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3.
Eur Psychiatry ; 63(1): e50, 2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32468988

RESUMO

The COVID-19 pandemic has raised significant concerns for population mental health and the effective provision of mental health services in the light of increased demands and barriers to service delivery [1]. Particular attention is being directed toward the possible neuropsychiatric sequelae of both COVID-19 and of the stringent societal mitigation steps deployed by national governments, concerns that are informed by historical increases in the incidence of psychotic disorders following influenza pandemics [2]. However, so far there has been scant attention paid to other important areas of psychiatry during COVID-19, including medico-legal aspects and human rights. In this paper, we discuss the legal implications for psychiatry of the COVID-19 pandemic and report a novel situation in which psychiatric patients may experience diminution of their statutory protections. We believe that this represents a paradigm shift in psychiatric care and that the consideration of the fundamental rights of psychiatric patients as "less important" than infection control measures compel mental health professionals to "advocate for … patients and their caregivers" in this time of crisis [1].


Assuntos
Infecções por Coronavirus , Direitos Humanos , Serviços de Saúde Mental , Saúde Mental , Pessoas Mentalmente Doentes , Pandemias , Pneumonia Viral , Betacoronavirus , Direitos Civis , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Surtos de Doenças , Pessoal de Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Psiquiatria
4.
Br J Psychiatry ; 217(2): 410-412, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32362295

RESUMO

COVID-19 presents new challenges for psychiatry as clinical management, ethical dilemmas and administrative complications need to be addressed. The psychiatrist should protect the needs and rights of the mentally ill while maximising population health and ensuring solidarity, reciprocity and community well-being for all.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções , Serviços de Saúde Mental , Pessoas Mentalmente Doentes , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Psiquiatria , Humanos , Serviços de Saúde Mental/ética , Serviços de Saúde Mental/normas , Psiquiatria/ética , Psiquiatria/normas
5.
Crim Behav Ment Health ; 30(2-3): 68-78, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32212284

RESUMO

Throughout the world, women involved in criminal justice systems often present with substantial needs and vulnerabilities. Diverting vulnerable people away from prison is government policy in England and Wales, but full psychiatric and social assessments are expensive and hard to access. A screening and quick response initiative - alternatives to custodial remand for women (ACRW) - was implemented across three areas of London (West, South and East) to supplement existing court liaison and diversion services, to assess the feasibility of a supplementary custodial remand service as part of a women's specialist service pathway in the criminal justice system in England. Three mental health trusts and two voluntary sector providers offered this service enhancement - a screening and service link provision in three London boroughs between 2012 and 2014. We conducted a service evaluation using routinely collected service use record data. The service made 809 contacts, of whom 104 had contact on multiple occasions. Many were identified as at risk of self-harm (46%) or had histories of hospital admission for mental disorder (36%), but few were referred either to the liaison and diversion service or specialist mental health services. The largest group of referrals was to women's community services outside the health service (e.g. counselling, domestic violence or sexual abuse services). 180 women had dependent children and 22 were pregnant, increasing the urgency to find non-custodial alternatives. As well as confirming high levels of need amongst women entering the criminal justice system, this evaluation confirms the feasibility of working across sectors in this field, providing an extra layer of service that can complement existing liaison and diversion service provision. The service was responsive and most women using it were kept out of custody. Research is now required to understand the appropriateness of the referrals, the extent to which women follow them through and the impact on their mental health and desistance from offending.


Assuntos
Crime/estatística & dados numéricos , Direito Penal , Criminosos/psicologia , Psiquiatria Legal/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Criança , Crime/legislação & jurisprudência , Inglaterra , Estudos de Viabilidade , Feminino , Humanos , Masculino , Competência Mental , Saúde Mental , Pessoas Mentalmente Doentes , Prisões , Medição de Risco , País de Gales , Adulto Jovem
6.
Hist Psychiatry ; 31(3): 341-350, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32172607

RESUMO

The British Mandate in Palestine ended abruptly in 1948. The British departure engendered a complex situation which affected all areas of life, and the country's health system was no exception. Gradual transition of the infrastructure was almost impossible owing to the ineffectiveness of the committee appointed by the United Nations. The situation was further complicated by the outbreak of the Arab-Israeli War. We relate for the first time the story of 75 Jewish patients who were left in a former British mental hospital in Bethlehem - deep behind the front lines. Despite the hostilities, there were complex negotiations about relocating those patients. This episode sheds light on the Jewish and Arab relationship as it pertained to mental institutions during and immediately after the British Mandate.


