law School, Bristol BS7 1RJ, UK.
| | - Jeremy Dixon
- Department of Social and Policy Sciences, University of Bath, Bath BA2 7AY, UK
| | - Kevin Stone
- Centre for Lifelong Learning, University of Warwick, Coventry CV4 7AL, UK
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Tromans S, Robinson G, Gabrielsson A, Bassett P, Sawhney I, Triantafyllopoulou P, Hassiotis A, Shankar R. The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study. Int J Soc Psychiatry 2024; 70:388-401. [PMID: 38001564 PMCID: PMC10913297 DOI: 10.1177/00207640231212112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. AIM To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. METHODS A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. RESULTS A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. CONCLUSION Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.
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Affiliation(s)
- Samuel Tromans
- Department of Population Health Sciences, University of Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, UK
| | - Gemma Robinson
- Forensic Community Learning Disability Team, Southern Health NHS Foundation Trust, Calmore, UK
| | | | | | | | | | | | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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Moran N, Naughton-Doe R, Wilberforce M, Wakeman E, Webber M. Supporting unpaid carers around hospital leave for people detained under the Mental Health Act (1983) in England: carer and practitioner perspectives. BMC Psychiatry 2024; 24:160. [PMID: 38395842 PMCID: PMC10885509 DOI: 10.1186/s12888-024-05602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND When an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers' instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave. METHODS Semi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis. RESULTS Three themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers. CONCLUSION Implications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a 'S.17 Standard', a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.
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Affiliation(s)
- Nicola Moran
- School for Business and Society, University of York, YO10 5DD, York, England.
| | - Ruth Naughton-Doe
- School for Business and Society, University of York, YO10 5DD, York, England
| | - Mark Wilberforce
- School for Business and Society, University of York, YO10 5DD, York, England
| | - Emma Wakeman
- St Andrew's Healthcare, Billing Road, NN1 5DG, Northampton, England
| | - Martin Webber
- School for Business and Society, University of York, YO10 5DD, York, England
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Kareem YA, Musami UB, Mahmood MY, Shuaib A, Ogualili PN. AN X-RAY OF THE NATIONAL MENTAL HEALTH ACT 2021 OF NIGERIA: OPPORTUNITIES, LIMITATIONS AND THE WAY FORWARD. West Afr J Med 2023; 40:S43. [PMID: 38071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The Nigerian Mental Health Law originated as a Lunacy ordinance in 1916 and matured into Lunacy Act CAP 524 of the law of Nigeria, 1964. This review of the National Mental Health Act (NMHA) 2021 of Nigeria examines the prospects, challenges, and possible ways forward. This act has a schedule, five parts, fifty-eight sections, and many subsections. It was compared with the WHO Checklist while the limitations were examined with a view to recommending solutions and identifying the tasks ahead. The NMHA 2021 provides for enhancing and regulating Mental Health Services through a Mental health Services Department. Also, a Mental Health Assessment committee is set up as a tribunal to protect the rights of persons with intellectual, cognitive and psychosocial disabilities, including the rights to a legal representative, employment, and housing. Persons with mental health conditions are to enjoy standard services and participate in formulating their medical plans devoid of coercion. The Presidential gazetting of the act is a good starting point in a positive direction. It should be adequately implemented with the coordinated efforts of all stakeholders and domesticated by the state governments. Finally, more advocacy by the Association of Psychiatrists in Nigeria and other key players. A key limitation is the access to the health care facility given the rural-urban access challenges and owing to the wide treatment gap and the low Doctor-patient ratio worsened by the brain drain.
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Affiliation(s)
- Yesiru A Kareem
- Mental Health Department, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria.
| | - Umar B Musami
- Mental Health Department, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria.
| | - Mohammed Y Mahmood
- Mental Health Department, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria.
| | - Abdulhakeem Shuaib
- Mental Health Department, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria.
| | - Placidus N Ogualili
- Mental Health Department, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria.
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Almadani AH, Altheyab ES, Alkheraiji MA, Alfraiji AF, Albrekkan F, Alkhamis AS, AlBuqami FH, Aljaffer MA. Perceptions and Attitudes of Mental Health Professionals toward the Mental Health Care Law in Saudi Arabia. Healthcare (Basel) 2023; 11:2784. [PMID: 37893858 PMCID: PMC10606621 DOI: 10.3390/healthcare11202784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The Saudi Mental Health Care Law (SMHL) was established in 2014; however, no prior study has evaluated mental health professionals' perceptions or attitudes toward it. This cross-sectional study examines these aspects and their associated factors among psychiatrists, psychologists, social workers, and psychiatric nurses in Saudi Arabia (SA). The data were collected from 432 participants using an online electronic survey consisting of four sections, including the Mental Health Legislation Attitudes Scale (MHLAS). Psychiatrists comprised most participants (46.06%), followed by psychologists (36.34%). Most participants were 40 years of age or younger (83.10%). Of the 432 participants, 226 (52.31%) were females. Overall, 28.70% were unaware of the existence of the SMHL. A total of 172 (66.67%) out of 258 participants agreed that the legislation operates well in ensuring treatment for persons who require involuntary admission. There was a statistically significant association between specialty and opinions of treatment efficacy and care benefits of the SMHL (p = 0.031 and p < 0.001, respectively). Official implementation of SMHL in participants' facilities resulted in high MHLAS scores (p = 0.007). Reading or attending lectures and workshops related to the SMHL resulted in high MHLAS scores (p = 0.044 and p = 0.021, respectively). Negative opinions and uncertainty regarding the effect of SMHL on confidentiality were associated with low total MHLAS scores (p < 0.001). This study highlights the need to increase awareness of the SMHL among Saudi Arabian healthcare workers.
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Affiliation(s)
- Ahmad H. Almadani
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (M.A.A.)
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
- SABIC Psychological Health Research and Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Eylaf S. Altheyab
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
| | - Meshal A. Alkheraiji
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
| | - Abdulaziz F. Alfraiji
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
| | - Fatimah Albrekkan
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (M.A.A.)
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
- SABIC Psychological Health Research and Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - AlRabab S. Alkhamis
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | - Fay H. AlBuqami
- College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed A. Aljaffer
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia; (F.A.); (M.A.A.)
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh 11362, Saudi Arabia; (E.S.A.)
- SABIC Psychological Health Research and Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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Connolly M, Schölin L, Robertson GS, Chopra A. Length and associated characteristics of short-term detentions: an analysis of detentions under the Mental Health Act in Scotland, 2006-2018. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1343-1352. [PMID: 36997745 PMCID: PMC10423135 DOI: 10.1007/s00127-023-02459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE The Mental Health Act in Scotland is under review. Previous iterations increased patients' rights but the maximum time for short-term detentions remains unchanged, despite evolving psychiatric treatment models. We explored length, mode of ending and factors of influence on the application of short-term detention certificates (STDCs), which can last up to 28 days, across Scotland between 2006 and 2018. METHODS Data on age, gender, ethnicity, date of commencement and ending of the STDC and detention site from all 42,493 STDCs issued to 30,464 patients over 12 years were extracted from the national repository for detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 and analysed using mixed models. RESULTS One in five STDCs lapsed on day 28. Two in five were revoked and the remainder extended to a treatment order. STDCs that were not extended averaged 19 days, and revoked STDCs 14 days. The probability of a detention lapsing varied across hospitals and increased with patient age. The odds of a detention lapsing on day 28 were 62% lower and revoked detentions 10% shorter in 2018 relative to 2006. The odds of a detention extending decreased significantly from 2012 to 2018. Extended STDCs were associated with increased patient age, male gender, and ethnicity other than White Scottish. There was little initiation of or active revocation of STDCs on weekend days. CONCLUSION The length of STDCs reduced over time, fewer detentions lapsed, and weekday patterning was evident in each year. These data can inform legislative and service reviews.
