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.

Trade impacts of external border measures under the European Union's plant health legislation.

BACKGROUND: This article assesses whether the European Union's (EU's) plant health regulations have had an impact on imports. A dynamic modelling approach was applied, using a two-step generalized method of moments estimator for panel data, and covering an 8-year period (2013-2020). The estimated equation includes volumes of trade, economic drivers, the trading partner, and variables capturing categories of import requirements (phytosanitary certificates, exemptions, restrictions) with regards to external border measures for enhanced biosecurity. RESULTS: From the analysis we can conclude that the import regime and its recent changes have had a limited impact, if any, on trade flows of the affected products. The most significant impact is found for products classified as high-risk plants, while the extension of the phytosanitary certificate requirement to new products seems to have had negligible effects on trade. CONCLUSION: Therefore, the plant protection regime for extra-EU trade seems to be not trade distorting while supplying a framework to enhance plant health in the EU. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study.

OBJECTIVES: To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. METHODS: This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency. RESULTS: Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). DISCUSSION/CONCLUSION: There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Perceptions and Attitudes of Mental Health Professionals toward the Mental Health Care Law in Saudi Arabia.

The Saudi Mental Health Care Law (SMHL) was established in 2014; however, no prior study has evaluated mental health professionals' perceptions or attitudes toward it. This cross-sectional study examines these aspects and their associated factors among psychiatrists, psychologists, social workers, and psychiatric nurses in Saudi Arabia (SA). The data were collected from 432 participants using an online electronic survey consisting of four sections, including the Mental Health Legislation Attitudes Scale (MHLAS). Psychiatrists comprised most participants (46.06%), followed by psychologists (36.34%). Most participants were 40 years of age or younger (83.10%). Of the 432 participants, 226 (52.31%) were females. Overall, 28.70% were unaware of the existence of the SMHL. A total of 172 (66.67%) out of 258 participants agreed that the legislation operates well in ensuring treatment for persons who require involuntary admission. There was a statistically significant association between specialty and opinions of treatment efficacy and care benefits of the SMHL (p = 0.031 and p < 0.001, respectively). Official implementation of SMHL in participants' facilities resulted in high MHLAS scores (p = 0.007). Reading or attending lectures and workshops related to the SMHL resulted in high MHLAS scores (p = 0.044 and p = 0.021, respectively). Negative opinions and uncertainty regarding the effect of SMHL on confidentiality were associated with low total MHLAS scores (p < 0.001). This study highlights the need to increase awareness of the SMHL among Saudi Arabian healthcare workers.

Online modules to improve health professionals' end-of-life law knowledge and confidence: a pre-post survey study.

BACKGROUND: Health professionals and medical students have knowledge gaps about the law that governs end-of-life decision-making. There is a lack of dedicated training on end-of-life law and corresponding research on the impact of this type of training. OBJECTIVE: To examine the impact of online training modules on key concepts of end-of-life law on Australian health professionals' legal knowledge and their self-reported confidence in applying the law in practice. METHODS: Online pre- and post-training surveys were completed by training participants. The optional surveys collected demographic data, directly assessed legal knowledge and measured self-reported confidence in applying the law in clinical practice, before and after training. RESULTS: Survey response rates were 66% (pre-training) and 12% (post-training). The final sample for analysis (n = 136 participants with matched pre- and post-training surveys), included nurses, doctors, allied health professionals, medical students and a small number of non-health professionals. Following completion of the online training modules, legal knowledge scores significantly increased overall and across each domain of end-of-life law. Participants were also more confident in applying the law in practice after training (median = 3.0, confident) than before training (median = 2.0, not confident). CONCLUSIONS: This study found that completion of online training modules on end-of-life law increased Australian health professionals' legal knowledge and self-reported confidence in applying the law in clinical practice. Participants demonstrated some remaining knowledge gaps after training, suggesting that the training, while effective, should be undertaken as part of ongoing education on end-of-life law. Future research should examine longer term outcomes and impacts of the training.

Psychiatry, Law, and Revolution: A View from Egypt.

