Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks.

BACKGROUND: For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents. METHODS: This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation. RESULTS: After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention. CONCLUSION: Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.

Mental Health Acts - Perspectives from Mental Health and Law in Ireland and in Portugal.

Mental health legislation is a cornerstone to ensure that individuals with severe mental illness access proper care and treatment. Each country establishes their own legislation. We aimed to compare the Portuguese and Irish Mental Health Acts (MHAs). We reviewed the respective MHA and the literature. While the definition of mental disorder is similar in general, who, where, when and how one can be detained differ. Judges decide on detentions in Portugal, while consultant psychiatrists may do so in Ireland. Community-based compulsory treatment is possible and used in Portugal while it is not possible in Ireland. Pros and cons of each approach are discussed with a reflection on the protection of human rights. Further theoretical and empirical studies comparing systems in different jurisdictions would be helpful to deepen our understanding of the legislation and guide on how to better serve individuals with severe mental illness.

Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England.

BACKGROUND: Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS: Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS: Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS: We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

[Clinical and regulatory challenges of forced hospitalization in Chile under the new Mental Health Law]. / Desafíos clínicos y normativos de la internación forzada en Chile, en virtud de la nueva Ley de Salud Mental.

Forced hospitalization is a common practice in psychiatry. It involves limiting the patient's freedom of movement in a clinical context without expressing informed consent, causing stress to the family and support network. Thus, forced hospitalization may cause violations, disturbances, or threats to the human rights of a vulnerable population. Considering this clinical reality, the present study seeks to analyze the current law on this subject in Chile compared to the international human rights guidelines. The analysis included a review of legal documents and referenced scientific articles. The new law No. 21,331 establishes a more demanding standard for the origin of forced internment, shortening the distance concerning the human rights guidelines regarding intellectual disability. The incoming development of the regulations mandated by the law could fill in the gaps in several situations that may arise and clarify fuzzy points. The key stakeholders' participation level will be critical in this matter.

Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review.

BACKGROUND: The use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government's vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date. OBJECTIVE: The objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government-based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change. METHODS: We reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions. RESULTS: Technology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT. CONCLUSIONS: This review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic.

A Study into the Operation of the Queensland Mental Health Review Tribunal.

The Queensland Mental Health Review Tribunal makes difficult decisions regarding involuntary treatment of people with mental illness, applying strict legislative criteria against a backdrop of fundamental human rights considerations. This article reports on focus group research with lawyers and advocates for people with mental illness who appear before the Queensland Mental Health Review Tribunal. Participants expressed concerns regarding the manner in which decisions are made. For example, participants said that their clients' views on the side effects of treatment do not receive adequate consideration when involuntary treatment is authorised. We review these concerns in the light of applicable legal obligations, including those arising from human rights law. We conclude that if these concerns are accurate, some adjustments to the Queensland Mental Health Review Tribunal's decision-making processes are required.

Decriminalizing severe mental illness by reducing risk of contact with the criminal justice system, including for forensic patients.

Risk of contact with the criminal justice system (CJS) is greater among those with mental illness, including severe mental illness-an observation that many argue reflects a process of "criminalizing" mental illness. Forensic patients represent a subgroup at one end of a spectrum of such criminalization, typically with histories of serious violence and psychotic illness. Strategies for decriminalizing mental illness in this context should consider a range of approaches, including intervening to prevent CJS contact in those with severe mental illness, particularly in the early or emerging stages of psychosis. However, it may be that even gold standard mental healthcare applied universally is insufficient to address CJS contact risks. While there is now an extensive literature documenting the relatively low rates of repeat CJS contact for forensic patients released from secure care, appropriate comparison groups are lacking and the key ingredients of any benefits of treatment are unknown. The CJS may well have something to learn from forensic mental health systems and services given the abject failure to stem rates of prison-release reoffending internationally. Understanding how to best identify risk and effectively intervene to prevent CJS contact in those with mental illness, whether early in the course of psychosis or following release from secure care, remains a priority for those seeking to address the criminalization of mentally illness in our communities.

Building a therapeutic relationship between probation officers and probationers with serious mental illnesses.