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Affiliation(s)
- Moira Connolly
- Mental Welfare Commission for Scotland, Edinburgh, Scotland.
| | - Lisa Schölin
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Gail S Robertson
- School of Mathematics, University of Edinburgh, Edinburgh, Scotland
| | - Arun Chopra
- Mental Welfare Commission for Scotland, Edinburgh, Scotland
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Alibudbud R. Gender in mental health: toward an LGBTQ+ inclusive and affirming psychiatry and mental healthcare in the Philippines. Front Psychiatry 2023; 14:1189231. [PMID: 37426100 PMCID: PMC10324514 DOI: 10.3389/fpsyt.2023.1189231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
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Babatunde A, Ruck Keene A, Simpson A, Gilbert S, Stephenson L, Chua KC, Owen G, Simpson AJ, Smith S, Henderson C. Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study. BMC Psychiatry 2023; 23:344. [PMID: 37198589 DOI: 10.1186/s12888-023-04825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The UK government committed to legislating for Advance Choice Documents/Advance Statements (ACD/AS) following their recommendation by the Independent Review of the MHA (2018). ACDs/AS are yet to be implemented in routine practice despite evidence and high demand; they are associated with improved therapeutic relationships and a reduction (25%, RR 0.75, CI 0.61-0.93) in compulsory psychiatric admission. Barriers to their implementation are well documented, ranging from low knowledge levels to logistical challenges in accessing the content during episodes of acute care. In the UK this is an issue for Black people, who experience detention rates disproportionately (over three times) higher than those of White British people and have poorer care experiences and outcomes. ACDs/AS allow for Black people to have their concerns heard by mental health professionals in a care system where they often feel their views are ignored. AdStAC aims to improve Black service users' experiences in mental health services in South London by co-producing and testing an ACD/AS implementation resource with Black service users, mental health professionals and carers/supporters of Black service users. METHODS/DESIGN The study will take place in South London, England over three phases: 1) formative work through stakeholder workshops; 2) co-production of resources through a consensus development exercise and working groups; and 3) testing of the resources using quality improvement (QI) methods. A lived experience advisory group, staff advisory group and project steering committee will support the study throughout. The implementation resources will comprise: advance choice document/advance statement (ACD/AS) documentation, stakeholder trainings, a manual for mental health professionals to facilitate the processes of creating and revising advance statements, and informatics development. DISCUSSION The implementation resources will help increase the likelihood of the new mental health legislation in England being implemented effectively; through aligning evidence-based medicine, policy and law to effectively provide positive clinical, social and financial outcomes for Black people, the National Health Service (NHS) and wider society. This study will likely benefit a wider group of people with severe mental illness, as when marginalised groups who are least engaged, can be supported with these strategies, then the strategies are likely to work for others.
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Affiliation(s)
- Abigail Babatunde
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Alex Ruck Keene
- Institute of Psychiatry, Psychology and Neuroscience, 39 Essex Chambers, London, UK
| | - Alan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Steven Gilbert
- Steve Gilbert Consulting, Blackthorn House, St Pauls Square, Birmingham, BC 1RL, UK
| | - Lucy Stephenson
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Kia-Chong Chua
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Gareth Owen
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF , UK
| | - Adelabu Jonathan Simpson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | | | - Claire Henderson
- Health Services and Population Research Department, David Goldberg Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
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Fuller SJ, Thomson S, Tan J. Nasogastric tube feeding under restraint: practical guidance for children's nurses. Nurs Child Young People 2023; 35:18-23. [PMID: 36408588 DOI: 10.7748/ncyp.2022.e1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.
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Affiliation(s)
- Sarah J Fuller
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Sharon Thomson
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Jacinta Tan
- child and adolescent mental health, Oxford Health NHS Foundation Trust, Bedford, England
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Tromans S, Bhui K, Sawhney I, Odiyoor M, Courtenay K, Roy A, Boer H, Alexander R, Biswas A, McCarthy J, Gulati G, Laugharne R, Shankar R. The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism. Br J Psychiatry 2023; 222:188-190. [PMID: 36746616 DOI: 10.1192/bjp.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.
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Affiliation(s)
- Samuel Tromans
- Department of Psychiatry, University of Leicester, Leicester, UK; and Leicestershire Partnership NHS Trust, Leicester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Indermeet Sawhney
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; and Hertfordshire Partnership NHS Foundation Trust, Braintree, UK
| | - Mahesh Odiyoor
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; Department of Psychiatry, University of Chester, Chester, UK; and Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ken Courtenay
- Psychiatry of Intellectual Disability Services, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Ashok Roy
- Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Harm Boer
- Learning Disabilities and Autism Services, West Midlands Partnership Alliance, Birmingham, UK
| | - Regi Alexander
- Intellectual Disability Forum, Royal Society of Medicine, London, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Jane McCarthy
- Learning/Intellectual Disability Service, Sussex Partnership NHS Foundation Trust, Worthing, UK; and Department of Psychiatry, King's College London, London, UK
| | - Gautam Gulati
- Department of Psychiatry, University of Limerick, Limerick, Ireland; and Faculty of Forensic Psychiatry, College of Psychiatrists of Ireland, Dublin, Ireland
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; Peninsula Clinical Research Network, Exeter, UK; and Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK
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Peters SJ, Schmitz-Buhl M, Karasch O, Zielasek J, Gouzoulis-Mayfrank E. Determinants of compulsory hospitalisation at admission and in the course of inpatient treatment in people with mental disorders-a retrospective analysis of health records of the four psychiatric hospitals of the city of Cologne. BMC Psychiatry 2022; 22:471. [PMID: 35836146 PMCID: PMC9284734 DOI: 10.1186/s12888-022-04107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to identify differences in predictors of involuntary psychiatric hospitalisation depending on whether the inpatient stay was involuntary right from the beginning since admission or changed from voluntary to involuntary in the course of in-patient treatment. METHODS We conducted an analysis of 1,773 mental health records of all cases treated under the Mental Health Act in the city of Cologne in the year 2011. 79.4% cases were admitted involuntarily and 20.6% were initially admitted on their own will and were detained later during the course of in-patient stay. We compared the clinical, sociodemographic, socioeconomic and environmental socioeconomic data (ESED) of the two groups. Finally, we employed two different machine learning decision-tree algorithms, Chi-squared Automatic Interaction Detection (CHAID) and Random Forest. RESULTS Most of the investigated variables did not differ and those with significant differences showed consistently low effect sizes. In the CHAID analysis, the first node split was determined by the hospital the patient was treated at. The diagnosis of a psychotic disorder, an affective disorder, age, and previous outpatient treatment as well as the purchasing power per 100 inhabitants in the living area of the patients also played a role in the model. In the Random Forest, age and the treating hospital had the highest impact on the accuracy and decrease in Gini of the model. However, both models achieved a poor balanced accuracy. Overall, the decision-tree analyses did not yield a solid, causally interpretable prediction model. CONCLUSION Cases with detention at admission and cases with detention in the course of in-patient treatment were largely similar in respect to the investigated variables. Our findings give no indication for possible differential preventive measures against coercion for the two subgroups. There is no need or rationale to differentiate the two subgroups in future studies.