In 2009, Egypt adopted the "Law for the Care of Mental Patients," a rights-based legislation intended to bring the country's mental health system-otherwise defined by resource gaps and chronic underfunding-closer to global standards of care. Yet, the new act stirred dissension among Egyptian psychiatrists. And, in the immediate aftermath of the 2011 uprising, debates about the 2009 law became intertwined with debates about the present and future of the 'new Egypt.' Based on field research in Cairo, this article provides an ethnographic analysis of the making of this mental health act and of the ensuing debates as they unfolded in 2011-2012. Showing the diverging perspectives at the core of these debates on psychiatric power, patient rights, and the law's fit in society, the article highlights the challenges of psychiatric reform in a country of the Global South. It also argues that in a context of revolutionary upheaval, debates about psychiatric reform become a site for political reflection and provide a language for imagining the future of the nation. The article also highlights the centrality of temporality in debating psychiatric reform in times of political transformation.

Multi-level protection of rights: India's Mental Healthcare Act, 2017 and the United Nations' Convention on the Rights of Persons with Disabilities (Articles 12 and 14).

Mental health law is a feature of mental health systems around the world, so legislative reform is an important way to advance compliance with the United Nations' Convention on the Rights of Persons with Disabilities (CRPD). This paper provides an overview of India's Mental Healthcare Act, 2017 in the context of Articles 12 ('Equal recognition before the law') and 14 ('Liberty and security of person'). Notwithstanding the potential of law to produce change, exclusive or disproportionate emphasis on law draws attention from other areas in need of equal if not greater reform, such as public education, mental health services, physical healthcare, social care networks, criminal justice systems, and gathering political backing for the profound reforms needed to transform the socio-economic landscapes in which mental illness develops, diagnoses are made, treatment is provided (or not provided), recovery occurs (or does not occur), and social citizenship is protected and promoted (or eroded and obstructed). There is a particular issue with misunderstandings of psychiatry in academic discussions of mental health legislation which appears to stem from lack of engagement with the full diversity of service-user views and the evidence base for psychiatric care. Greater recognition of upstream factors that shape both suffering and services would acknowledge that the decisions of politicians and service managers have a much greater impact on rights, especially the right to treatment and support, than the decisions of individual clinicians whose options are often very limited at the level of individual care. India's legislation seeks to address not only individual-level care, but also this higher level of reform through its articulation of an explicit 'right to access mental healthcare and treatment'. Similar multi-level legislative reform elsewhere would increase cooperation from all stakeholders, improve compliance with the CRPD, and help move towards zero coercion in mental health services.

Efetivação das garantias ao direito à saúde: legislação e jurisprudência no combate à pandemia / Effectiveness of the guarantees to the right to health: legislation and jurisprudence in the fight against the pandemic / Efectividad de las garantías al derecho a la salud: legislación y jurisprudencia en la lucha contra la pandemia

Objetivo: o presente artigo visa estudar os contornos teóricos e práticos da efetivação do direito à saúde em seu respectivo regime jurídico. Essa efetivação foi colocada à prova no contexto da pandemia de COVID-19, o que reclamou uma profunda reflexão sobre as bases de sustentabilidade desse regime jurídico. Metodologia: foi realizada uma abordagem sobre a natureza jurídica do direito à saúde, que ensejou no advento do direito sanitário como, reconhecidamente, um direito subjetivo público, com princípios próprios e ampla eficácia, bem como levantaram-se os marcos legais e jurisprudenciais do sistema único de saúde, utilizados na pandemia. Resultados: a crise pandêmica tornou necessária uma série de medidas para garantir a estabilização da estrutura constitucional desenhada para o exercício desse poder de efetivação do direito à saúde, que passa pela conformação do Estado brasileiro, orientada pelo princípio republicano e federativo, motivo pelo qual também se estudam as funções legislativas e jurisdicionais, além da importância de seus respectivos papéis nesse mister. Conclusão: a legislação de emergência editada pelo Congresso Nacional e as decisões proferidas pelo Supremo Tribunal Federal nessa atividade de resguardo demonstraram a importância das funções legislativas e jurisdicionais para a manutenção da ordem constitucional brasileira no que concerne ao direito à saúde, especialmente durante o enfrentamento da pandemia de COVID-19.

