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1.
J Law Med ; 26(4): 732-736, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682352

RESUMO

The use of electroconvulsive therapy (ECT) is highly regulated across Australia. Its use on those under compulsory mental health treatment orders remains controversial and the United Nations Special Rapporteur on Torture and Other Cruel and Inhuman Treatment or Punishment has called for a ban on its nonconsensual use. Mental health tribunals must consider whether or not the person concerned has capacity to consent to ECT and there have been different understandings of just what capacity means in this regard. This column discusses the influence of human rights law and a recent decision by Justice Bell of the Supreme Court of Victoria setting a low threshold for a person's capacity to consent to or refuse ECT.


Assuntos
Eletroconvulsoterapia , Consentimento Livre e Esclarecido , Justiça Social , Humanos , Legislação Médica , Nações Unidas , Vitória
2.
Front Psychiatry ; 10: 414, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31244699

RESUMO

This paper presents findings from an interdisciplinary project undertaken in Victoria, Australia, investigating the barriers and facilitators to supported decision-making (SDM) for people living with diagnoses including schizophrenia, psychosis, bipolar disorder, and severe depression; family members supporting them; and mental health practitioners, including psychiatrists. We considered how SDM can be used to align Australian laws and practice with international human rights obligations. The project examined the experiences, views, and preferences of consumers of mental health services, including people with experiences of being on Community Treatment Orders (CTOs), in relation to enabling SDM in mental health service delivery. It also examined the perspectives of informal family members or carers and mental health practitioners. Victoria currently has high rates of use of CTOs, and the emphasis on SDM in the Mental Health Act, 2014, is proposed as one method for reducing coercion within the mental health system and working towards more recovery-oriented practice. Our findings cautiously suggest that SDM may contribute to reducing the use of CTOs, encouraging less use of coercive practices, and improving the experience of people who are subject to these orders, through greater respect for their views and preferences. Nonetheless, the participants in our study expressed an often ambivalent stance towards CTOs. In particular, the emphasis on medication as the primary treatment option and the limited communication about distressing side effects, alongside lack of choice of medication, was a primary source of concern. Fears, particularly among staff, about the risk of harm to self and others, and stigma attached to complex mental health conditions experienced by consumers and their families, represent important overarching concerns in the implementation of CTOs. Supporting the decision-making of people on CTOs, respecting their views and preferences about treatment, and moving towards reducing the use of CTOs require system-wide transformation and a significant shift in values and practice across mental health service delivery.

3.
J Law Med ; 26(2): 300-305, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30574718

RESUMO

Informed consent to medical treatment is generally presumed to be central to the provision of good quality health care. Despite this presumption, legislation exists in many countries that enables the compulsory detention and treatment of people with severe mental health conditions regardless of their wishes. This column discusses global efforts to reduce, prevent and end compulsory detention, treatment and coercive practices in mental health and community settings. It summarises the current state of research, identifying overarching themes in the search for effective non-coercive practices, before focusing on hospital and community-based initiatives.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Mentais/terapia , Serviços Comunitários de Saúde Mental , Humanos , Saúde Mental , Satisfação do Paciente
4.
J Law Med ; 25(2): 315-319, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29978638

RESUMO

The World Health Organization and several United Nations bodies and personnel have called for a human rights perspective to be integrated into mental health and community services. While there are ongoing debates about what this means for law reform and practice, the World Health Organization QualityRights program provides a starting point for educational training in human rights that may be of benefit for mental health practitioners. This column explores some of the challenges for integrating a human rights perspective into mental health treatment and care and outlines the QualityRights program.


Assuntos
Direitos Humanos , Saúde Mental , Tomada de Decisões , Humanos , Nações Unidas , Organização Mundial da Saúde
5.
J Law Med ; 25(4): 894-898, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29978673

RESUMO

Computational modelling is now being used to analyse posts on social media to predict the emergence of mental health conditions. While the aim is to develop tools for early detection and treatment of such conditions, computational modelling raises issues of user consent and privacy. The European Union has moved to regulate automated profiling of large databases and Australia has introduced a data breach notification scheme for cases where personal information held by an organisation is lost or subjected to unauthorised access or disclosure. There remains the question, however, of whether such regulation will be enough to prevent third-party access to social media and health-related datasets by those with less than benign motives. Opting out of using social media and schemes such as My Health Records may be one option to preserve privacy and avoid the use of personal data being used without consent, but that may be unattainable in a digital age.