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Affiliation(s)
- Sönke Johann Peters
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411097.a0000 0000 8852 305XUniversity Hospital of Cologne, Cologne, Germany
| | - Mario Schmitz-Buhl
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Olaf Karasch
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany. .,LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
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13
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Hemachandra D, Riordan D, Sabir A, Keightley P. Criminal and financial penalties for clinicians in the ACT Mental Health Act weigh more heavily on senior doctors. Australas Psychiatry 2022; 30:179-184. [PMID: 34192472 DOI: 10.1177/10398562211025015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to assess the attitudes of ACT public psychiatry doctors towards the financial and criminal penalties in the ACT Mental Health Act 2015. METHOD Baseline attitude was surveyed with an 11-item 5-point Likert scale. Education was then provided about the offences outlined in the Act and the associated penalties. The same initial survey was then repeated. Primary outcomes were changes in attitude pre- and post- information, and secondarily data was explored for differences related to gender and seniority. RESULTS Forty-nine percent of 89 eligible public mental health system doctors responded. The majority of the survey respondents were female (59%). Provision of information resulted in a significant improvement in understanding of liabilities (2.80 (SD 1.14) versus 3.58 (SD 0.93), t(39) = 4.06, p < 0.001). Gender had no significant impact on scores. Senior staff were less legally secure and less satisfied with the Mental Health Act pre-information being provided. With regards to notification penalties, with education, junior staff became more secure and seniors less so. CONCLUSIONS Information provision improves understanding of the penalties under the Mental Health Act 2015. Having a senior role predicts lower satisfaction with the penalties in the Act.
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Affiliation(s)
| | - Denise Riordan
- Senior Staff Specialist Psychiatrist, Acting Director of Clinical Services, Clinical Director of the Child and Adolescent Mental Health Service, Canberra Health Services, ACT, Australia.,Honorary Senior Lecturer, Australian National University Australia
| | - Azra Sabir
- Staff Specialist Psychiatrist, Deputy Clinical Director Adult Community Mental Health Services, Canberra Health Services, ACT, Australia
| | - Philip Keightley
- Senior Staff Specialist Psychiatrist, Director of Psychiatry Training, Canberra Health Services, ACT, Australia.,Clinical Lecturer, Australian National University Medical School, Garran, ACT, Australia
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14
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Lenagh-Glue J, Dawson J, Potiki J, O'Brien AJ, Thom K, Casey H, Glue P. Use of advance directives to promote supported decision-making in mental health care: Implications of international trends for reform in New Zealand. Aust N Z J Psychiatry 2022; 57:636-641. [PMID: 35164527 DOI: 10.1177/00048674221079225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advance directives are advocated, in many jurisdictions, as a way to promote supported decision-making for people who use mental health services and to promote countries' compliance with their obligations under the United Nations Convention on the Rights of Persons with Disabilities. The United Nations Convention on the Rights of Persons with Disabilities promotes the use of tools to further personal autonomy which would include integrating the use of advance directives into mental health law, to clarify the effect (or force) an advance directive carries when its maker comes under the relevant mental health legislation. In addition, securing the active use of advance directives requires adoption of certain supportive practices and policies within health services. Here, we discuss a number of approaches taken to advance directives in revised mental health legislation, and the associated practices we think are required.
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Affiliation(s)
- Jessie Lenagh-Glue
- Faculty of Law, University of Otago, Dunedin, New Zealand.,Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - John Dawson
- Faculty of Law, University of Otago, Dunedin, New Zealand
| | | | | | - Katey Thom
- Law School, Auckland University of Technology, Auckland, New Zealand
| | - Heather Casey
- Southern District Health Board, Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.,School of Medical Sciences, University of Otago, Dunedin, New Zealand
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15
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Robins JE, Morley KI, Hayes RD, Ross KR, Pritchard M, Curtis V, Kalk NJ. Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt. Drug Alcohol Depend 2021; 224:108725. [PMID: 33940325 DOI: 10.1016/j.drugalcdep.2021.108725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. METHODS We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. RESULTS Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001). CONCLUSIONS The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.
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Affiliation(s)
- John E Robins
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Katherine I Morley
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; Innovation, Health, and Science, RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia
| | - Richard D Hayes
- Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Kezia R Ross
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Vivienne Curtis
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; Health Education England, 4 Stewart House, 32 Russell Square, Bloomsbury, London, WC1B 5DN, UK
| | - Nicola J Kalk
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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16
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Payne-Gill J, Whitfield C, Beck A. The effect of rapidly discharging psychiatric inpatients from Mental Health Act section during COVID-19: a cohort study. Epidemiol Psychiatr Sci 2021; 30:e54. [PMID: 34167612 DOI: 10.1017/S2045796021000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS In March 2020, the UK government ordered mental health services to free up bed space to help manage the COVID-19 pandemic. This meant service users detained under the Mental Health Act were discharged at a higher rate than normal. We analysed whether this decision compromised the safety of this vulnerable group of service users. METHODS We utilised a cohort study design and allocated service users to either the pre-rapid discharge, rapid discharge or post-rapid discharge group. We conducted a recurrent event analysis to assess group differences in the risk of experiencing negative outcomes during the 61 days post-discharge. We defined negative outcomes as crisis service use, re-admission to a psychiatric ward, community incidents of violence or self-harm and death by suicide. RESULTS The pre-rapid discharge cohort included 258 service users, the rapid discharge cohort 127 and the post-rapid discharge cohort 76. We found no statistical association between being in the rapid discharge cohort and the risk of experiencing negative outcomes (HR: 1.14, 95% CI: 0.72-1.8, p = 0.58) but a trend towards statistical significance for service users in the post-rapid discharge cohort (HR: 1.61, 95% CI: 0.91-2.83, p = 0.1). CONCLUSIONS We did not find evidence that service users rapidly discharged from section experienced poorer outcomes. This raises the possibility that the Mental Health Act is applied in an overly restrictive manner, meaning that sections for some formally detained service users could be ended earlier without compromising safety.
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17
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Abbas MJ, Kronenberg G, McBride M, Chari D, Alam F, Mukaetova-Ladinska E, Al-Uzri M, Brugha T. The Early Impact of the COVID-19 Pandemic on Acute Care Mental Health Services. Psychiatr Serv 2021; 72:242-246. [PMID: 33076794 DOI: 10.1176/appi.ps.202000467] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to explore the effects of COVID-19 and the lockdown measures adopted in England on patients with acute mental illness. METHODS The authors analyzed referrals to the crisis resolution and home treatment (CRHT) team and inpatient admissions to acute adult wards, at Leicestershire Partnership National Health Service Trust, an integrated community and mental health trust in the United Kingdom. Number of CRHT referrals and inpatient admissions during a 4-week period starting March 16, 2020 ("COVID-19 period"), was studied and compared with the same period in 2018 and 2019 ("control periods"). Demographic and clinical characteristics of patients admitted during the COVID-19 period were compared with those admitted during the 2019 control period. RESULTS The number of CRHT referrals and inpatient admissions were lower during the COVID-19 period, compared with the control periods, by approximately 12% and 20%, respectively. Patients admitted during the COVID-19 period were significantly more often detained under the Mental Health Act and were considered to pose a risk of aggression. The pattern of diagnoses differed significantly between 2020 and 2019. A higher percentage of patients admitted during the COVID-19 period were diagnosed as having nonaffective psychotic disorders (52% versus 35%) or bipolar disorder (25% versus 15%), and fewer received a diagnosis of depression (8% versus 16%), anxiety disorder (0% versus 3%), adjustment disorder (0% versus 8%), emotionally unstable personality disorder (6% versus 15%), or any other personality disorder (0% versus 5%) (p=0.01). CONCLUSIONS These findings suggest that the pandemic has profoundly affected care by acute mental health services.