Objective: this article aims at studyingthe theoretical and practical outlines of the realization of the right to health in its respective legal framework. This realization has been put to the test in the context of the COVID-19 pandemic, which has called for a profound reflection on the sustainability foundations of this legal regime. Methods: an approachwas carried out onthelegal nature of the right to health, which led to the advent of health law as a recognized subjective public right, with its own principles and broad effectiveness, as well a survey of the legal and jurisprudential frameworks of the unified health system, used in the pandemic. Results: the pandemic crisis has required a series of measures to ensure the stabilization of the constitutional structure designed for the exercise of this power to enforce the right to health, which involves the conformation of the Brazilian State, guided by the republican and federative principle. Therefore, the legislative and judicial functions and the importance of their respective roles are also studied in this regard. Conclusion: this emergency legislation enacted by the National Congress and the decisions rendered by the Federal Supreme Court in this safeguarding activity demonstrated the importance of legislative and jurisdictional functions for the maintenance of the Brazilian constitutional order regarding the right to health, especially during the confrontation of the COVID-19 pandemic.

Objetivo: este artículo pretende estudiar los contornos teóricos y prácticos de la efectividad del derecho a la salud en su respectivo régimen jurídico. Esta efectividad se puso a prueba en el contexto de la pandemia del COVID-19, que ha exigido una reflexión profunda sobre las bases de la sostenibilidad de este régimen jurídico. Metodología: se abordó la naturaleza jurídica del derecho a la salud, que dio lugar al advenimiento del derecho sanitario comoun derecho público subjetivo reconocido, con principios propios y amplia eficacia, además de plantear los marcos jurídicos y jurisprudenciales del sistema único de salud sanitaria, utilizado en la pandemia. Resultados: la crisis pandémicahizo necesaria una serie de medidas para garantizar la estabilización de la estructura constitucional diseñada para el ejercicio de ese poder de efectividaddel derecho a la salud, lo que implica la configuración del Estado brasileño, guiado por el principio republicano y federativo, por lo que también se estudian las funciones legislativa y jurisdiccional, así comola importancia de sus respectivos papeles en esta tarea. Conclusión: la legislación de emergencia dictada por el Congreso Nacional y las decisiones emitidas por el Supremo Tribunal Federal en esta actividad de protección demostraron la importancia de las funciones legislativas y jurisdiccionales para el mantenimiento del orden constitucional brasileño en lo que concierne al derecho a la salud, especialmente durante el enfrentamiento de la pandemia de COVID-19.

The Impact of Changes in Mental Health Legislation on Psychiatry Trainee Stress in Victoria, Australia.

In Victoria, Australia, the introduction of a new state Mental Health Act (MHA) in 2014 resulted in changes to the workload and type of work undertaken by trainee psychiatrists. In addition to long working hours, workload intensity is most often cited by trainees as a factor that leads to fatigue, with trainees often taking work home or doing overtime in order to fulfill work responsibilities and satisfy training requirements. This administrative burden is compounded by the high emotional burden associated with the practice of psychiatry, including patient suicides, aggression, and threats. This study aimed to explore the impact of these legislative changes on psychiatry trainees' stress and well-being, using a qualitative research methodology involving semi-structured interviews. Despite reporting that the length and number of reports they were preparing under the new MHA had increased, as had the amount of time spent at Tribunal hearings, psychiatry trainees were understanding of the necessity of MHA changes in improving patient rights. The trainees did not express a desire for the MHA changes to be reversed, but rather recognition by their workplaces that changes are also needed at a ground level-such as an increase in staff numbers-to accommodate for these. While mental health legislative changes are designed to improve the system and better protect patient rights, measures must also be taken to ensure that any policy-level changes are adequately adjusted for in hospital staffing levels.

A conceptual framework for culturally appropriate advocacy with racialised groups.

Independent mental health advocacy was introduced in England to protect and promote the rights of people detained under mental health legislation. However, shortcomings in access and delivery to racialised people, raising concerns about equity, were identified by a review of the Mental Health Act. The development of culturally appropriate advocacy was recommended. While the term culturally appropriate may be taken for granted it is poorly defined and limited efforts have conceptualized it in relation to advocacy. Ideally, advocacy operates as a liberatory practice to challenge epistemic injustice, which people experiencing poor mental health are at acute risk of. This is amplified for people from racialised communities through systemic racism. This paper argues that advocacy and culturally appropriate practices are especially relevant to racialised people. It clarifies the importance of culture, race and racism to the role of advocacy, and understanding advocacy through the conceptual lens of epistemic injustice. A central aim of the paper is to draw on and appraise cultural competency models to develop a conceptual framing of cultural appropriate advocacy to promote epistemic justice.

