'I was going into it blind': Nearest Relatives, legal literacy, and the Mental Health Act 1983.

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.

The Professional Identity of Social Workers in Mental Health Services: A Scoping Review.

Recent research into the role of mental health social work has identified a need for increased critical engagement with accounts of professional role and identity. Notably, a number of studies have found that social workers struggle to articulate their role within mental health teams and services. This study aimed to identify the ways in which social workers in mental health settings defined their professional identity and role. An international scoping review utilizing Arksey and O'Malley's method was conducted, identifying 35 papers published between 1997 and 2022. A thematic analysis grouped the findings into three predominant themes: (i) distinct social work approaches to mental health, (ii) organizational negotiations for mental health social workers, and (iii) professional negotiations for mental health social workers. These thematic findings are discussed in relation to existing research and critical perspectives, with particular emphasis on accounts of the bureaucratic and ideological functioning of professionalism in mental health services, as well as the global direction of mental health policy. This review finds that mental health social work embodies a coherent identity that aligns with international mental health policy agendas but faces significant challenges in developing and expressing this identity within mental health services.

Models of mental health problems: a quasi-systematic review of theoretical approaches.

BACKGROUND: Mental health and mental illness have been contested concepts for decades, with a wide variety of models being proposed. To date, there has been no exhaustive review that provides an overview of existing models. AIM: To conduct a quasi-systematic review of theoretical models of mental health problems. METHODS: We searched academic databases, reference lists, and an electronic bookshop for literature that proposed, endorsed, reviewed, or critiqued such models. Papers, book chapters, and books were included with material by researchers, clinicians, non-medical professions, and service users writing between 2000 to June 2020 being considered. The study was registered with the Open Science Framework (No. osf.io/r3tjx). RESULTS: Based on 110 publications, we identified 34 different models which were grouped into five broader categories. Many models bridged two or more categories. Biological and psychological approaches had the largest number of models while social, consumer and cultural models were less diversified. Due to the non-empirical nature of the publications, several limitations in terms of search and quality appraisal apply. CONCLUSIONS: We conclude that mental health care needs to acknowledge the diversity of theoretical models on mental health problems.

Treading a tightrope: Professional perspectives on balancing the rights of patient's and relative's under the Mental Health Act in England.

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.

End of Life Care: A Scoping Review of Experiences of Advance Care Planning for People with Dementia.

Despite increasing attention given to dementia by international governments and policy makers, the focus of end of life care has been on the dying trajectory of malignant disease. People with severe dementia have complex physical and psychological needs, yet the disease is not always recognised as terminal. Advance Care Planning involving people with dementia and their families can provide opportunities to discuss and later, initiate timely palliative care. We conducted a scoping review of studies exploring decisions associated with the EoLC of people with dementia. Eligible studies had to report on decision making at the end of life and by whom (the dying person, clinician/health professional or relative/family member). Twenty-five eligible studies reported on Advance Care Planning and end of life care decisions for individuals with dementia. The papers highlight several challenges that need to be addressed in order to provide adequate and effective care for people with dementia as they near the end of their life.

Narratives of illness and offending: mentally disordered offenders' views on their offending.

Narratives have been used in both the sociology of health and illness and in criminology to examine how groups of people present themselves in moral terms. This article focuses on the narratives of offenders with mental health problems in England subject to section 37/41 of the Mental Health Act 1983 to examine how they justified offending prior to admission. Participants presented illness in a variety of different ways indicating a range of moral positions towards offending. In line with previous research a first group used mental illness to excuse offending and saw themselves as achieving moral reform through treatment. A second group also used illness to excuse offending, but did so inconsistently, seeking to mitigate responsibility whilst distancing themselves from treatment obligations. A third group portrayed themselves as dishonourable both due to their category of offence and the type of illness experienced. A final group rejected both labels of illness and offending, seeking to portray themselves as consistently moral.

The Views of Mental Health Manager Towards the Use of a Family Work Model for Psychosis in Guangzhou, China.

Family Interventions in Psychosis (FIP) have been promoted internationally but have been criticised for being based on western cultural models. This paper reports on a focus group study with 10 Integrated Mental Health Service Managers in Guangzhou, China using thematic analysis. Managers believed FIP might benefit families but identified potential difficulties due to (a) families avoiding services due to the 'shame' of mental illness (b) unrealistic expectations of services amongst families (c) deferral to 'key decision-makers' within families when discussing family issues with workers. The findings indicate that FIP work should focus on interaction between carers in the first instance with service users being introduced into sessions at a later date and that more attention needs to be given by the research community to how FIP may be adapted to cultural norms within China.

Dying well with reduced agency: a scoping review and thematic synthesis of the decision-making process in dementia, traumatic brain injury and frailty.

BACKGROUND: In most Anglophone nations, policy and law increasingly foster an autonomy-based model, raising issues for large numbers of people who fail to fit the paradigm, and indicating problems in translating practical and theoretical understandings of 'good death' to policy. Three exemplar populations are frail older people, people with dementia and people with severe traumatic brain injury. We hypothesise that these groups face some over-lapping challenges in securing good end-of-life care linked to their limited agency. To better understand these challenges, we conducted a scoping review and thematic synthesis. METHODS: To capture a range of literature, we followed established scoping review methods. We then used thematic synthesis to describe the broad themes emerging from this literature. RESULTS: Initial searches generated 22,375 references, and screening yielded 49, highly heterogeneous, studies that met inclusion criteria, encompassing 12 countries and a variety of settings. The thematic synthesis identified three themes: the first concerned the processes of end-of-life decision-making, highlighting the ambiguity of the dominant shared decision-making process, wherein decisions are determined by families or doctors, sometimes explicitly marginalising the antecedent decisions of patients. Despite this marginalisation, however, the patient does play a role both as a social presence and as an active agent, by whose actions the decisions of those with authority are influenced. The second theme examined the tension between predominant notions of a good death as 'natural' and the drive to medicalise death through the lens of the experiences and actions of those faced with the actuality of death. The final theme considered the concept of antecedent end-of-life decision-making (in all its forms), its influence on policy and decision-making, and some caveats that arise from the studies. CONCLUSIONS: Together these three themes indicate a number of directions for future research, which are likely to be applicable to other conditions that result in reduced agency. Above all, this review emphasises the need for new concepts and fresh approaches to end of life decision-making that address the needs of the growing population of frail older people, people with dementia and those with severe traumatic brain injury.