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Affiliation(s)
- Mohammed J Abbas
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Golo Kronenberg
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Martin McBride
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Damodar Chari
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Faisel Alam
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Elizabeta Mukaetova-Ladinska
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Mohammed Al-Uzri
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
| | - Traolach Brugha
- Leicestershire Partnership National Health Service Trust, Leicestershire, United Kingdom (Abbas, Kronenberg, McBride, Chari, Alam, Al-Uzri); Department of Health Sciences (Abbas, Al-Uzri, Brugha), College of Life Sciences (Kronenberg), and Department of Neuroscience, Psychology and Behaviour (Mukaetova-Ladinska), University of Leicester, Leicester, United Kingdom
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Kent T, Cooke A, Marsh I. "The expert and the patient": a discourse analysis of the house of commons' debates regarding the 2007 Mental Health Act. J Ment Health 2020; 31:152-157. [PMID: 32930654 DOI: 10.1080/09638237.2020.1818706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Mental Health Act 1983 was amended in 2007. This legislation appears to be predicated on the assumption that an entity of "mental disorder" exists and that people who are designated mentally disordered require medical treatment, administered by force if necessary. AIMS To explore the ways in which mental disorder is constructed and the possible practical effects of these constructions in the House of Commons' debates regarding the Mental Health Act 2007. METHOD Verbatim transcripts from the House of Commons debates on the Mental Health Act were studied through a discourse analysis. RESULTS Two primary discursive constructions were identified: "The Expert" and "The Patient." CONCLUSION Mental disorder and associated roles, such as "The Expert," were constructed through particular selective rhetoric, which taken together, made particular psychiatric practices and the need for legislation, such as compulsory detention, seem normal, and necessary.
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Affiliation(s)
- Tom Kent
- School of Psychology, University of Surrey, Guildford, UK
| | - Anne Cooke
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Ian Marsh
- Canterbury Christ Church University, Canterbury, UK
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19
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Wang HY, Huang JJ, Su SF, Hsu SH, Chou LS, Chou FHC. From folk therapy to evidence-based psychiatry practice: The benefit of evidence-based psychiatry in treatment-naive psychotic patients. Int J Soc Psychiatry 2020; 66:593-599. [PMID: 32466700 DOI: 10.1177/0020764020924698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As Taiwan's Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. AIMS To evaluate the outcomes of these patients from folk therapy to conventional treatment. METHOD The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. RESULTS The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. CONCLUSION The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.
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Affiliation(s)
- Hung-Yu Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City
| | - Joh-Jong Huang
- Department of Family Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung City.,Department of Health, Kaohsiung City Government, Kaohsiung City.,Bureau of Social Affairs, Tainan City Government, Kaohsiung City
| | - Shu-Fang Su
- Department of Health, Kaohsiung City Government, Kaohsiung City
| | - Sheng-Hao Hsu
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City
| | - Li-Shiu Chou
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City
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20
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Leonard SJ, Webb RT, Shaw JJ. Service transitions, interventions and care pathways following remittal to prison from medium secure psychiatric services in England and Wales: national cohort study. BJPsych Open 2020; 6:e80. [PMID: 32741401 PMCID: PMC7453795 DOI: 10.1192/bjo.2020.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/22/2020] [Accepted: 06/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes. AIMS To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development. METHOD Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons. RESULTS Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team. CONCLUSIONS Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals' legal rights to ongoing aftercare are upheld.
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Affiliation(s)
- Sarah-Jayne Leonard
- Offender Health Research Network, Centre for Mental Health and Safety, University of Manchester, UK
| | - Roger T. Webb
- Centre for Mental Health and Safety, University of Manchester, UK
| | - Jennifer J. Shaw
- Centre for Mental Health and Safety, University of Manchester, UK
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21
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Brown C, Ruck Keene A, Hooper CR, O'Brien A. Isolation of patients in psychiatric hospitals in the context of the COVID-19 pandemic: An ethical, legal, and practical challenge. Int J Law Psychiatry 2020; 71:101572. [PMID: 32768110 PMCID: PMC7205628 DOI: 10.1016/j.ijlp.2020.101572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 05/18/2023]
Abstract
Psychiatric inpatients are particularly vulnerable to the transmission and effects of COVID-19. As such, healthcare providers should implement measures to prevent its spread within mental health units, including adequate testing, cohorting, and in some cases, the isolation of patients. Respiratory isolation imposes a significant limitation on an individual's right to liberty, and should be accompanied by appropriate legal safeguards. This paper explores the implications of respiratory isolation in English law, considering the applicability of the common law doctrine of necessity, the Mental Capacity Act 2005, the Mental Health Act 1983, and public health legislation. We then interrogate the practicality of currently available approaches by applying them to a series of hypothetical cases. There are currently no 'neat' or practicable solutions to the problem of lawfully isolating patients on mental health units, and we discuss the myriad issues with both mental health and public health law approaches to the problem. We conclude by making some suggestions to policymakers.
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Affiliation(s)
- Christian Brown
- South West London and St. George's Mental Health NHS Trust, 61 Glenburnie Road, London SW17 7DJ, UK.
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22
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Taylor-Sands M, Nicholson Z. The role of the Mental Health Tribunal in setting duration of compulsory treatment in Victoria. Psychiatr Psychol Law 2020; 28:343-362. [PMID: 35530126 PMCID: PMC9067996 DOI: 10.1080/13218719.2020.1775153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article explores the role of the Mental Health Tribunal (the Tribunal) in setting duration of compulsory treatment orders under the Mental Health Act 2014 (Vic) (the MH Act) using qualitative analysis of data obtained by a Tribunal working group. It explores the extent to which there is a difference between the duration of treatment orders requested by treating teams and those made by the Tribunal, as well as the factors the Tribunal takes into account in setting a different duration. Results reveal the Tribunal made a treatment order of different (mostly shorter) duration in one out of five hearings. In these cases, two out of four factors identified by the working group were dominant influences: (1) ensuring congruence with the principles of the MH Act; and (2) information presented by one or more participants at the hearing. There were also high levels of attendance from either the patient, their support person or their legal representative when the Tribunal made a treatment order of different duration. This suggests participation by patients and support people at hearings provides the Tribunal with the information it needs to consider the principles under the MH Act meaningfully when exercising its discretion to determine the duration of compulsory treatment orders.
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Affiliation(s)
- Michelle Taylor-Sands
- Melbourne Law School, University of Melbourne, Carlton, Australia
- Victoria Department of Health and Human Services, Mental Health Tribunal, Melbourne, Australia
| | - Zashalla Nicholson
- Victoria Department of Health and Human Services, Mental Health Tribunal, Melbourne, Australia
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23
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Dixon J, Wilkinson-Tough M, Stone K, Laing J. Treading a tightrope: Professional perspectives on balancing the rights of patient's and relative's under the Mental Health Act in England. Health Soc Care Community 2020; 28:300-308. [PMID: 31566844 DOI: 10.1111/hsc.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
Involuntary detention is used internationally to detain and treat people who are deemed to have a mental disorder. In England and Wales, approved mental health professionals (AMHPs) co-ordinate Mental Health Act assessments which allow for patients to be detained. AMHPs have legal duties to identify, inform and consult with a patient's nearest relative (NR), who are, in turn, given powers to initiate or challenge detention. Our study takes an original approach through examining how AMHPs interpret their duties towards nearest relatives. We adopted a two-stage design, which involved an online questionnaire with 55 AMHPs and focus group discussions with 33 AMHPs. The research was conducted in England between 2017 and 2018. Our questionnaire found that a high proportion of AMHPs reported that they had spoken to NRs for background information when assessing patients under the Mental Health Act. However, AMHPs were less likely to ask patients about their views of involving the NR prior to assessment. Focus group findings showed that AMHPs saw the NR role as offering an important 'safeguard' on the basis that NRs could provide information about the patient and advocate on their behalf. AMHPs identified practical difficulties in balancing their legal obligation towards NRs and patients; particularly where issues of potential abuse were raised or where patients had identified that they did not want NR involvement. While AMHPs stated that they sought to prioritise patient wishes regarding confidentiality, their accounts identified that patient consent about information sharing was sometimes implied rather than sought explicitly. Our findings reinforce conclusions by the recent Independent Review of the MHA, which states that current NR provisions are 'outdated, variable and insufficient'. We identify that current practice could be improved using advanced choice documents and outline implications for AMHP practice.