US state laws relevant to incentives for health behavior: A qualitative analysis.

Contingency management (CM) involves provision of incentives for positive health behaviors via a well-defined protocol and is among the most effective treatments for patients with substance use disorders (SUDs). An understanding of laws affecting incentives for health behaviors and outcomes, including contexts in which incentives are already permitted, could inform efforts to disseminate CM. We conducted a systematic NexisUni legal database review of state statutes and regulations effective during 2022 to identify (a) laws that explicitly permit or prohibit delivery of incentives to patients, employees, or insurance beneficiaries for SUD-specific behaviors or outcomes, and (b) laws that explicitly permit delivery of incentives for any health behaviors or outcomes. We identified 27 laws across 17 jurisdictions that explicitly permit delivery of incentives for SUD-related behaviors or outcomes, with most occurring in the context of wellness programs. No state laws were identified that explicitly prohibit SUD-specific incentives. More broadly, we identified 57 laws across 29 jurisdictions permitting incentives for any health outcomes (both SUD- and non-SUD-related). These laws occurred in the contexts of wellness programs, K-12/early childhood education, government public health promotion, and SUD treatment provider licensing. Considering the urgent need to expand evidence-based SUD treatment in rural and underserved areas throughout the US, these findings could inform efforts to develop laws explicitly permitting provision of incentives in SUD care and enhance efforts to disseminate CM more broadly.

Legal issues in end-of-life care for speech-language pathologists and social workers: A scoping review.

PURPOSE: End-of-life law governs end-of-life decision-making in clinical practice. There has been little analysis of the specific legal issues relevant to allied health professionals working in end-of-life care. METHOD: A scoping review was undertaken to identify and examine the extent, range, and nature of literature on the legal issues relevant to end-of-life practice for Australian speech-language pathologists and social workers, including current gaps. Literature was identified by searching six electronic databases, Google Scholar, the websites of relevant professional organisations and State/Territory health departments, scanning reference lists, and drawing on existing knowledge. Data charting and thematic analysis of findings was performed. RESULT: Twenty documents were included, spanning various document types. Most focused on adult clinical practice. Documents demonstrated that the two professions encounter similar legal issues. CONCLUSION: Key gaps exist in the literature. Findings will inform these professionals of the legal issues relevant to their clinical practice and inform the development of further resources.

An assessment of legislative responses to cancer in Brazil's House of Representatives.

BACKGROUND: Cancer is a public health issue in Brazil. To mitigate exposure to risk factors, change habits and ensure access to cancer care, an increasing number of bills are presented every year. This article analyzes the changes proposed in these bills, portraying how the representatives perceive and respond to the challenges imposed by cancer on the healthcare system and society. METHODS: Through a systematic search on the Brazilian House of Representatives website, this exploratory study examines cancer-related bills presented up to 2022. RESULTS: Of 1311 bills identified, 310 met the inclusion criteria and were categorized based on their content. The increasing annual number of cancer bills reflects the interest of representatives on the topic. The cancer types addressed correspond to the most prevalent ones, except for the colorectal. The most common strategy is primary prevention (n: 129), proposing the reduction of risk factors exposure or the promotion of protective ones, followed by tertiary (n: 106) and secondary (n: 36) strategies, targeting, respectively, cancer treatment/management and its early diagnosis/detection. On the nature of proposed changes, most seek to implement increased healthcare access (n: 125), production/sale (dis)incentives for goods containing carcinogens (n: 60), and fiscal/financial (dis)incentives (n: 53). CONCLUSION: The identified gaps - such as the limited use of data and evidence to support what is proposed, overlapping but fragmented efforts with previous bills, scarce efforts directly addressing the determinants of health, and the low rate of conversion to law - entails opportunities to advance the Legislative propositions. POLICY SUMMARY: To effectively respond to cancer-related challenges, is essential that the Legislative branch takes into account what is already being proposed or being left out, inputs from society, real-world data, and the results produced by the multisectoral policies in place.

How the Dobbs Decision Could Affect U.S. National Security.