Treatment, deterrence or labelling: mentally disordered offenders' perspectives on social control.

Mentally disordered offenders are a group of service users who experience substantial amounts of control and supervision. This article uses theories of social control to analyse the way in which mechanisms of control are understood by this group. Semi-structured interviews with mentally disordered offenders in England who were subject to a restriction order under the Mental Health Act 1983 (as amended by the Mental Health Act 2007) provided the empirical basis for this study. The offenders had a number of perspectives on the restriction order. Firstly, it was seen as a mechanism for identifying those suffering from a mental disorder and for providing appropriate treatment. Secondly, the restriction order was viewed as a form of disciplinary control through which societal norms might be internalised. Thirdly, it was seen as labelling offenders in a manner that was experienced as limiting and oppressive. A number of research participants were aware that the order acted to limit staff actions. These participants saw the order as a means by which they might shape the support that they received in order to further their own aims.A video abstract of this article can be found at: https://www.youtube.com/watch?v=qwIwDI2sOTY&feature=youtu.be.

Network modularity reveals critical scales for connectivity in ecology and evolution.

For nearly a century, biologists have emphasized the profound importance of spatial scale for ecology, evolution and conservation. Nonetheless, objectively identifying critical scales has proven incredibly challenging. Here we extend new techniques from physics and social sciences that estimate modularity on networks to identify critical scales for movement and gene flow in animals. Using four species that vary widely in dispersal ability and include both mark-recapture and population genetic data, we identify significant modularity in three species, two of which cannot be explained by geographic distance alone. Importantly, the inclusion of modularity in connectivity and population viability assessments alters conclusions regarding patch importance to connectivity and suggests higher metapopulation viability than when ignoring this hidden spatial scale. We argue that network modularity reveals critical meso-scales that are probably common in populations, providing a powerful means of identifying fundamental scales for biology and for conservation strategies aimed at recovering imperilled species.

Novel method for quantitative assessment of physical workload of healthcare workers by a tetherless ergonomics workstation.

Healthcare workers are at risk of physical injury. Our laboratory has developed a tetherless ergonomics workstation that is suitable for studying physicians' and nurses' physical workloads in clinical settings. The workstation uses wearable sensors to record multiple channels of body orientation and muscle activity and wirelessly transmits them to a base station laptop computer for display, storage, and analysis. The ergonomics workstation generates long records of multi-channel data, so it is desired that the workstation automatically process these records and provide graphical and quantitative summaries of the physical workloads experienced by the healthcare workers. This paper describes a novel method of automated quantitative assessment of physical workload, termed joint cumulative amplitude-duration (JCAD) analysis, that has advantages over previous methods and illustrates its use in a comparison of the physical workloads of robotically-assisted surgery versus manual video-endoscopic surgery.

Heme Oxygenase-1 Attenuates Hypoxia-Induced sFlt-1 and Oxidative Stress in Placental Villi through Its Metabolic Products CO and Bilirubin.

One of the most prevalent complications of pregnancy is preeclampsia, a hypertensive disorder which is a leading cause of maternal and perinatal morbidity and premature birth with no effective pharmacological intervention. While the underlying cause is unclear, it is believed that placental ischemia/hypoxia induces the release of factors into the maternal vasculature and lead to widespread maternal endothelial dysfunction. Recently, HO-1 has been shown to downregulate two of these factors, reactive oxygen species and sFlt-1, and we have reported that HO-1 induction attenuates many of the pathological factors of placental ischemia experimentally. Here, we have examined the direct effect of HO-1 and its bioactive metabolites on hypoxia-induced changes in superoxide and sFlt-1 in placental vascular explants and showed that HO-1 and its metabolites attenuate the production of both factors in this system. These findings suggest that the HO-1 pathway may be a promising therapeutic approach for the treatment of preeclampsia.

Effectiveness of a regional corridor in connecting two Florida black bear populations.

Corridors may mitigate the adverse effects of habitat fragmentation by restoring or maintaining connectivity between disjunct populations. The efficacy of corridors for large carnivores, however has rarely been evaluated objectively. We used noninvasive sampling, microsatellite analysis, and population assignment tests to evaluate the effectiveness of a regional corridor in connecting two Florida black bear (Ursus americanus floridanus) populations (Osceola and Ocala). Bear movement was predominantly unidirectional, with a limited mixing of individuals from the two populations in one area of the corridor We also documented bears in Osceola that were genetically assigned to Ocala and bears in Osceola that may be offspring from an Osceola-Ocala mating. Our results indicate that the Osceola-Ocala corridor is functional and provides a conduit for gene flow between these populations. Human development, however may hinder the use of the Osceola-Ocala corridor by bears. The noninvasive sampling and genetic methods we used provide a means of evaluating corridor effectiveness that can help identify linkages necessary for maintaining metapopulation structure and population viability.