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1.
Int J Law Psychiatry ; 71: 101602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768125

RESUMO

This article examines the changes made to mental health and capacity laws in Northern Ireland through temporary emergency legislation, known as the Coronavirus Act 2020. The purpose of the legislation was to respond to the emergency situation created by the COVID-19 pandemic, in particular the increase pressure placed on health services in the United Kingdom. An overview is provided of the government's rationale for the changes to Northern Ireland mental health and capacity laws, as well as exploring how they are likely to be operationalised in practice. Consideration is also given as to how such changes may impact upon existing human rights protections for persons assessed as lacking mental capacity. It is argued that it is important that regular parliamentary oversight is maintained in relation to the potential impact and consequences of such changes during the period they are in force. This should be done in order to assess whether they remain a necessary, proportionate and least restrictive response to the challenges faced in managing mental health and capacity issues in Northern Ireland during this public health emergency.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Betacoronavirus , Internação Compulsória de Doente Mental/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Irlanda do Norte/epidemiologia , Pandemias , Saúde Pública/legislação & jurisprudência
2.
Int J Law Psychiatry ; 70: 101564, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-102131

RESUMO

Many countries have enacted, or are in the process of enacting, emergency mental health legislation in response to the global pandemic of Covid-19 (coronavirus). In Ireland, the Emergency Measures in the Public Interest (Covid-19) Act, 2020 amends the Mental Health Act 2001 to permit the Mental Health Commission to request an independent psychiatric report about an involuntary patient from any consultant psychiatrist who is not treating the patient (and not just those on its designated panel). This independent examination may occur 'in person', 'by other appropriate means', or even, 'due to the exigencies of the public health emergency', not occur at all, once this is explained in the resultant report. The 2020 Act acknowledges that 'the exigencies of the public health emergency' might hamper the independent psychiatrist's work and requires a written report from the patient's treating psychiatrist 'no earlier than the day before' the tribunal, in lieu of the psychiatrist physically attending a tribunal hearing, although, if possible, they will attend (i.e. phone in to) a tribunal held by conference call. The 2020 Act permits the Mental Health Commission to, if necessary, appoint tribunals 'consisting of one member who shall be a practising barrister or solicitor'. Such a tribunal shall, if possible, consult with a consultant psychiatrist if the reports from the independent psychiatrist and treating psychiatrist conflict or if it is otherwise 'necessary in the interest of the patient'. A tribunal can extend an involuntary order by a second period of 14 days 'of its own motion if the tribunal, having due regard to the interest of the patient, is satisfied that it is necessary'. Tribunals for current involuntary patients will be prioritised over retrospective tribunals for discharged patients; a tribunal can direct a witness to provide 'a written statement' rather than attending; and the patient can make written representation to the tribunal instead of physically attending a tribunal hearing, although they may attend (i.e. phone in to) a tribunal held by conference call. Psycho-surgery for involuntary patients is banned. While it is clear that revisions are urgent and necessary in light of Covid-19, the proportionality of these changes will depend on how, and the extent to which, they are used in practice. With good communication, efficient team-working and close adherence to professional codes of practice and ethics, it is hoped that these amendments will result in a review system that is as reasonable, robust and reassuring as the current, highly unusual circumstances permit.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Infecções por Coronavirus , Saúde Mental/legislação & jurisprudência , Pandemias , Pneumonia Viral , Psiquiatria/legislação & jurisprudência , Psiquiatria/métodos , Comitês Consultivos , Betacoronavirus , Tomada de Decisões , Serviço Hospitalar de Emergência , Humanos , Irlanda , Transtornos Mentais/terapia
3.
Int J Law Psychiatry ; 70: 101564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32482306