Assuntos
Consentimento Livre e Esclarecido , Privacidade , Mídias Sociais , Austrália , Confidencialidade , Revelação , Modelos Teóricos
6.
Aust N Z J Psychiatry ; 52(9): 826-833, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29952217

RESUMO

BACKGROUND: Supporting the decision-making of mental health service users fulfils professional, ethical and moral obligations of mental health practitioners. It may also aid personal recovery. Previous research on the effectiveness of supported decision-making interventions is limited. AIMS: The study aims to explore from several perspectives the barriers and facilitators to supported decision-making in an Australian context. Supported decision-making was considered in terms of interpersonal experiences and legal supported decision-making mechanisms. METHODS: In all, 90 narrative interviews about experiences of supported decision-making were conducted and analysed. Participants were mental health service users who reported diagnoses of schizophrenia, psychosis, bipolar disorder and severe depression; family members supporting them and mental health practitioners, including psychiatrists. The data were analysed thematically across all participants. RESULTS: Negative interpersonal experiences in the mental health care system undermined involvement in decision-making for people with psychiatric diagnoses and family carers. Mental health practitioners noted their own disempowerment in service systems as barriers to good supported decision-making practices. All groups noted the influence of prevailing attitudes towards mental health service users and the associated stigma and discrimination that exist in services and the broader community. They believed that legal supported decision-making mechanisms facilitate the participation of mental health service user and their family supporters in supported decision-making. CONCLUSIONS: Enabling supported decision-making in clinical practice and policy can be facilitated by (1) support for good communication skills and related attitudes and practices among mental health practitioners and removing barriers to their good practice in health and social services and (2) introducing legal supported decision-making mechanisms.


Assuntos
Tomada de Decisões , Família/psicologia , Pessoal de Saúde/psicologia , Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Participação do Paciente/legislação & jurisprudência , Participação do Paciente/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Australas Psychiatry ; 26(3): 299-302, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29463100

RESUMO

OBJECTIVES: The aim of this study was to report on a half-day multi-stakeholder symposium on community treatment orders (CTOs) hosted by the Melbourne Social Equity Institute (MSEI), which identified research gaps and opportunities, and produced an agreed agenda for future CTO research. METHODS: The MSEI convened a symposium for 22 experts in CTO research to discuss research priorities in this field in Australasia. An independent moderator elicited views and recommendations and produced a report detailing possible research projects. RESULTS: Research on CTOs is contentious and there is a need to gather and examine information regarding both their use and utility. Due to the complexities involved, it was agreed that research should be undertaken in partnership with persons with had lived experience of mental health problems, clinicians, policymakers and other interdisciplinary stakeholders. Five key areas for future investigation were identified. CONCLUSIONS: The issues and recommendations arising from the symposium should shape the scope, nature and conduct of future research directions in the field.


Assuntos
Serviços Comunitários de Saúde Mental , Tratamento Psiquiátrico Involuntário , Legislação como Assunto , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Austrália , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Humanos , Tratamento Psiquiátrico Involuntário/estatística & dados numéricos , Legislação como Assunto/estatística & dados numéricos
8.
Australas Psychiatry ; 26(5): 474-477, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26530349

RESUMO

OBJECTIVES: Our aim was to develop a framework for clinical decision-making that can be used to take into account risk in an era of recovery and rights. CONCLUSION: We developed a framework influenced by civil liability law to develop a guide for clinical decision-making which emphasises collaboration, clarification of the available information and communication of decisions as essential components of recovery-oriented risk management.


Assuntos
Tomada de Decisão Clínica , Transtornos Mentais/terapia , Saúde Mental , Pessoas Mentalmente Doentes , Psiquiatria , Gestão de Riscos , Humanos , Saúde Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Psiquiatria/legislação & jurisprudência , Psiquiatria/métodos , Gestão de Riscos/legislação & jurisprudência , Gestão de Riscos/métodos
10.
Aust Health Rev ; 40(6): 599-604, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26934498