Women are an integral part of the military, comprising 17.2 percent of the active-duty force. They are the fastest-growing subpopulation in the military. In recent years, the Department of Defense (DoD) and military services have been deliberately recruiting women because they represent a higher percentage of the recruitable population than their male counterparts. Service women and their civilian counterparts have been and are serving in roles that are essential to military readiness. The Dobbs v. Jackson Supreme Court ruling will limit service women's and DoD civilian women's access to reproductive health care and affect the health of these critical populations. In this article, the authors use publicly available data to provide an estimate of the scope of the effects of the decision on the health and readiness of the U.S. armed forces. They estimate how many military-employed women's reproductive health options have been or might soon be limited and identify force readiness-related concerns, such as effects on the military health care, education, and child care systems, as well as on military recruiting and retention.

The role of 'micro-decisions' in involuntary admissions decision-making for inpatient psychiatric care in general hospitals in South Africa.

While the ethics of involuntary admission for psychiatric inpatient care is widely contested, the practice is legally permissible across most jurisdictions. In many countries, laws governing the use of involuntary admission set out core criteria under which involuntary admission is permitted; these parameters broadly related to either risk of harm to self or others, need for treatment, or both. In South Africa, the use of involuntary admission is governed by the Mental Health Care Act no. 17 of 2002 (MHCA 2002), which sets out clear criteria to direct mental healthcare practitioners' decision-making and delineates a process by which decision-making should occur. However, recent research suggests that, in practice, the process of decision-making differs from the procedure prescribed in the MHCA 2002. To further explore how decision-making for involuntary admission occurs in practice, we interviewed 20 mental healthcare practitioners, all with extensive experience of making involuntary admission decisions, working in district, regional, and tertiary hospitals across five provinces. We also interviewed four mental health advocates to explore patient-centered insights. Our analysis suggests that the final decision to involuntarily admit individuals for a 72-h assessment period under the MHCA 2002 was preceded by a series of 'micro-decisions' made by a range of stakeholders: 1) the family's or police's decision to bring the individual into hospital, 2) a triage nurse's decision to prioritise the individual along a mental healthcare pathway in the emergency centre, and 3) a medical officer's decision to sedate the individual. Practitioners reported that the outcomes of each of these 'micro-decisions' informed aspects of their final decision to admit an individual involuntarily. Our analysis therefore suggests that the final decision to admit involuntarily cannot be understood in isolation because practitioners draw on a range of additional information, gleaned from these prior 'micro-decisions', to inform the final decision to admit.

The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway.

BACKGROUND: Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects. AIM: To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others. METHODS: Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014-2017 predicted an increase in the standardized suicide ratios in 2014-2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287). RESULTS: We found no adverse effects on patients' health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care. CONCLUSIONS: Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

Practising psychiatry in Sri Lanka: challenges and opportunities.

This month's issue of BJPsych International focuses on psychiatry in Sri Lanka, with articles on suggested improvements in education and training, the country's outdated legislation regarding involuntary psychiatric treatment, and the misuse of prescription medications.

NHS mental health services' policies on leave for detained patients in England and Wales: A national audit.

WHAT IS KNOWN ON THE SUBJECT?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge. Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective. While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The leave policies of NHS mental health services in England and Wales are highly inconsistent. The extent to which policies are consistent with guidance differs depending on which service is providing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is very likely that, because of inconsistencies between services and policies, practice also differs. Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey. Policymakers need to revisit leave policies in light of evidence from this study. ABSTRACT: INTRODUCTION: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies. AIM: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. METHOD: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave-related terms were extracted and analysed. RESULTS: Fifty-seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain-level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. DISCUSSION: Mental health professionals are inconsistently supported by the policy in their leave-related practice. This could potentially contribute to inconsistent practice and leave-related patient outcomes. IMPLICATIONS FOR PRACTICE: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs.

Policy and legislation for the treatment of mental health and substance use disorders in Qatar.

There is a marked paucity of publications on the policy and legislation of mental health, and substance use disorders in the public domain in Qatar. Qatar National Vision provides a framework for national strategies and the State of Qatar has developed policies and legislation dedicated to mental health and substance use. In doing so, Qatar has adopted international guidance to shape its mental health services and relevant policy and legislation. This article is a narrative description of the evolution of the mental health and substance use policy and legislation in Qatar.