Assuntos
Conflitos Armados/história , Hospitais Psiquiátricos/história , Pessoas Mentalmente Doentes/história , Árabes , História do Século XX , Humanos , Israel , Judeus , Oriente Médio , Psiquiatria/história
8.
Hist Psychiatry ; 31(2): 178-193, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32063064

RESUMO

The fate of Jewish psychiatric patients in occupied Europe during World War II is inseparable from the fate of the disabled and mentally ill, as planned by the Nazi regime. But Jews found themselves at the confluence of eugenics, Christian anti-Judaism and Nazi racist and anti-Semitic madness. They faced the twin promise of death - both as Jews and as mentally ill. They did not escape from the euthanasia programme and, if by a miracle they survived, they disappeared into the extermination camps. The modalities of annihilation of Jewish psychiatric patients are inseparable from the forms of German occupation, which differed from country to country. In this research we focus initially on various countries in occupied Europe, and then on France.


Assuntos
Hospitais Psiquiátricos/história , Judeus/história , Pessoas Mentalmente Doentes/história , II Guerra Mundial , Pessoas com Deficiência/história , Eugenia (Ciência)/história , Eutanásia/história , Feminino , França , História do Século XX , Humanos , Masculino , Socialismo Nacional/história
11.
Epidemiol Psychiatr Sci ; 29: e82, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839013

RESUMO

AIMS: This review aims to understand the scope of the literature regarding mental health-related microaggressions towards people affected by mental health problems. METHODS: A scoping review was conducted to explore this question. Four electronic health-oriented databases were searched alongside Google Scholar. As per scoping review principles, the inclusion criteria were developed iteratively. The results of included studies were synthesised using a basic narrative synthesis approach, utilising principles of thematic analysis and thematic synthesis where appropriate. RESULTS: A total of 1196 records were identified, of which 17 met inclusion criteria. Of these, 12 were peer-reviewed journal articles, three were research degree theses and two were book chapters. Six included empirical studies were qualitative, four were quantitative and two employed a mixed-methods design. Within these, five qualitative studies aimed to describe the nature of mental health microaggressions experienced by people with mental health problems. Themes identified in a thematic synthesis of these five studies included stereotypes about mental illness, invalidating peoples' experience and blaming people with mental illness for their condition. The included publications informed on the perpetration of mental health microaggressions by family, friends, health professionals and social workers. In addition, two studies created scales, which were then used in cross-sectional surveys of the general public and community members to assess characteristics, such as right-wing political views, associated with endorsement of mental health microaggressions. A consensus definition of microaggressions emerged from the included studies: microaggressions are brief, everyday slights, snubs or insults, that may be subtle or ambiguous, but communicate a negative message to a target person based on their membership of a marginalised group, in this case, people affected by mental illness. CONCLUSIONS: The study of mental health microaggressions is an emerging, heterogeneous field, embedded in the wider stigma and discrimination literature. It has been influenced by earlier work on racial microaggressions. Both can be ambiguous and contradictory, which creates difficulty defining the boundaries of the concept, but also underpins the key theoretical basis for the negative impact of microaggressions. Mental illness is a more concealable potential type of identity, so it follows that the reported perpetrators of microaggressions are largely friends, family and professionals. This has implications for intervening to reduce the impact of microaggressions. There are several challenges facing research in this area, and further work is needed to understand the impact of mental health microaggressions on people affected by mental health problems.