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Affiliation(s)
- Jeremy Dixon
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Megan Wilkinson-Tough
- Avon and Wiltshire Mental Health Partnership NHS Trust, Callington Road Hospital, Bristol, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Kevin Stone
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Judy Laing
- University of Bristol Law School, Bristol, UK
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Oram S, Colling C, Pritchard M, Khondoker M, Fonseca de Freitas D, Ter-Minassian L, Downs J, Lloyd-Evans B, Markham S, Werbeloff N, Chang CK, Johnson S, Hotopf M, Hayes RD. Patterns of use of the Mental Health Act 1983, from 2007-2008 to 2016-2017, in two major London secondary mental healthcare providers. BJPsych Open 2019; 5:e102. [PMID: 31771677 PMCID: PMC7000989 DOI: 10.1192/bjo.2019.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007-2008 and 2016-2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.
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Affiliation(s)
- Sian Oram
- Senior Lecturer in Women's Mental Health, NIHR Mental Health Policy Research Unit & Section for Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Craig Colling
- Information Manager, NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, UK
| | - Megan Pritchard
- CRIS Training and Development Lead, NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, UK
| | - Mizanur Khondoker
- Senior Lecturer in Medical Statistics, Norwich Medical School, University of East Anglia, UK
| | - Daniela Fonseca de Freitas
- Postdoctoral Researcher, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucile Ter-Minassian
- Research Worker, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Johnny Downs
- Clinical Lecturer, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Brynmor Lloyd-Evans
- Senior Lecturer, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, UK
| | - Sarah Markham
- Visiting Researcher, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nomi Werbeloff
- Senior Research Associate, Division of Psychiatry, UCL; and Camden and Islington NHS Foundation Trust, UK
| | - Chin-Kuo Chang
- Associate Professor, Department of Health and Welfare, University of Taipei, Taiwan
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL; and Camden and Islington NHS Foundation Trust, UK
| | - Matthew Hotopf
- Professor of General Hospital Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Richard D Hayes
- Senior Lecturer, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Abstract
OBJECTIVE Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). METHODS We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008-2010 (Mental Health Act 1986) and 2014-2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge - whether by the treating psychiatrist, external body or through expiry. RESULTS Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge - 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) - and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. CONCLUSION The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.
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Affiliation(s)
- Ruth Vine
- 1 NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,2 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Holly Tibble
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Judd
- 2 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,4 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Matthew J Spittal
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Pang S. Criminalising Health Care? The Use of Offences in the Mental Health Act 2015 (ACT). J Law Med 2019; 26:638-654. [PMID: 30958655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health statutes in every Australian jurisdiction contain penalties for breaching certain provisions. The Australian Capital Territory's new Mental Health Act 2015 (ACT) is notable in using not only financial penalties, but also including specific offences and the possibility of imprisonment to regulate certain procedures related to the involuntary detention and treatment of those with mental illness. The penalties for committing the offences range from small fines to 12 months' imprisonment. There is a concern that the threat of criminal punishment may discourage practitioners from routinely using the Act's immediate detention procedure. Failure to adhere to extensive notification requirements can result in financial penalties. Private psychiatric facilities may also face particular penalties. The inclusion of separate provisions which are specifically labelled as offences in mental health legislation has received minimal attention. Criminalising aspects of mental health care creates stigma, may encourage defensive medical practice, and works against the recovery movement. There is a slow development of this trend in other health specialties.
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Affiliation(s)
- Sam Pang
- Advanced Trainee in Forensic Psychiatry, the Victorian Institute of Forensic Mental Health, Melbourne
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Smith M, O'Regan R, Goldbeck R. Detaining patients in the general hospital - current practice and pitfalls. Scott Med J 2019; 64:91-96. [PMID: 30885059 DOI: 10.1177/0036933019836054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals. METHOD AND RESULTS We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates - the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations. CONCLUSION General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.
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Affiliation(s)
- Murray Smith
- 1 Specialty Registrar in Psychiatry, Department of Psychological Medicine, NHS Grampian Aberdeen Royal Infirmary, Aberdeen, UK
| | - Rian O'Regan
- 2 Specialty Registrar in Psychiatry, Leverndale Hospital, Glasgow, UK
| | - Rainer Goldbeck
- 3 Consultant Liaison Psychiatrist, Department of Psychological Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
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Pugh J, Aziz T, Herring J, Savulescu J. Deep brain stimulation and revising the Mental Health Act: the case for intervention-specific safeguards. Br J Psychiatry 2019; 214:133-136. [PMID: 30774052 PMCID: PMC6420052 DOI: 10.1192/bjp.2018.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/28/2018] [Accepted: 08/31/2018] [Indexed: 01/19/2023]
Abstract
Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.Declaration of interestT.A. is a paid consultant for Boston Scientific, Medtronic and St. Jude Medical. He has received honoraria from Abbott, Boston and Medtronics and served as consultant to all three.
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Affiliation(s)
- Jonathan Pugh
- Research Fellow in Applied Moral Philosophy, The Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK
| | - Tipu Aziz
- Professor of Neurosurgery, The Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK
| | | | - Julian Savulescu
- Uehiro Chair in Practical Ethics, Oxford Functional Neurosurgery, University of Oxford, UK
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Heo YC, Kahng SK, Kim S. Mental health system at the community level in Korea: development, recent reforms and challenges. Int J Ment Health Syst 2019; 13:9. [PMID: 30805025 PMCID: PMC6373148 DOI: 10.1186/s13033-019-0266-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/08/2019] [Indexed: 11/10/2022] Open
Abstract
Since the introduction of the Mental Health Act (MHA) in 1995, mental health services have expanded at the community level in Korea. While community facilities for mental health have grown considerably, large numbers of people with mental disorders are accommodated as before in private mental hospitals. Korea needs to reduce the level of dependence on long-term treatments in hospitals and expand coverage of services for the people with mental illness (PMI) to all in local communities. To achieve this objective, the significant legislative changes were made through the amendment of the MHA. The completely revised act indicates that the Korean government seeks a harmonized balance between inpatient care and outpatient care by declaring the necessity of various welfare services to ensure human rights of the PMI. Particularly, mental health system furthers to provide comprehensive services for the majority of community population to monitor risk factors of mental disorders as well as for the PMI. In this sense, the Korean government could refer to the British case of “Improving Access to Psychological Therapies” as suggested by an OECD investigation team. Achieving the goal calls for both a deliberate realignment of existing services and additional resources in line with legislative reforms. Further public efforts should be made in collaboration with medical institutions and private service providers to realize the valuable goals pursued by the amended act.