RESUMO

Many countries have enacted, or are in the process of enacting, emergency mental health legislation in response to the global pandemic of Covid-19 (coronavirus). In Ireland, the Emergency Measures in the Public Interest (Covid-19) Act, 2020 amends the Mental Health Act 2001 to permit the Mental Health Commission to request an independent psychiatric report about an involuntary patient from any consultant psychiatrist who is not treating the patient (and not just those on its designated panel). This independent examination may occur 'in person', 'by other appropriate means', or even, 'due to the exigencies of the public health emergency', not occur at all, once this is explained in the resultant report. The 2020 Act acknowledges that 'the exigencies of the public health emergency' might hamper the independent psychiatrist's work and requires a written report from the patient's treating psychiatrist 'no earlier than the day before' the tribunal, in lieu of the psychiatrist physically attending a tribunal hearing, although, if possible, they will attend (i.e. phone in to) a tribunal held by conference call. The 2020 Act permits the Mental Health Commission to, if necessary, appoint tribunals 'consisting of one member who shall be a practising barrister or solicitor'. Such a tribunal shall, if possible, consult with a consultant psychiatrist if the reports from the independent psychiatrist and treating psychiatrist conflict or if it is otherwise 'necessary in the interest of the patient'. A tribunal can extend an involuntary order by a second period of 14 days 'of its own motion if the tribunal, having due regard to the interest of the patient, is satisfied that it is necessary'. Tribunals for current involuntary patients will be prioritised over retrospective tribunals for discharged patients; a tribunal can direct a witness to provide 'a written statement' rather than attending; and the patient can make written representation to the tribunal instead of physically attending a tribunal hearing, although they may attend (i.e. phone in to) a tribunal held by conference call. Psycho-surgery for involuntary patients is banned. While it is clear that revisions are urgent and necessary in light of Covid-19, the proportionality of these changes will depend on how, and the extent to which, they are used in practice. With good communication, efficient team-working and close adherence to professional codes of practice and ethics, it is hoped that these amendments will result in a review system that is as reasonable, robust and reassuring as the current, highly unusual circumstances permit.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Infecções por Coronavirus , Saúde Mental/legislação & jurisprudência , Pandemias , Pneumonia Viral , Psiquiatria/legislação & jurisprudência , Psiquiatria/métodos , Comitês Consultivos , Betacoronavirus , Tomada de Decisões , Serviço Hospitalar de Emergência , Humanos , Irlanda , Transtornos Mentais/terapia
6.
J Law Med ; 27(3): 570-573, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32406621

RESUMO

Mental health legislation, which enables compulsory detention and treatment of those with severe mental health conditions, usually contains criteria that include the need to prevent harm to self or others. This column provides an overview of criticisms of the harm to others criterion and recent research investigating the association between violence and severe mental health conditions. It argues that despite several criticisms and research indicating only a modest association between violence and certain mental health conditions, there is little momentum for omitting this criterion.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Mentais , Humanos , Saúde Mental
7.
J Am Acad Psychiatry Law ; 48(2): 244-250, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32321738

RESUMO

Bloom and Kirkorsky discuss three models of special commitment procedures in use today in California, Oregon, and Ohio, regarding the management of individuals found incompetent to stand trial, not restorable (IST/NR) and considered dangerous. They suggest that a fourth model, one merging the population of dangerous IST/NR individuals into the system of insanity acquittees, would offer this group the advantages of a definitive legal disposition, more equal treatment, and improved chance of recovery. This commentary explores their proposal by reviewing recovery outcomes for forensic patients and insanity acquittees and discusses possible improvements such as intensive community monitoring and large-scale data collection. Although both groups face obstacles to recovery and release, the population of dangerous IST/NR individuals would benefit from the more conclusive forensic legal status and pathway to recovery offered insanity acquittees.


Assuntos
Defesa por Insanidade , Transtornos Psicóticos , Internação Compulsória de Doente Mental , Humanos , Ohio , Oregon
9.
Fortschr Neurol Psychiatr ; 88(4): 248-254, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31234213