RESUMO

Objective This paper examines the perspectives of consumers and their supporters regarding the use of seclusion and restraint in mental health settings. Methods Five focus groups for consumers and five focus groups for supporters were conducted in four Australian cities and in one rural location. The 66 participants were asked about strategies to reduce or eliminate the use of seclusion and restraint in mental health settings. Results All participants supported the reduction of the use of seclusion and restraint. Barriers to reducing these practices related to the environment, the effects of drug and alcohol issues, lack of a human rights focus and poor recognition of trauma, stigma and discrimination. Strategies for reducing or eliminating seclusion and restraint included workforce development, environmental and cultural changes. Conclusions Participants clearly identified that the status quo needs to change and conveyed urgency for action. Participants suggested that the involvement of supporters and a range of consumer roles are integral to reducing the use of seclusion and restraint. The findings support the current policy emphasis of working towards the elimination of these practices. What is known about the topic? Mental health policies across many jurisdictions support the reduction and elimination of restraint and seclusion. Evidence suggests those subjected to restraint and seclusion largely experience a range of harmful consequences. No studies focus on the views of supporters of consumers regarding the reduction and elimination of seclusion and restraint, whereas the views of consumers appear in a minority of international studies. What does this paper add? The research enabled an opportunity to hear from people who have been personally affected by and/or have lived experience of these coercive practices. Participants identified local reforms that can uphold the human rights of consumers. They suggested practices to increase accountability, peer support and family involvement, areas that have not been analysed in depth in any of the seclusion and restraint literature. What are the implications for practitioners? This paper will give healthcare services a deeper insight into how to reduce or eliminate restraint or seclusion from the perspective of those with lived experience.


Assuntos
Família/psicologia , Transtornos Mentais/terapia , Isolamento de Pacientes , Pacientes/psicologia , Restrição Física , Adulto , Austrália , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Masculino
11.
Artigo em Inglês | MEDLINE | ID: mdl-26855669

RESUMO

BACKGROUND: Seclusion and restraint are interventions currently permitted for use in mental health services to control or manage a person's behaviour. In Australia, serious concerns about the use of such seclusion and restraint have been raised at least since 1993. Consumers and their supporters have also expressed strong views about the harm of these practices. This paper presents the results of ten focus group discussions with people with lived experience of mental health issues and also carers, family members and support persons in relation to the use of seclusion and restraint. METHODS: The 30 consumers and 36 supporters participating in the focus groups convened in four Australian cities and one regional centre discussed their understandings of the use of seclusion and restraint and its impact on the people involved. Participants also presented their observations about poor practice and what contributes to it as well as providing ideas and recommendations regarding strategies to reduce or eliminate seclusion and restraint. Focus group discussions were recorded and transcribed, then analysed using the NVivo 10 qualitative data analysis software with a general inductive approach used to analyse data. This analysis enabled consideration of the responses to key questions in the focus groups as well as the identification of emerging themes. RESULTS: Six themes emerged from the analysis, these being: human rights, trauma, control, isolation, dehumanisation and 'othering', and anti-recovery. Examples of poor practice identified by focus groups included the use of excessive force, lack of empathy/paternalistic attitudes, lack of communication and interaction and a lack of alternative strategies to the use of seclusion and restraint. There was a confluence of factors identified by participants as contributing to poor practice, with the main factors being organisational culture, the physical environment, under-resourced mental health services and fear and stigma. CONCLUSIONS: Focus group participants in the main viewed seclusion and restraint practices in mental health settings as unnecessarily overused, exacerbating problems for individuals, carers, staff and the broader system of care. This study highlights that lived experience of both consumers and their supporters can make an important contribution to mental health services and its ongoing reform.

13.
J Law Med ; 24(1): 15-19, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-30136770

RESUMO

Various forms of restraint may be used in a variety of health care settings to control behaviour. Laws and policies regulate the use of physical and mechanical restraint across health care settings, but there is a gap in relation to the regulation of chemical restraint. This may partly be because of problems in defining the term and partly because of a lack of information as to the extent of the use of drugs aimed at controlling behaviour rather than ameliorating a medical condition. This column provides an overview of current definitions and argues that there is a need for national guidance as to what constitutes chemical restraint in order to reduce its use.


Assuntos
Antipsicóticos/administração & dosagem , Controle Comportamental/legislação & jurisprudência , Controle Comportamental/métodos , Antipsicóticos/efeitos adversos , Uso Indevido de Medicamentos , Instalações de Saúde , Humanos , Uso Excessivo de Medicamentos Prescritos
14.
J Law Med ; 22(4): 739-44, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26349374

RESUMO

In 2014, the Australian Law Reform Commission released a report dealing with recognition before the law and legal capacity of people with disability. The report recommended that "supported decision-making" should be introduced into relevant Commonwealth laws and legal frameworks. This column explores what is meant by "support" to exercise legal capacity and what role the law may play in attempting to move beyond the traditional substituted decision-making model for those with mental and intellectual impairments.


