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1.
Int J Law Psychiatry ; 72: 101601, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32889420

RESUMO

The coronavirus pandemic, referred to here as Covid-19, has brought into sharp focus the increasing divergence of devolved legislation and its implementation in the United Kingdom. One such instance is the emergency health and social care legislation and guidance introduced by the United Kingdom Central Government and the devolved Governments of Wales, Scotland and Northern Ireland in response to this pandemic. We provide a summary, comparison and discussion of these proposed and actual changes with a particular focus on the impact on adult social care and safeguarding of the rights of citizens. To begin, a summary and comparison of the relevant changes, or potential changes, to mental health, mental capacity and adult social care law across the four jurisdictions is provided. Next, we critique the suggested and actual changes and in so doing consider the immediate and longer term implications for adult social care, including mental health and mental capacity, at the time of publication.several core themes emerged: concerns around process and scrutiny; concerns about possible changes to the workforce and last, the possible threat on the ability to safeguard human rights. It has been shown that, ordinarily, legislative provisions across the jurisdictions of the UK are different, save for Wales (which shares most of its mental health law provisions with England). Such divergence is also mirrored in the way in which the suggested emergency changes could be implemented. Aside from this, there is also a wider concern about a lack of parity of esteem between social care and health care, a concern which is common to all. What is interesting is that the introduction of CVA 2020 forced a comparison to be made between the four UK nations which also shines a spotlight on how citizens can anticipate receipt of services.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Legislação Médica/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Transtornos Mentais/terapia , Irlanda do Norte/epidemiologia , Pandemias , Reino Unido/epidemiologia
2.
Int J Law Psychiatry ; 71: 101602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768125

RESUMO

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


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Mental/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Betacoronavirus , Internação Compulsória de Doente Mental/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Humanos , Competência Mental/legislação & jurisprudência , Irlanda do Norte/epidemiologia , Pandemias , Saúde Pública/legislação & jurisprudência
3.
Int J Law Psychiatry ; 70: 101564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32482306

RESUMO

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


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Infecções por Coronavirus , Saúde Mental/legislação & jurisprudência , Pandemias , Pneumonia Viral , Psiquiatria/legislação & jurisprudência , Psiquiatria/métodos , Comitês Consultivos , Betacoronavirus , Tomada de Decisões , Serviço Hospitalar de Emergência , Humanos , Irlanda , Transtornos Mentais/terapia
4.
Fortschr Neurol Psychiatr ; 88(4): 248-254, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31234213

RESUMO

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


Assuntos
Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Internação Compulsória de Doente Mental/legislação & jurisprudência , Tratamento Involuntário/legislação & jurisprudência , Adesão à Medicação , Esquizofrenia/tratamento farmacológico , Agressão , Coerção , Alemanha , Humanos , Tempo de Internação , Estudos Longitudinais
5.
Rev. esp. sanid. penit ; 22(1): 41-48, 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195429

RESUMO

INTRODUCCIÓN: El tratamiento ambulatorio involuntario (TAI) es una forma de tratamiento obligatorio de carácter extrahospitalario aplicado en la comunidad, que pretende mejorar la adhesión al tratamiento de las personas con una enfermedad mental grave, sin conciencia de enfermedad, en los que el abandono terapéutico supone un riesgo alto de recaída, con aparición de conductas disruptivas y/o autoagresivas o heteroagresivas, hospitalizaciones repetidas y urgencias frecuentes. La aplicación del TAI no está exenta de polémica y, por tanto, la necesidad o no de su regulación legislativa en España es un tema controvertido desde hace varios años, que encuentra tanto defensores como detractores. OBJETIVO: Recoger la opinión de los psiquiatras clínicos y médicos internos residentes en psiquiatría acerca del tratamiento ambulatorio involuntario y su regulación legislativa. MATERIAL Y MÉTODO: Se trata de un estudio de carácter descriptivo. La población de estudio está compuesta por 42 profesionales clínicos de la salud mental (32 psiquiatras y 10 médicos internos residentes en psiquiatría), los cuales estaban ejerciendo en alguno de los dispositivos de los que se compone el Servicio de Psiquiatría del Complejo Hospitalario Universitario de Huelva al inicio del estudio (en marzo de 2018). Se realizó una encuesta personal en formato papel constituida por diez cuestiones sobre el TAI a cada uno de los miembros de la muestra. RESULTADOS: El 85,7% de los clínicos conoce la iniciativa actual de intentar llevar a cabo la regulación legislativa del TAI, estando de acuerdo con dicha regulación el 92,8% de ellos. En este sentido, un 83,3% está en contra de que estén reguladas medidas más coercitivas para el paciente psiquiátrico, como el internamiento involuntario o la incapacitación civil, y no lo esté el TAI. Por otra parte, un 78,6% de los profesionales de la salud mental cree que el TAI es beneficioso para los pacientes, mientras que un 95,2% piensa que también es beneficioso para sus familias. Por otro lado, el 78,6% de los clínicos no considera estigmatizante la aplicación del TAI a los enfermos mentales graves. CONCLUSIÓN: La gran mayoría de los clínicos ve necesaria la regulación legislativa del tratamiento ambulatorio involuntario en España, al considerarlo beneficioso para el enfermo mental grave y su familia