RESUMO

BACKGROUND: After the decisions of the German Federal Constitutional Court in 2011 and the Federal Supreme Court in 2012, involuntary treatment was not approvable for a period of seven months in the State of Baden-Wuerttemberg. Previous analyses of routine data had demonstrated that at that time in a rather small group of patients, aggressive incidents and coercive interventions had significantly increased and then decreased to the previous level after the new legislation came into force. The changes concerned a relatively small group of involuntary patients. Based on an analysis of medical charts in 6 hospitals, this study aimed to investigate 1) whether refusal of prescribed medication became more frequent in that period and 2) how frequently antipsychotic medication was administered without coercion. METHOD: We conducted a longitudinal intra-individual comparison and included all of the patients with schizophrenic and manic disorders who had been admitted in the period without the option of involuntary treatment and in a defined control period one year before as well (N = 174). Thus, study group and control group were identical. RESULTS: In the period without the option of involuntary treatment, patients remained involuntarily committed significantly more frequently (+ 26 %) but only insignificantly longer. Length of stay and number of mechanical restraints remained unchanged, number of seclusions doubled, and some patients could not leave the ward for long periods of time and had frequent readmissions. Persistent refusal of prescribed medication was significantly more frequent (+ 130 %, p < .001). However, the percentage of patients who received an antipsychotic drug during their hospital stay did not differ (96.0 vs. 96.6 %). The dosage at discharge as calculated in chlorpromazine units tended to be even higher during the period without option of involuntary treatment (+ 7.9 %, p = .06). All differences concerned both voluntary and involuntary patients. CONCLUSIONS: Without the option of involuntary treatment, persistent refusal of medication and different forms of deprivation of liberty increased. Nevertheless, oral antipsychotic treatment was realized in nearly all cases until discharge.


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Internação Compulsória de Doente Mental/legislação & jurisprudência , Tratamento Involuntário/legislação & jurisprudência , Adesão à Medicação , Esquizofrenia/tratamento farmacológico , Agressão , Coerção , Alemanha , Humanos , Tempo de Internação , Estudos Longitudinais
10.
J Forensic Nurs ; 16(1): 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31834077

RESUMO

INTRODUCTION: Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients. METHODS: An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis. FINDINGS: Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation. DISCUSSION: Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde Mental/organização & administração , Internação Compulsória de Doente Mental , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Serviços de Saúde Mental/legislação & jurisprudência , Zimbábue
11.
Artigo em Inglês | MEDLINE | ID: mdl-31795314

RESUMO

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee's relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços de Saúde Mental/legislação & jurisprudência , Polícia/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , País de Gales , Adulto Jovem
12.
BMC Psychiatry ; 19(1): 422, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881954

RESUMO

BACKGROUND: Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France. METHODS: A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis. SETTING: Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews. PARTICIPANTS: 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French. INTERVENTIONS: The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care. MAIN OUTCOMES AND MEASURES: The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs. DISCUSSION: Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.


Assuntos
Transtorno Bipolar/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/estatística & dados numéricos , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/terapia , Adulto , Diretivas Antecipadas , Feminino , França , Humanos , Masculino , Pesquisa Qualitativa , Qualidade de Vida , Adulto Jovem
17.
Int J Law Psychiatry ; 66: 101469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706384

RESUMO

The relationship between age and mental capacity among psychiatry inpatients is not fully understood. We aimed to assess mental capacity for treatment decisions in voluntary and involuntary psychiatry inpatients in Ireland and, in this analysis of our data-set, to elucidate the linear relationship, if any, between linear (as opposed to categorical) mental capacity and age. We used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to assess mental capacity for treatment decisions in 215 psychiatry inpatients (176 voluntary and 39 involuntary) in four psychiatry admission units in Ireland. Mean age was 46.2 years and majorities were male (58.1%), never married (74.0%), unemployed (64.2%) and of Irish ethnicity (87.0%). The most common primary diagnoses were schizophrenia and related disorders (42.8%) followed by affective disorders (36.7%). On multi-variable linear regression analysis, linear mental capacity was significantly associated with voluntary admission status, being employed, having a primary diagnosis other than schizophrenia or a related disorder, and younger age. Together, these factors accounted for 44.4% of the variance in mental capacity between participants. Overall, while increased age is associated with diminished mental capacity, other factors appear more significant, including involuntary admission status which is likely an indicator of symptom severity. There is a need for further research to (a) elucidate the relationships between the significant factors identified in this study and the cognitive status of patients (which impacts on assessments of mental capacity); (b) identify and elucidate other factors of likely relevance to mental capacity (e.g. medical illness, medication use); and (c) translate these findings into targeted interventions to support decision-making in clinical practice among psychiatry inpatients, especially those with involuntary status.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Tomada de Decisões , Competência Mental/psicologia , Transtornos Mentais/psicologia , Admissão do Paciente/estatística & dados numéricos , Adulto , Feminino , Hospitalização , Humanos , Irlanda/epidemiologia , Modelos Lineares , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria
18.
Int J Law Psychiatry ; 66: 101452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706387