OBJECTIVE: The purpose of this study was to engage in a collaborative process with a variety of stakeholders to develop the Brief Intervention to Promote Service Engagement (BIPSE), which aims to enhance the therapeutic relationship between probation officers and probationers with serious mental illnesses (SMI). METHODS: The BIPSE intervention was developed through a multistage "design for implementation" process, including a series of stakeholder meetings, observations of probation supervision sessions, incorporating existing intervention approaches, and workshopping initial BIPSE components with three randomly selected officers from a specialized mental health probation unit. Acceptability and feasibility of BIPSE components were assessed through focus groups with probation officers, additional observations of probation sessions, and qualitative interviews with probationers with SMI. RESULTS: Two foundational components of the BIPSE intervention were identified during the stakeholder meetings and observations: (1) engagement and (2) shared decision-making. These two components inform and undergird the intervention's third component, strategic case management. During focus groups, probation officers expressed interest in using the modified tools they were given and also saw the benefit of structuring their sessions. Probationers expressed their appreciation for the caring and collaborative nature with which their probation officers approached their sessions. CONCLUSION: Building a therapeutic relationship between probation officers and probationers with SMI is an essential task toward improving mental health and criminal justice outcomes. The BIPSE development and refinement process demonstrates that interventions targeting the therapeutic relationship are acceptable to officers and clients, and can be tailored and feasibly structured into standard probation practices.

Principles and practices of risk assessment in mental health jail diversion programs.

Eligibility criteria for participation in mental health jail diversion programs often specify that, to be diverted, a candidate must not pose a level of threat to public safety that cannot be managed in the community. Risk assessment tools were developed to increase consistency and accuracy in estimates of threat to public safety. Consequently, risk assessment tools are being used in many jurisdictions to inform decisions regarding an individual's appropriateness and eligibility for mental health jail diversion and the strategies that may be successful in mitigating risk in this context. However, their use is not without controversy. Questions have been raised regarding the validity and equity of their estimates, as well as the impact of their use on criminal justice outcomes. The purpose of this review is to provide an overview of the science and practice of risk assessment to inform decisions and case planning in the context of mental health jail diversion programs. Our specific aims include: (1) to describe the process and components of risk assessment, including differentiating between different approaches to risk assessment, and (2) to consider the use of risk assessment tools in mental health jail diversion programs. We anchor this review in relevant theory and extant research, noting current controversies or debates and areas for future research. Overall, there is strong theoretical justification and empirical evidence from other criminal justice contexts; however, the body of research on the use of risk assessment tools in mental health jail diversion programs, although promising, is relatively nascent.

The Cal-DSH diversion guidelines.

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

Decriminalizing LGBTQ+: Reproducing and resisting mental health inequities.

Secure settings are not queer because lesbian, gay, bisexual, transgender, queer, questioning, Two Spirit, and asexual (LGBTQ+) people populate them, and neither are LGBTQ+ people inherently criminal because they are found in those spaces. Queer people bear disproportionate health, mental health, and social inequities that have had, historically and currently, the effect to criminalize them. This review discusses effective language and ideologies when working with LGBTQ+ people in secure settings. Major health, mental health, and social inequities are reviewed, along with the applied framework of minority stress. Then, the process of criminalization is diagrammed across the phases of predetainment, being in the system, and through re-entering the community. Finally, multilevel strategies are offered to decriminalize LGBTQ+ people ideologically and in practice.

The accuracy and accessibility of cited evidence: a study examining mental health policy documents.

PURPOSE: Evidence-based policy making is increasingly being advocated by governments and scholars. To show that policies are informed by evidence, policy-related documents that cite external sources should ideally provide direct access to, and accurately represent, the referenced source and the evidence it provides. Our aim was to find a way to systematically assess the prevalence of referencing accuracy and accessibility issues in referenced statements selected from a sample of mental health-related policy documents. METHOD: 236 referenced statements were selected from 10 mental health-related policy documents published between 2013 and 2018. Policy documents were chosen as the focus of this investigation because of their relative accessibility and impact on clinical practice. Statements were rated against their referenced sources in terms of the (i) content accuracy in relation to the information provided by the referenced source and (ii) degree of accessibility of the source and the required evidence from the references provided. RESULTS: Of the 236 statements, 141 (59.7%) accurately represented the referenced source, 45 (19.1%) contained major errors and 50 (21.2%) contained minor errors in accuracy. For accessibility, 126 (53.4%) directly referenced primary sources of evidence that supported the claims made, 36 (15.3%) contained indirect references, 18 (7.6%) provided 'dead-end' references, and 11 (4.7%) references were completely inaccessible. CONCLUSIONS: With only slightly over half of all statements assessed providing fully accessible references and accurately representing the referenced source, these components of referencing quality deserve further attention if evidence-informed policy goals are to be achieved. The rating framework used in the current study proved to be a simple and straightforward method to assess these components and can provide a baseline against which interventions can be designed to improve referencing quality.