INTRODUCTION: Involuntary outpatient treatment (IOT) is a kind of compulsory outpatient treatment, whose aim is to improve the adherence to the treatment in people with severe mental illness and with no awareness of disease. In these cases, therapeutic abandonment involves a high risk of relapse, with appearance of disruptive and/or self-aggressive or hetero-aggressive behavior, repeated hospitalizations and frequent emergencies. The application of IOT is not an issue without contention. Therefore, the need of legislative regulation in Spain has been a controversial subject for several years, and there are both advocates and opponents. OBJECTIVE: The objective of this study is to bring together the opinion of clinical psychiatrists and resident doctors in psychiatry on the involuntary outpatient treatment and its legislative regulation. MATERIAL AND METHOD: This study is descriptive in nature. The study population consists of 42 clinical professionals in mental health (32 psychiatrists and 10 resident doctors in psychiatry). At the beginning of this study (March 2018), some of these professionals were working in the Psychiatry Department's facilities of the University Hospital Complex of Huelva. A personal survey in paper form consisting of ten questions about IOT was carried out to each member of this study. RESULTS: 85.7% of clinicians know the current initiative that tries to carry out the legislative regulation of IOT, and 92.8% of them agree to such regulation. In this sense, 83.3% of them are against the fact that more coercive measures for the psychiatric patients such as the involuntary commitment or the civil incapacitation are regulated and IOT is not. On the one hand, 78.6% of the professionals in mental health believe that IOT is beneficial for the patients. Moreover, 95.2% of them think that is beneficial for their relatives, too. On the other hand, 78.6% of clinicians do not consider that the application of IOT to mentally-ill patients is stigmatizing. CONCLUSIONS: The vast majority of clinicians think that the legislative regulation of involuntary outpatient treatment is necessary in Spain, and they think this treatment is beneficial not only for the patient but also for their family


Assuntos
Humanos , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Assistência Ambulatorial/tendências , Temas Bioéticos , Transtornos Mentais/terapia , Psicoses Induzidas por Substâncias/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Medicamentos do Componente Especializado da Assistência Farmacêutica , Aceitação pelo Paciente de Cuidados de Saúde , Epidemiologia Descritiva , Médicos/estatística & dados numéricos , Prisões/estatística & dados numéricos
6.
BMC Psychiatry ; 19(1): 422, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881954

RESUMO

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


Assuntos
Transtorno Bipolar/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/estatística & dados numéricos , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/terapia , Adulto , Diretivas Antecipadas , Feminino , França , Humanos , Masculino , Pesquisa Qualitativa , Qualidade de Vida , Adulto Jovem
9.
Int J Law Psychiatry ; 66: 101452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706387

RESUMO

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


Assuntos
Internação Compulsória de Doente Mental , Serviços Comunitários de Saúde Mental , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Defesa do Paciente , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Saúde Mental , Avaliação de Programas e Projetos de Saúde , Vitória
10.
Int J Law Psychiatry ; 66: 101489, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706390

RESUMO

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


Assuntos
Internação Compulsória de Doente Mental , Serviços Comunitários de Saúde Mental , Transtornos Mentais/terapia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Tomada de Decisões , Humanos , Internacionalidade , Serviço Social
11.
Int J Law Psychiatry ; 66: 101462, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706396

RESUMO

Modern legal systems typically link the insanity or diminished responsibility of an offender for a crime committed in the past to his future dangerousness. This nexus serves across legal systems as a justification for the indeterminate commitment of the offender with diminished or no criminal responsibility. Conceptually, however, insanity and risk are not related legal issues. Moreover, empirical research suggests that there is only a weak link between insanity, diminished responsibility and mental illness on the one hand and risk of recidivism on the other. Other risk factors seem to be more important. The inference of risk from insanity or diminished responsibility that lies at the heart of the indeterminate commitment of mentally disordered offenders is therefore problematic. This should lead to a reconsideration of the preconditions for indeterminate commitment of mentally disordered defendants.