Assuntos
Competência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/legislação & jurisprudência , Austrália , Humanos
15.
Int J Law Psychiatry ; 40: 60-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25958054

RESUMO

The six Australian states and two territories each have legislation that enables the involuntary detention and treatment of individuals diagnosed with mental illness who are considered in need of treatment and where there is evidence of a risk of harm to self or others. A number of governments have undertaken or are currently undertaking reviews of mental health laws in light of the Australian Government's ratification of the Convention on the Rights of Persons with Disabilities. While United Nations bodies have made it clear that laws which enable the detention of and substituted decision-making for persons with disabilities should be abolished, debates in Australia about the reform of mental health legislation have largely focused on Article 12 of the CRPD and what is meant by the right of persons with disabilities to enjoy legal capacity on an equal basis with others. It is argued that a more holistic view of the CRPD rather than the current narrow focus on Article 12 would best serve the needs of persons with mental impairments.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Saúde Mental , Austrália , Tomada de Decisões , Direitos Humanos/legislação & jurisprudência , Humanos , Nações Unidas
16.
J Law Med ; 23(2): 297-302, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26939495

RESUMO

The practices of seclusion and restraint may be used in a variety of health settings to control behaviour. Laws and policies that seek to regulate these practices define seclusion and restraint in various ways and there are gaps as to which practices are regulated and in what circumstances. This column provides an overview of consumer and carer perspectives as to what is meant by these practices.


Assuntos
Cuidadores/psicologia , Isolamento de Pacientes/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Austrália , Comportamento Perigoso , Feminino , Grupos Focais , Humanos , Masculino , Isolamento de Pacientes/psicologia , Formulação de Políticas , Restrição Física/psicologia , Gestão de Riscos
17.
J Law Med ; 22(1): 17-21, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25341316

RESUMO

A recent decision by the Queensland government to lock its 16 mental health inpatient facilities has met with condemnation by a number of professional bodies. This column canvasses some of the legal and ethical issues relating to locked wards and provides an overview of the literature on whether or not locking wards reduces absconding. It is argued that any benefits in preventing absconding through locking all mental health inpatient facilities is outweighed by the adverse effects locked wards have on those detained.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Medidas de Segurança/ética , Medidas de Segurança/legislação & jurisprudência , Austrália , Hospitais Psiquiátricos , Humanos
18.
J Law Med ; 21(2): 251-4, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24597370

RESUMO

A recent report submitted to the United Nations Human Rights Council by the United Nations Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, has called for "an absolute ban" on the use of seclusion and restraint in mental health facilities. In Australia, seclusion and some, but not all, forms of restraint are regulated either by legislation or guidelines. This column explores some of the issues raised by the lack of national reporting requirements for these practices and moves by the National Mental Health Commission towards their reduction or elimination.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Isolamento de Pacientes/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Austrália , Coleta de Dados , Direitos Humanos/legislação & jurisprudência , Humanos , Nações Unidas
19.
J Law Med ; 20(1): 22-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23156644

RESUMO

Article 12 of the United Nations Convention on the Rights of Persons with Disabilities requires states parties to ensure that persons with disabilities "enjoy legal capacity on an equal basis with others in all aspects of life". This column explores what is meant by "legal capacity" and its constituent elements of legal standing and legal agency. It outlines recent research on what is meant by "support" to exercise legal capacity and explores the issue of whether mental health and guardianship laws that enable substituted decision-making for those with mental and intellectual impairments contravene Article 12.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Austrália , Humanos
20.
Med Law Rev ; 19(4): 548-80, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22038746

RESUMO

Mental health law reform in recent decades has drawn on the international human rights movement. The entering into force of the Convention on the Rights of Persons with Disabilities (CRPD) on May 3 2008 has been hailed by some as signalling a new era in relation to how domestic mental health laws should be reformed. Both Australia and New Zealand have ratified the CRPD and Australia has acceded to its Optional Protocol. New Zealand and the Australian Capital Territory and Victoria have statutory bills of rights which have an interpretive effect, but are unable to render other statutes invalid. Drawing on the results of interviews conducted with fifty-two representatives of consumer and carer organisations, lawyers, and mental health professionals across Australia and New Zealand, this paper examines the current thinking on human rights and mental health laws in these countries and outlines what changes, if any, may be brought to domestic legislation in light of the Convention.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Atitude do Pessoal de Saúde , Austrália , Humanos , Entrevistas como Assunto , Serviços de Saúde Mental/legislação & jurisprudência , Nova Zelândia , Autonomia Pessoal
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