Current situation and comparison of school mental health in ASEAN countries.

School-based mental health interventions are considered to have potential for the promotion of mental health in developing countries. We held a workshop to discuss the promotion of mental health in schools in southeast Asian countries. This review report aimed to summarize the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop. To summarize the current situation of ASEAN countries in relation to school mental health, we qualitatively analyzed the content of the discussions from four perspectives: (i) laws and regulations: (ii) mental health services; (iii) teacher training on mental health; (iv) mental health education for students. With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers. Our results show that mental health services in schools are centered on professionals such as guidance counselors, although the coverage varied among the different ASEAN countries. Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited. Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.

Conscience clauses and sexual and gender minority mental health care: A case study.

Tennessee is one of the first states in the United States to have a law that enables counselors and therapists in independent practice to deny services to any client based on the practitioner's "sincerely held principles." This so-called "conscience clause" represents a critical moment in professional psychology, in which mental health care providers are on the frontlines of cultural and legal debates about religious freedom. Though the law's language is ambiguous, it was widely perceived to target sexual and gender minority (SGM) individuals. We interviewed 20 SGM people living in Tennessee to understand their experiences with mental health care in the state and their perceptions of the law. Our participants perceive the law as fundamentally discriminatory, though they overwhelmingly conceptualize the conscience clause as legalizing discrimination toward members of all stigmatized groups-not just SGM individuals. They described individual and societal consequences for the law, including an understanding of the conscience clause as harmful above and beyond any individual discrimination event it may engender. We situate these findings amid the research on structural stigma and suggest that counseling psychologists become actively engaged in combatting conscience clauses, which appear to have profound consequences on mental health care engagement, particularly for populations vulnerable to discrimination. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014.

OBJECTIVE: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria. METHOD: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act. RESULTS: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT. CONCLUSION: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed.

Preventing prejudice by preserving the spirit of mental health legislation during the COVID-19 national emergency.

OBJECTIVE: The COVID-19 national emergency activates legislative powers that allow a proportional infringement upon individual liberties. We canvas the complex legal landscape governing mental health consumers in this climate, highlight ethical considerations in application of the law and offer a simple algorithm to navigate this space. CONCLUSION: In times of emergency, it is crucial that we uphold the safeguards embodied within mental health legislation to prevent prejudicial treatment of mental health consumers.

Introduction to the special section: The development of infant mental health home visiting in Michigan state government.

This issue of the Infant Mental Health Journal presents the first papers from a tripartite evaluation study of state-sponsored infant mental health home visiting program in Michigan, United States. This series of studies has been led by Kate Rosenblum PhD and Maria Muzik MD, Department of Psychiatry, the University of Michigan and faculty from the Michigan Collaborative for Infant Mental Health Research for the State of Michigan, Department of Health and Human Services, Mental Health Services for Children, to fulfill the requirements of state legislation (State of Michigan Act No. 291, Public Acts of 2013) that required that all home visiting programs meet certain requirements to be established as an evidence-based practice. In this introduction, we provide a historical context for the delivery of infant mental health home visiting through the community mental health system in the state of Michigan.

The Michigan infant mental health home visiting model.

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent-child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.

Holding powers in hospitals under the Mental Health Act 1983.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the holding powers available under the Mental Health Act 1983 and why their use is prone to error.

The Abolition or Reform of Mental Health Law: How Should the Law Recognise and Respond to the Vulnerability of Persons with Mental Impairment?

Vulnerability theory challenges the assumption that human beings are abstract and invulnerable liberal subjects and insists that any decent and just society must create law that takes into account and tries to ameliorate human vulnerability. In this article, I explore how vulnerability might apply in the context of the debate about the future of mental health law that has arisen since the entry into force of the Convention on the Rights of Persons with Disabilities (CRPD) in 2008; namely, whether mental health law should be abolished or reformed. In doing so, this article addresses three key issues: (i) how to conceptualise vulnerability; (ii) whether persons with mental impairments really are vulnerable and in what ways; and (iii) how the law should respond to the vulnerability of persons with mental impairments post-CRPD. It describes and compares three different approaches with respect to how well they address vulnerability: the Abolition with Support, Mental Capacity with Support, and the Support Except Where There is Harm Models. It argues that the law should try to accurately capture and ameliorate the vulnerability of those who are subject to it as much as possible. It also argues that from a vulnerability perspective, the reform of mental health law may be better than its abolition and that decreasing the vulnerability of persons with mental impairment requires systemic reform, resources, and cultural change.