Assuntos
Agressão/psicologia , Discriminação Psicológica , Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes/psicologia , Preconceito/psicologia , Discriminação Social , Estigma Social , Grupos de Populações Continentais/psicologia , Humanos , Saúde Mental , Estereotipagem
12.
BMC Med Educ ; 19(1): 461, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830962

RESUMO

BACKGROUND: Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians' negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians' decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. METHODS: A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). RESULTS: A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p <  0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p <  0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. CONCLUSIONS: Additional background information on past medical history of schizophrenia increased physicians' mistakes in decision making. Patients' psychiatric backgrounds should not bias physicians' decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Médicos/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoas Mentalmente Doentes , Relações Médico-Paciente , Inquéritos e Questionários
13.
Artigo em Inglês | MEDLINE | ID: mdl-31877954

RESUMO

The positive effect of forest bathing on the mental health and wellbeing of those suffering from post-traumatic stress disorder or experiencing stress has been proven. It is not known, however, how 'forest therapy' affects the mental health of people who are treated in a psychiatric hospital for affective or psychotic disorders. Potentially, forest therapy could bring many benefits to these people. To test the potential effectiveness of this therapy, a quasi-experiment was carried out in a psychiatric hospital in Olsztyn (north Poland). In the summer and autumn of 2018, the patients of the psychiatric hospital in Olsztyn participated in forest therapy interventions. The proposed forest therapy consisted of participating in one hour and forty-five minutes walks under the supervision of a therapist. Subjects filled out the Profile of Mood States Questionnaire (POMS) and the State Trait Anxiety Inventory (STAI-S) before and after the study. In the case of a group of patients with affective disorders, forest therapy had a positive effect on nearly all POMS scale subscales, with the exception of the 'anger-hostility' subscale, which did not change its values significantly after the intervention. In these patients, the greatest impacts were noted in the subscales 'confusion' and 'depression-dejection'; the level of anxiety measured with the STAI-S scale also significantly decreased. In the case of patients with psychotic disorders, the values of the 'confusion' and 'vigour' subscales and the STAI-S scale exhibited the greatest changes. These changes were positive for the health of patients. Regarding the 'fatigue' subscale, no significant changes were observed in patients with psychotic disorders. The observed changes in psychological indicators in psychiatric hospital patients with both kinds of disorders indicate that the intervention of forest therapy can positively affect their mental health. The changes observed in psychological indicators were related to the characteristics of the given disorder.


Assuntos
Florestas , Transtornos Psicóticos/terapia , Caminhada/psicologia , Adulto , Ansiedade/terapia , Depressão/terapia , Feminino , Hospitais Psiquiátricos , Hostilidade , Humanos , Pacientes Internados , Masculino , Saúde Mental , Pessoas Mentalmente Doentes , Pessoa de Meia-Idade , Polônia
14.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 543-551, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747145

RESUMO

The study conducted in the framework of "Our Patient - Our Citizen" Project has examined methods and possibilities of rehabilitating mentally ill people who were prone to anti-social behaviors and have been committed to involuntary treatment. The research has introduced the criteria for identifying patients with high rehabilitation potential. The work has described methods and possibilities of their rehabilitation in hospital (training psychological programs, ergotherapy, art therapy, occupational therapy, etc.) and analyzed possibility of their outpatient implementation. Concrete examples of such successful rehabilitation have been considered. Financial value was determined.


Assuntos
Transtornos Mentais , Pessoas Mentalmente Doentes , Humanos , Transtornos Mentais/reabilitação , Defesa do Paciente
15.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592608

RESUMO

BACKGROUND: Since 2016, all health regions have been instructed to provide drug-free psychiatric treatment options. The evidence base for such treatment has been called for. At Jæren District Psychiatric Centre we therefore identified the patients' wishes for drug-free treatment. MATERIAL AND METHOD: One hundred patients were sequentially asked upon admission whether they would want a drug-free treatment programme, given that it was available. The patients' age, sex, diagnosis and medical history were recorded, as well as their experience with the use of psychoactive drugs and counselling. RESULTS: Altogether 52 out of the 100 patients would want a drug-free treatment programme if this were available. The largest proportion was registered among patients who had been coercively sectioned (10 out of 13 patients) and among those who experienced least benefit from their drugs (17 out of 25). Even among those who reported to benefit well from their drugs, a considerable proportion wanted a drug-free option (24 out of 58). The majority of the patients had long illness trajectories and a high consumption of psychoactive drugs. INTERPRETATION: The observation that a large proportion of the patients would want a drug-free treatment programme if this were available can be seen as a reflection of frustration caused by persistent symptoms, adverse effects and a large burden of suffering despite the use of medication. An alternative interpretation is that the patients had an insufficient understanding of their need for preventive treatment or for their need for treatment at all.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/psicologia , Preferência do Paciente , Adolescente , Adulto , Idoso , Internação Compulsória de Doente Mental , Feminino , Humanos , Tratamento Psiquiátrico Involuntário , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Adulto Jovem
16.
Work ; 64(3): 461-475, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658080