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Affiliation(s)
- Yong-Chang Heo
- 1Department of Social Welfare, Keimyung University, 331-2, College of Social Science Building, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
| | - Sang Kyoung Kahng
- 2Department of Social Welfare, Seoul National University, 16-651, College of Social Science Building, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.,Korean Research Center for Guardianship and Trusts (KCGAT), 222 Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea
| | - Sungyong Kim
- 4Institute of Social Welfare, Seoul National University, 220-551, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
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Hill SA, Riordan-Eva E, Hosking A. Trends in the number of restricted patients in England and Wales 2003-2016: Implications for forensic psychiatry services. Med Sci Law 2019; 59:42-48. [PMID: 30669946 DOI: 10.1177/0025802419825596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper uses data produced by the Ministry of Justice to look for trends in the numbers of various categories of patients detained under the Mental Health Act in England and Wales between 2003 and 2016. Specifically, we have focussed on patients detained with Ministry of Justice restrictions in place. The number of 'restricted' patients, who are largely detained in secure psychiatric hospitals, has risen substantially during this period. If this trend continues, there will be the need for further expansion of secure psychiatric beds in the years ahead. Factors driving the increased number of restricted patients are discussed in this paper.
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Affiliation(s)
- Simon A Hill
- Bluebird House, Tatchbury Mount Southern Health NHS Foundation Trust, UK
| | | | - Alexandra Hosking
- Bluebird House, Tatchbury Mount Southern Health NHS Foundation Trust, UK
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Abstract
Delays in accessing appropriate care affect patients with most major health conditions, including psychosis. These delays may also be affected by pathways to care. In a recent article in BMC Medicine, Bhui and colleagues review the current evidence for ethnic differences in pathways to care for psychosis in England. They reveal that black and Asian people are 3 and 1.5 times more likely, respectively, to come to the attention of psychosis services via compulsory admission than white British people. In this Commentary, I discuss the implications of this on achieving equitable care for psychosis patients and outcomes following their care. The current review of the Mental Health Act provides a timely opportunity to remove such inequalities in England.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1201-9 .
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Affiliation(s)
- James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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McGuinness D, Murphy K, Bainbridge E, Brosnan L, Keys M, Felzmann H, Hallahan B, McDonald C, Higgins A. Individuals' experiences of involuntary admissions and preserving control: qualitative study. BJPsych Open 2018; 4:501-509. [PMID: 30564446 PMCID: PMC6293449 DOI: 10.1192/bjo.2018.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established. AIMS To develop an understanding of individuals' experiences over the course of the involuntary admission process. METHOD Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach. RESULTS The 'theory of preserving control' (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: 'losing control', 'regaining control' and 'maintaining control', and a number of related subcategories. CONCLUSIONS Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission. DECLARATION OF INTEREST None.
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Affiliation(s)
- David McGuinness
- Research Nurse, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Emma Bainbridge
- Honorary Clinical Fellow, School of Medicine, National University of Ireland, Ireland
| | - Liz Brosnan
- Survivor Researcher and Consultant, Centre for Disability Law and Policy, National University of Ireland, Ireland
| | - Mary Keys
- Former Lecturer in Law, School of Law, National University of Ireland, Ireland
| | - Heike Felzmann
- Lecturer in Philosophy/Ethics, Centre of Bioethical Research and Analysis, National University of Ireland, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Colm McDonald
- Professor of Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College, University of Dublin,Ireland
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Bainbridge E, Hallahan B, McGuinness D, Gunning P, Newell J, Higgins A, Murphy K, McDonald C. Predictors of involuntary patients' satisfaction with care: prospective study. BJPsych Open 2018; 4:492-500. [PMID: 30564445 PMCID: PMC6293452 DOI: 10.1192/bjo.2018.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/12/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated. AIMS We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors. METHOD Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling. RESULTS Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care. CONCLUSIONS There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness. DECLARATION OF INTEREST None.
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Affiliation(s)
- Emma Bainbridge
- Honorary Clinical Fellow, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - David McGuinness
- Research Nurse, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Patricia Gunning
- Clinical Research Biostatistician, HRB Clinical Research Facility, National University of Ireland Galway, Ireland
| | - John Newell
- Professor of Biostatistics, HRB Clinical Research Facility, National University of Ireland Galway and School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Colm McDonald
- Professor of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway and HRB Clinical Research Facility, National University of Ireland Galway, Ireland
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Abstract
BACKGROUND Concerns have been raised about the increase in the use of involuntary detentions under the Mental Health Act in England over a number of years, and whether this merits consideration of legislative change.AimsTo investigate changes in the rate of detentions under Part II (civil) and Part III (forensic) sections of the Mental Health Act in England between 1984 and 2016. METHOD Retrospective analysis of data on involuntary detentions from the National Archives and NHS Digital. Rates per 100 000 population were calculated with percentage changes. The odds of being formally admitted to a National Health Service hospital compared with a private hospital were calculated for each year. RESULTS Rates of detention have at least trebled since the 1980s and doubled since the 1990s. This has been because of a rise in Part II (civil) sections. Although the overall rate of detentions under Part III (forensic) sections did not rise, transfers from prison increased and detentions by the courts reduced. The odds of being detained in a private hospital increased fivefold. CONCLUSIONS The move to community-based mental health services in England has paradoxically led to an increase in the number of people being detained in hospital each year, and in particular an inexorable rise in involuntary admissions. This is likely to be partly because of improved case finding with an increased focus on treatment and risk management, and partly because of changes in legislation. An increasing proportion of this government-funded care is being provided by private hospitals.Declaration of interestNone.
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Affiliation(s)
- Patrick Keown
- Academic Psychiatry, Campus for Ageing & Vitality,Institute of Neuroscience, Newcastle University,UK
| | - Hannah Murphy
- Academic Psychiatry, Campus for Ageing & Vitality,Institute of Neuroscience, Newcastle University,UK
| | - Dannielle McKenna
- Academic Psychiatry, Campus for Ageing & Vitality,Institute of Neuroscience, Newcastle University,UK
| | - Iain McKinnon
- Academic Psychiatry, Campus for Ageing & Vitality,Institute of Neuroscience, Newcastle University,UK
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Abstract
OBJECTIVES The assessment and management of a patient who refuses medical treatment requires clinical skill, and consideration of the relevant law and the patient's decision-making capacity. Psychiatrists are often asked to advise in these situations. We aimed to develop an algorithm describing the relevant legal pathways to assist clinicians, especially psychiatrists, working in New South Wales (NSW), Australia. METHODS We reviewed the academic literature on treatment refusal, relevant legislation, judicial rulings and NSW Health policy directives and guidelines. We consulted with clinicians and representatives of relevant tribunals. RESULTS We developed an algorithm for managing patients who refuse medical treatment in NSW. The algorithm emphases the evaluation of decision-making capacity and tracks separate pathways depending upon a person's status under the Mental Health Act 2007 (NSW). CONCLUSIONS The algorithm provides a clear decision tree for clinicians responding to a patient refusing medical treatment in NSW.
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Affiliation(s)
- Kylie Cheng
- Psychiatry Registrar, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Anne Wand
- Staff Specialist Psychiatrist, Conjoint Senior Lecturer, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Christopher Ryan
- Staff Specialist Psychiatrist, Clinical Associate Professor, Discipline of Psychiatry and Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sascha Callaghan
- Solicitor and Barrister, Doctoral Scholar, Lecturer, Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Panesar N, Valachova I, Schmidtman R, Chan DKY. Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons. Australas Psychiatry 2018; 26:469-473. [PMID: 29480017 DOI: 10.1177/1039856218758545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study aimed to survey hospital staff knowledge of the application of the Mental Health Act 2007 (NSW) (MHA) and the Guardianship Act 1987 (NSW) (GA) in the care and treatment of older persons in a teaching hospital in Sydney. Method Over a two-month period in 2017, a survey questionnaire was distributed to staff involved in older persons' care across the hospital. RESULTS The majority of the hospital staff demonstrated basic theoretical knowledge of both the GA (76%) and of the MHA (84.5%). Fewer (64.5%) appeared to understand the practical application of the MHA in the hypothetical clinical situations. An even lower proportion of staff appeared to understand the application of the GA either to obtain consent for medical treatment or to appoint a guardian through the Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT). CONCLUSION Although clinical staff of the hospital displayed fair knowledge and awareness about the application of the MHA and the GA to inpatient care of older adults, further education is necessary, particularly about the application of the GA. The authors suggest similar findings may occur at other New South Wales hospitals, which may raise concern and need for education.
