[Involuntary admissions in accordance to the Mental Health Act (PsychKG) - what are the strongest predictors?]. / Die stationäre Unterbringung nach dem Psychisch-Kranken-Gesetz (PsychKG NRW) - was sind die stärksten Prädiktoren?

OBJECTIVE: Involuntary psychiatric admissions under the Mental Health Act increased significantly nationwide. Little is known, however, about the influencing factors of this phenomenon. METHODS: The aim of this regional cross-sectional study in North Rhine-Westphalia was to compare voluntary and involuntary psychiatric admissions (under the PsychKG NRW) regarding personal, institutional, social-psychiatric and demographic characteristics. A retrospective analysis of hospital admission registers over a period of 6 years with over 200 000 cases was conducted. RESULTS: Elderly patients with dementia were most frequently involuntarily admitted. The existence of a locked ward in hospitals did not per se increase involuntary admissions, whereas the scope and quality of local social-psychiatric services had a major impact. CONCLUSION: Social-psychiatric services and home-treatment must be strengthened to achieve lower involuntary admission rates and to further improve the quality of mental health care all over Germany.

Psychiatric collaborations in the Hispanic world / Colaboraciones en psiquiatría en el mundo hispánico

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Italian community psychiatry in practice: description and comparison of three regional systems.

The psychiatric reform in 1978 assigned the regions the task of implementing community mental health (MH) services; 30 years on in Italy, there are as many MH systems as there are Italian regions and all completely differentiated. Three Italian regions (Lombardy, Emilia-Romagna, and Campania) in different geographic areas are here chosen as representing three different models of community care implementation as well as certain similarities and differences at a regional level. For each region, the article focuses on MH policy, financing, the network of community health facilities, service provision, MH staff, and the information system.

[The challenges and perspectives of collaborative networking]. / Enjeux et perspectives du travail en réseau.

The mental health action plan for Europe dates back to 2005 and sets out the terms for drawing up, implementing and strengthening global mental health policies in all European countries. While in the area of psychiatry, the advantages of working in a network must be emphasised, it can be developed on the level of the local community, the health care territory or the department as well as on a regional basis.

Leverage and other informal pressures in community psychiatry in England.

PURPOSE: Informal practices aimed at managing psychiatric patients in the community setting fall outside legal and policy provision or guidance. "Leverage" is an informal practice whereby practitioners attempt to influence patients' treatment adherence by, for example, making patients' access to subsidised housing conditional upon adherence to treatment or by making treatment adherence a condition of patients' avoidance of financial control. Lower rates of leverage are reported in the UK compared to the USA, possibly due to differences between the US and European social welfare systems. These differences raise questions as to the international comparability of leverage practices described in the literature. The study aimed to capture patients' experiences and perceptions of pressures and to explore (a) whether "leverage" can be distinguished from other pressures, and (b) how a concept of leverage derived from patient experiences in England might fit with the literature to date. In this article we present the different types of pressure that we identified from patients' accounts, and a set of criteria derived for the purpose of distinguishing between these different types of pressure. METHOD: Twenty-nine qualitative interviews with a purposive subsample from a study of leverage in the English mental health system were analysed. RESULTS: Participants reported a range of what can be classified as both leveraged and non-leveraged pressures. These were perceived as pressures to adhere to treatment, as well as "staying well." Leveraged pressures were distinguishable from non-leveraged pressures by the presence of three features: conditionality, a lever and direct communication. CONCLUSIONS: The portrayal of "leverage" in the current literature does not fully capture patient experiences of pressure. Our analysis offers a clearer concept of leverage and other pressures that influence patients, and which may have different legal, ethical and clinical implications.

La reforma psiquiátrica 25 años después de la Ley General de Sanidad / Psychiatric reform after 25 years the general Law of Health

El artículo analiza la situación de la reforma psiquiátrica a los 25 años de la Ley General de Sanidad. Se pregunta por lo que se ha hecho y lo que se ha dejado de hacer; por el grado de implantación del modelo comunitario que adopta la Ley y por su sostenibilidad futura. Entre las fortalezas se señalan la pérdida de hegemonía del hospital psiquiátrico y el gran desarrollo de recursos alternativos, y se trata de explicar el porqué de las insuficiencias asistenciales, normativas y formativas, así como de las amenazas: los cambios producidos en la gestión de los servicios sociales y sanitarios, la creciente privatización de los servicios, la precarización teórica y los cambios en la demanda de la población(AU)

The paper analyzes the situation of the psychiatric reform 25 years of the General Health Law. The author wonders what has been done and what has been left undone, on the degree of implementation of the Communitymodel that adopts the law and its future sustainability. It highlights, among the strengths, the loss of hegemony of the psychiatric hospital and the great development of alternative resources, and seeks to explain the reason for the inadequacies of care, policy and training, as well as threats: the changes in the management of social and health services, increased privatization of services, the theoretical impoverishment and changing demands of the population(AU)

Section 5(4) of the Mental Health Act 1983: the art of applying the Act.

Section 5(4) of the Mental Health Act 1983 allows patients to be detained by nurses of the 'prescribed class' for a maximum of 6 hours. There is a paucity of research on the subject of Section 5(4); however, the little research that has been conducted has shown that there are gaps in the knowledge of registered nurses and nursing students due to be registered with regard to the following areas of Section 5(4): duration of the holding power; whether the client can be treated against their will; eligibility for detention; and criteria for implementation. This article will seek to clarify these gaps and provide nurses with a comprehensive systematic guide to follow should they have to invoke the section.

[Expert decisions concerning disability pensions in the area of psychiatry--in view of a court-appointed expert]. / Orzecznictwo rentowe z zakresu psychiatrii--z perspektywy bieglego sadowego.

Inability of social services to provide a non-working person with the necessary minimal financial support as well as a high unemployment rate make acquiring of a disability pension appear the only means of coming to terms with existential problems. After the fairly tolerant decision policy of the Social Insurance Institution (ZUS) in the first half of the 1990s, the criteria of granting disability pensions hassince been made stricter--through replacing of the former disability pensions by the concept of inability to work. The author evaluates the theory and practice of experts' decision-making in the prospect of his over ten year experience as an expert appointed by the Regional Court of Law in Cracow. Mental disorders are rated third among disturbances most frequently indicated as the reason for deciding about long-term inability to work. Psychiatric disorders, unlike most illnesses from other domains of medicine--do not require the use of modern methods of instrumental diagnostics. The only instrument supporting the clinical diagnosis is a psychological examination--especially in regards to the assessment of the depth of intellectual deficit. In psychiatry, clinical diagnosis is of a descriptive character: "As the district psychiatrist perceives or wants to perceive the patient during the examination--so does he describe this patient in the medical documentation". It is verification of actual intensity of mental disorders during a short examination--here the examination by a Social Insurance Institution's expert physician or an expert appointed by court--that becomes a problem. Of special importance in decision making must be prescribed to medical documentation, including regularity of treatment, applied pharmacotherapy, hospital treatment and its duration, etc.

Trends in the use of the Italian Mental Health Act, 1979--1997.

Italian statistics on psychiatric bed availability, voluntary and compulsory admissions were examined from 1979 to 1997. Although the number of psychiatric beds dropped by 62.5%, the absolute number of compulsory admissions has remained substantially stable. The proportion of all admissions that were compulsory decreased from 17.1% to 11%. This study shows that a shift to community care was not associated with an increase in compulsory admissions in Italy.