RESUMO

BACKGROUND: Work accommodations are adjustments made in the work place or to policies surrounding employment to accommodate an individual with a mental disorder to be successful in completing work related tasks. OBJECTIVE: The purpose of this systematic review is to identify work accommodations that are available and that are provided to individuals with mental disorders. In addition, associated cost-effectiveness and cost-benefits of these accommodations are examined. METHODS: Studies published between 1990-2016 from four databases were reviewed. From these databases, studies that specified accommodations that were available/provided and/or addressed cost-effectiveness or cost-benefit analysis of work accommodations were included. RESULTS: Of the 1362 eligible studies, only 15 were included. Work accommodations that were provided to individuals assisted in mitigating limitations in the work place and improved length of job tenure, as well as reduced the severity of certain mental disorders. The costs associated with these accommodations were found to be minimal and had positive economic benefits for employers. CONCLUSION: Work accommodations help individuals with mental disorders meet employment expectations with minimal cost.


Assuntos
Readaptação ao Emprego/economia , Transtornos Mentais , Pessoas Mentalmente Doentes , Análise Custo-Benefício , Humanos , Local de Trabalho/economia
17.
Isr J Health Policy Res ; 8(1): 71, 2019 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610806

RESUMO

Recently, Miodownik et al. reported in this journal the results of a study on seclusion and mechanical restraint of psychiatric patients in Israel (Isr J Health Policy Res 8:9, 2019). The study was a retrospective examination over a year of one inpatient ward in a psychiatric hospital. They found negative associations between length of use of coercive measures and the diagnosis of schizophrenia, being single, and the presence of academic nurses. Positive associations were found between length of use of coercive measures and the use of antipsychotic medications, violence towards oneself, and the use of restraint compared to seclusion. Interesting and important as they are, these results were obtained from data gathered in 2014. As the authors note, since then there has been a dramatic change in the official policy of the Israeli Ministry of Health on this topic and in the practice of seclusion and mechanical restraint in Israel. This commentary reviews and comments on the current situation.


Assuntos
Transtornos Mentais , Pessoas Mentalmente Doentes , Demografia , Humanos , Israel , Isolamento de Pacientes , Restrição Física , Estudos Retrospectivos
18.
Australas Psychiatry ; 27(5): 438-440, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545089

RESUMO

OBJECTIVE: To examine capacity assessment, coercive care and principles by which a seemingly reasonable request for the discontinuation of treatment may be considered. CONCLUSIONS: A clinical and socio-legal case may be made for 'coercive care'.


Assuntos
Coerção , Direitos Humanos , Competência Mental , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes , Psiquiatria , Direitos Humanos/ética , Direitos Humanos/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Psiquiatria/ética , Psiquiatria/legislação & jurisprudência
19.
Am J Bioeth ; 19(10): 29-39, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31557090

RESUMO

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons' mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.


Assuntos
Competência Mental , Pessoas Mentalmente Doentes , Psiquiatria/ética , Suicídio Assistido/ética , Suicídio/prevenção & controle , Feminino , Humanos , Masculino , Princípios Morais , Dor/prevenção & controle , Psiquiatria/tendências , Estresse Psicológico/prevenção & controle , Suicídio Assistido/legislação & jurisprudência , Doente Terminal
20.
Am J Bioeth ; 19(10): 71-83, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31557114

RESUMO

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15-24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity.


Assuntos
Coerção , Pacientes Internados/psicologia , Tratamento Involuntário/ética , Tratamento Involuntário/tendências , Autonomia Pessoal , Ideação Suicida , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoas Mentalmente Doentes , Padrão de Cuidado/ética , Padrão de Cuidado/legislação & jurisprudência , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia
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