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Affiliation(s)
- Narinder Panesar
- Consultant Psychogeriatrician, Psychogeriatric Department, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Iveta Valachova
- Consultant Psychogeriatrician, Psychogeriatric Department, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Robert Schmidtman
- Consultant Psychogeriatrician, Psychogeriatric Department, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
| | - Daniel Kam Yin Chan
- Professor and Consultant Geriatrician, Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital and University of New South Wales, Bankstown, NSW, Australia
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Eswaravel A, O'Brien A. A retrospective cohort study describing the characteristics of patients under 18 years old in one section 136 suite. Med Sci Law 2018; 58:222-232. [PMID: 30149768 DOI: 10.1177/0025802418790856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Section 136 of the Mental Health Act 1983 is an authority allowing police officers to remove a person 'who appears to him to be suffering from mental disorder' from a public area. There has been much media coverage regarding the inappropriate detention of minors under section 136 and the suggestion that many were taken to police cells, as there were no suitable places of safety. Although previous studies describe characteristics of a typical individual detained under section 136, few distinguish the differences between adults and adolescents. Profiling these adolescents can help to identify adolescents at risk, allowing for earlier intervention and prevent the inappropriate detention of individuals. Data were collected retrospectively for all patients under 18 years of age who were brought to a section 136 suite in south-west London over a five-year period. The typical profile of an adolescent presenting to this suite was a 16-year-old female of white ethnicity who was sectioned in a public area due to attempted suicide or deliberate self-harm. The individual is more likely to have mental or behavioural difficulties, a history of abuse, be under the care of local authorities and have had previous convictions compared to adolescents in the general population.
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Abstract
OBJECTIVES The 'Service Users' Perspective of their Admission' study examined voluntarily and involuntarily admitted services users' perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study. METHODS The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission. RESULTS A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders. CONCLUSIONS This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.
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Abstract
District nurses require a vast array of skills to enable effective care delivery for patients living with a diagnosis of dementia in the community setting. Complex care needs provide challenges for the provision and delivery of district nursing services, which must be overcome to provide patientcentred care. Demographic and financial constraints hamper service delivery and the availability of services; however, district nurses are required to use their problem solving skills and tacit knowledge to deal with these challenges. The Northern Ireland Single Assessment Tool (NISAT) uses a person-centred framework to provide a holistic approach to care. The case study reflects a holistic and person centred approach to care for a person with dementia by a district nursing student.
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Affiliation(s)
- Laura Dixon
- District Nurse, Belfast Health and Social Care Trust, Belfast
| | - Hilary Thompson
- Lecturer in Nursing, Option Leader Specialist Nursing, District Nursing, University of Ulster, Jordanstown, Belfast
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Mercer D, Perkins E. Sex, gender and the carceral: Female staff experiences of working in forensic care with sexual offenders. Int J Law Psychiatry 2018; 59:38-43. [PMID: 29996986 DOI: 10.1016/j.ijlp.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
English high-secure hospitals have contained individuals deemed mentally disordered, and dangerous, since the mid-nineteenth century. With the development of gender sensitive services female patients have been moved out of these institutions into smaller secure settings. Female staff continue to work in high secure hospitals, but are often in a minority in these services. Little is known about how female staff experience the everyday world of work. This paper is based on in-depth interviews with female nurses employed in a unit caring for detained male sexual offenders with a diagnosis of personality disorder. It forms part of a much larger discourse-analytic study of nine patients, with a history of sexual offending, and eighteen mental health nurses, which focused on talk about pornography and criminality. The findings from this project have been previously reported in Mercer and Perkins (2014). This paper demonstrates how patriarchy remains an enduring cultural characteristic of caring for men detained under the Mental Health Act (1983, 2007) because of sexually violent crimes against women and children. It textures the ward environment and the relationships between people who work within it, constructing women as 'outsiders' and producing a masculine culture which leaves female staff feeling vulnerable and at risk. The analytic focus of the paper is concerned with exploring how women experience working in the male-dominated environment of a high-security Personality Disorder Unit (PDU). Three discursive repertoires are identified: the institutional space as male, the impact of working with men detained as a result of sexual offending, and the construction of therapeutic work as a 'job for the boys'. In this world, female staff, as a product of their gender, constructed themselves both as at risk and inviting risk.
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Affiliation(s)
- Dave Mercer
- Department of Nursing, University of Liverpool, United Kingdom
| | - Elizabeth Perkins
- William Rathbone VI Chair of Community Nursing Research, Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
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Sondhi A, Luger L, Toleikyte L, Williams E. Patient perspectives of being detained under section 136 of the Mental Health Act: Findings from a qualitative study in London. Med Sci Law 2018; 58:159-167. [PMID: 29742992 DOI: 10.1177/0025802418774966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Detention under section 136(1) of the Mental Health Act 1983 allows for the police to arrest a person from a public place and remove them to a 'place of safety', typically an emergency department or mental-health unit if it is 'in the interests of that person or for the protection of other persons in immediate need of care or control'. Aims/objective: The aim of this study was to describe the views and perceptions of the process for people with lived experience of mental distress who have been detained under section 136 of the Mental Health Act 1983. Method Semi-structured interviews were conducted with a non-probability sample of people with lived experience of mental distress who have been detained under section 136 across Greater London. Interviews were transcribed and thematically analysed using grounded theory. Fifty-eight people with lived experience of mental distress detained under section 136, including four carers, participated in this study. Results Three interwoven themes were identified: (a) process or procedural issues; (b) the professional-patient relationship; and (c) the importance of a supportive therapeutic environment. Conclusion The length of time, multiple assessment points and processes juxtapose against the need for a humane physical environment and supportive therapeutic interactions from all professional agencies. It is unclear how changes proposed in the Policing and Crime Act 2017 will address these patient needs.
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Affiliation(s)
- Arun Sondhi
- 1 Therapeutic Solutions (Addictions) Ltd, UK
| | | | - Lina Toleikyte
- 3 Health Equity Unit, Health Improvement Directorate, Public Health England, UK
| | - Emma Williams
- 4 Canterbury Centre for Policing Research. Canterbury Christ Church University, UK
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Smyth S, Casey D, Cooney A, Higgins A, McGuinness D, Bainbridge E, Keys M, Georgieva I, Brosnan L, Beecher C, Hallahan B, McDonald C, Murphy K. Qualitative exploration of stakeholders' perspectives of involuntary admission under the Mental Health Act 2001 in Ireland. Int J Ment Health Nurs 2017; 26:554-569. [PMID: 27785894 DOI: 10.1111/inm.12270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 12/15/2022]
Abstract
There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment.
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Affiliation(s)
- Siobhán Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Adeline Cooney
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - David McGuinness
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary Keys
- School of Law, National University of Ireland, Galway, Ireland
| | - Irina Georgieva
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Liz Brosnan
- Centre for Disability Law and Policy, National University of Ireland, Galway, Ireland
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Kathy Murphy
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Bradbury J, Hutchinson M, Hurley J, Stasa H. Lived experience of involuntary transport under mental health legislation. Int J Ment Health Nurs 2017; 26:580-592. [PMID: 27897380 DOI: 10.1111/inm.12284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
Abstract
Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales (NSW) Mental Health Act (MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most (n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports.