RESUMO

Independent mental health advocacy (IMHA) has been proposed as a way of maintaining peoples' rights in involuntary settings, but little is known about the challenges and opportunities associated with the provision of independent mental health advocacy to those on compulsory treatment orders in the community. In Victoria, Australia, an IMHA service is available to people who are at risk of or subject to compulsory treatment, including those who are subject to Community Treatment Orders. The IMHA service is based on the independent advocacy model developed in the United Kingdom. This paper details the benefits and challenges of providing independent non-legal advocacy to those in the community, drawing on a 15-month independent co-produced evaluation of the IMHA service. With limited publicly available sector level data, the evaluation employed qualitative approaches. Issues raised include the need to better target limited resources in the most effective way and the problem of ensuring timely and adequate access. While advocacy was well received by consumers, tensions specific to the community setting were influenced by the attitudes of clinicians to need, risk and recovery as opposed to a coherent understanding of consumer preference and choice.


Assuntos
Internação Compulsória de Doente Mental , Serviços Comunitários de Saúde Mental , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Defesa do Paciente , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Saúde Mental , Avaliação de Programas e Projetos de Saúde , Vitória
19.
Int J Law Psychiatry ; 66: 101472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706388

RESUMO

Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between gender, diagnosis and other features of involuntary treatment are not clear. We studied all voluntary and involuntary psychiatry admissions at Tallaght University Hospital, Dublin over 2 years (n = 1230). Admission rates in Tallaght were lower than national rates for all admissions (224.9 admissions per 100,000 population per year in Tallaght versus 376.8 nationally), voluntary admissions (194.0 versus 328.4) and involuntary admissions (30.9 versus 48.4). Compared to men, proportionately fewer admissions of admissions of women were involuntary (11% versus 16%) and women were more commonly diagnosed with affective (mood) disorders (29.5% of women versus 22.6% of men), neuroses (anxiety disorders) (14.0% versus 8.8%) and personality and behavioural disorders (18.0% versus 9.2%), and less commonly diagnosed with schizophrenia group disorders (21.8% versus 32.0%), alcohol disorders (2.9% versus 4.3%) and drug disorders (3.6% versus 8.1%). Schizophrenia group disorders accounted for a greater proportion of male (63.2%) than female (55.6%) involuntary admissions, and affective disorders accounted for a greater proportion of female (17.5%) than male (12.3%) involuntary admissions. Duration of admission was independently associated with, in order of strength of association, involuntary status, schizophrenia group disorders and increasing age, but duration of involuntary care was not associated with any of these factors. The chief gender-related features of involuntary psychiatry admission are that (a) proportionately fewer admissions of admissions of women are involuntary compared to men, and (b) diagnoses of affective disorders are more common in women, and schizophrenia group diagnoses more common in men. Future research could usefully explore gender differences in grounds for involuntary detention and police involvement in the involuntary admission process. Future research is also warranted into whether gender associations differ in older compared to younger involuntary patients.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Universitários , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Psiquiatria , Distribuição por Sexo , Adulto Jovem
20.
Int J Law Psychiatry ; 66: 101489, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706390

RESUMO

The use of compulsion has become one of the most contentious issues in psychiatry. This special edition, guest edited by Professor Steve Kisely and Professor Lisa Brophy, brings together a range of perspectives on Community Treatment Orders or outpatient commitment.


Assuntos
Internação Compulsória de Doente Mental , Serviços Comunitários de Saúde Mental , Transtornos Mentais/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Tomada de Decisões , Humanos , Internacionalidade , Serviço Social
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