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Affiliation(s)
- Joanne Bradbury
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Helen Stasa
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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Murphy R, McGuinness D, Bainbridge E, Brosnan L, Felzmann H, Keys M, Murphy K, Hallahan B, McDonald C, Higgins A. Service Users' Experiences of Involuntary Hospital Admission Under the Mental Health Act 2001 in the Republic of Ireland. Psychiatr Serv 2017; 68:1127-1135. [PMID: 28669292 DOI: 10.1176/appi.ps.201700008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland. METHODS In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process. RESULTS Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters. CONCLUSIONS This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being.
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Affiliation(s)
- Rebecca Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - David McGuinness
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Emma Bainbridge
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Liz Brosnan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Heike Felzmann
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Mary Keys
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Kathy Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Brian Hallahan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Colm McDonald
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Agnes Higgins
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
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Abstract
OBJECTIVE The objective of this study was to examine the presentations of patients by ambulance, under Section 20 of the NSW Mental Health Act of 2007, to a hospital emergency department (ED) with a 24-hour Mental Health Team. METHODS Patient records between December 2013 and December 2014 were audited and analysed in Excel. RESULTS There were 47 such presentations: 51% required a mental health admission. Patients required management for up to six of the nine identified mental health and physical problems. As the number of clinical problems in these patients increased, the length of their stay and the likelihood of discharge to home increased. The need for psychiatric admission did not appear to prolong their length of stay, though chemical sedation did. The availability of an ED mental health team did assist in achieving a length of stay that was in keeping with Australian National Emergency Access Target guidelines. CONCLUSIONS A 24-hour ED mental health team provided specialised assessment and management for patients, alongside the necessary emergency medical intervention. This team assisted in easing the increasing pressure on the ED and minimising the patients' length of stay. The team redirected patients requiring admission, facilitated timely discharge of others and revoked Section 20 when less restrictive care was appropriate.
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Affiliation(s)
- Michaela A Skopek
- Consultant Psychiatrist and Visiting Medical Officer, Gosford Hospital Emergency Department Mental Health Team, Central Coast Local Health District, Gosford, NSW, Australia
| | - Jeryl Lynn Francis
- Biostatistician, School of Medicine and Public Health, University of Newcastle, NSW, and; Teaching and Research Unit, Gosford Hospital, Central Coast Local Health District, Gosford, NSW, Australia
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Abstract
The Maxwell Centre, a health-based place of safety (POS) adjacent to a psychiatric hospital, was opened in Gloucestershire in February 2009. It provides a POS for people detained under Sections 135 and 136 of the Mental Health Act 1983 as amended in 2007. Prior to the opening of the Maxwell Centre, police cells were the only designated POSs. To assess the impact of the opening of this new facility, we undertook a service evaluation. In the five years (February 2009 to December 2013) following the opening of the Maxwell Centre, the use of Section 136 increased by more than 60%.
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Affiliation(s)
- David Pugh
- Independent Consultant, Gloucestershire, UK
| | - Jim Laidlaw
- 2gether NHS Foundation Trust, Gloucestershire, UK
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Gajwani R, Parsons H, Birchwood M, Singh SP. Ethnicity and detention: are Black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007? Soc Psychiatry Psychiatr Epidemiol 2016; 51:703-11. [PMID: 26886264 PMCID: PMC4846695 DOI: 10.1007/s00127-016-1181-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/17/2016] [Indexed: 12/05/2022]
Abstract
PURPOSE There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders. METHODS A prospective study of all MHA assessments conducted in 1 year (April 2009-March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity. RESULTS Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for. CONCLUSION The BME 'disproportionality' in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, Yorkhill Hospital, University of Glasgow, Caledonia House, Glasgow, G3 8SJ, UK.
| | - Helen Parsons
- Cancer Research, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK.
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Abstract
OBJECTIVE In this study we aimed to examine the characteristics of Mental Health Act (MHA) usage in the Emergency Department (ED) of an urban teaching hospital in Sydney. METHODS All MHA certificates written on individuals in the ED over a 12-week period in 2013 were collected. The medical record of each individual was reviewed by a member of the research team using an audit tool developed for the study. Any uncertainty over individual cases was addressed through research team consensus. RESULTS A total of 172 MHA certificates were collected; 67 were written by police, 45 by ambulance, 54 by medical officers and three by accredited persons. Three magistrate orders for assessment were also received. Seventy percent of police and 60% of ambulance MHA certificates did not result in admission. Over a third were revoked by ED physicians. Forty-five people (32.4%) who presented voluntarily were subsequently detained. CONCLUSIONS Police and ambulance MHA certification was a poor predictor of admission. Least restrictive measures were predominantly the outcome. Delegating ED physicians with authorised medical officer status assisted in facilitating this process. Formalised education and training on the principles and practicalities of MHA legislation should be ongoing for all professionals involved.
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Affiliation(s)
- Kate Derrick
- Transitional Nurse Practitioner, Mental Health Liaison, Emergency Department, Royal Prince Alfred Hospital Sydney, Camperdown, NSW, Australia
| | - Justin Chia
- Clinical Nurse Specialist, Mental Health Liaison, Emergency Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sarah O'Donovan
- Clinical Nurse Specialist, Mental Health Liaison, Emergency Department Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alexandra Emerton
- Clinical Nurse Specialist, Mental Health Liaison, Emergency Department Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Marika Hamlyn
- Clinical Nurse Consultant, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Timothy Wand
- Associate Professor and Nurse Practitioner, University of Sydney and; Sydney Local Health District, Camperdown, NSW, Australia
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Abstract
OBJECTIVE To review the case of an acutely psychotic person who was discharged into the care of a friend whom he killed later the same day, and to consider the reasoning of the High Court in the subsequent negligence action of the victim's relatives. CONCLUSIONS By a narrow interpretation, the High Court found that the exercise of the powers and duties in relation to the involuntary detention of a mentally ill person as prescribed by the Mental Health Act were inconsistent with a common law duty of care to another person or the relatives of another person.
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Affiliation(s)
- Russ Scott
- Forensic Psychiatrist, High Security Inpatient Services, The Park Centre for Mental Health, Treatment and Research, Brisbane, QLD, Australia
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50
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Seed T, Fox J, Berry K. Experiences of Detention under the Mental Health Act for Adults with Anorexia Nervosa. Clin Psychol Psychother 2015; 23:352-62. [PMID: 26123878 DOI: 10.1002/cpp.1963] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022]
Abstract
UNLABELLED People with Anorexia Nervosa are often resistant to treatment and can be detained under the Mental Health Act. Detention can be distressing for some client groups; however, there is little research to explore how people with Anorexia Nervosa experience detention and how these experiences impact on recovery. This study utilized a qualitative methodology to develop a model for understanding how people perceive, experience and process detention under the Mental Health Act. Data from 12 participants was analysed using constructivist grounded theory. Four overarching categories conceptualize their experience over time: 'the battle', 'the bubble', 'stepping out of the bubble' and 'the anorexic self'. Within each overarching category are further subordinate categories that represent the nuances of the data. The resultant model is discussed in relation to the literature, whilst recommendations have been made to embed person-centred, recovery practice into inpatient services. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE People detained under the mental health act with anorexia nervosa often respond by engaging in a battle with clinicians. This follows by the person withdrawing into a 'bubble' where the individual starts to feel some relief that they are no longer in control of their eating, but this competes with the lack of self and the emerging anorexic self. Clinicians need to be aware that individuals detained may have mixed feelings about their hospital admission.
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Affiliation(s)
- Tara Seed
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - John Fox
- Department of Psychology, Royal Holloway University of London, Egham, UK
- Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust
| | - Katherine Berry
- School of Psychological Sciences, The University of Manchester, Manchester, UK
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