Assuntos
Internação Compulsória de Doente Mental , Crime/prevenção & controle , Defesa por Insanidade , Internação Compulsória de Doente Mental/legislação & jurisprudência , Crime/legislação & jurisprudência , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Comportamento Perigoso , Humanos , Internacionalidade , Medição de Risco
12.
Int J Law Psychiatry ; 66: 101497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706399

RESUMO

This article explores the current debate which exists within the United Nations human rights system regarding the right to liberty of persons with psychosocial disabilities. Article 14 of the UN Convention on the Rights of Persons with Disabilities states that the existence of a disability cannot be a justificatory ground for the involuntary detention of a person. In interpreting Article 14, the UN Committee on the Rights of Persons with Disabilities has called for States Parties to repeal legislation which provides for detention based on the existence of a psychosocial disability, either solely or in combination with other factors such as a perceived dangerousness or need for treatment - essentially requiring the abolition of mental health laws. However, a number of other human rights bodies within the UN, including the Human Rights Committee, have continued to affirm the lawfulness of deprivations of liberty under mental health legislation in certain circumstances. This article will set out the current state of this discourse and conclude by making a determination on the governing legal interpretation of the right to liberty of persons with psychosocial disabilities under international law.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Nações Unidas , Internação Compulsória de Doente Mental/legislação & jurisprudência , Tomada de Decisões , Pessoas com Deficiência/psicologia , Liberdade , Direitos Humanos/psicologia , Humanos , Transtornos Mentais
14.
Sci Rep ; 9(1): 15252, 2019 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-31649331

RESUMO

Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China's first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Hospitalização/legislação & jurisprudência , Hospitais Psiquiátricos , Internação Involuntária/legislação & jurisprudência , Transtornos Mentais/terapia , Adulto , China , Coerção , Internação Compulsória de Doente Mental/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Adulto Jovem
15.
Camb Q Healthc Ethics ; 28(4): 752-758, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31526417

RESUMO

For individuals whose mental illness impair their ability to accept appropriate care-the depressed, acutely suicidal mother, or the psychotic lawyer too paranoid to eat any food-statutes exist to permit involuntary hospitalization, a temporary override of paternalistic benefice over personal autonomy. This exception to the primacy of personal autonomy at the core of bioethics has the aim of restoring the mental health of the temporarily incapacitated individual, and with it, their autonomy.


Assuntos
Internação Compulsória de Doente Mental/ética , Internação Compulsória de Doente Mental/legislação & jurisprudência , Competência Mental , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/psicologia , Autonomia Pessoal , Adulto , Bioética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
J Am Acad Psychiatry Law ; 47(4): 467-475, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31527090

RESUMO

Patients admitted involuntarily to psychiatric hospitals may face waits of varying lengths before receiving civil commitment hearings. We aimed to assess the effects of the time spent awaiting a hearing on outcomes for such patients in a university health system, hypothesizing that patients with a longer prehearing length of stay (LOS) would also have increased LOS after their hearings. We included subjects who were admitted from January 1 through December 31, 2013, and had county court records of commitment hearings. Models for each outcome were constructed using generalized linear models to control for available confounding variables. 109 subjects were included in the analysis, 58 (53.2%) of whom had delayed commitment hearings (with prehearing LOS greater than seven days). The average posthearing LOS for the delayed group was 6.2 days greater. After controlling for covariates, prehearing LOS was statistically predictive of posthearing LOS, even after controlling for potential confounds. These results suggest that delays in involuntary civil commitment hearings for psychiatric inpatients are associated with extended posthearing LOS and extended total LOS, implying that LOS for involuntary patients could be improved by measures to increase the efficiency of commitment processes.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Involuntária/legislação & jurisprudência , Função Jurisdicional , Tempo de Internação , Adulto , Feminino , Hospitais Psiquiátricos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Alta do Paciente , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
17.
Tijdschr Psychiatr ; 61(8): 536-543, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512737

RESUMO

BACKGROUND: Various measures aim to stimulate prosecution of violence and aggression against mental-health workers. Considering a possible increase of inpatient incidents through article 2.3 of the Bill Forensic Care, this is a desirable development. Mental health care and the judiciary seem to have opposing opinions whether the emphasis should lie on care or punishment in handling intramural offense.
AIM: To investigate which arguments judges apply in their trial of intramural incidents, to gain insight into the obstacles which impede awarding punishment during treatment, and to give recommendations for balancing the need for care and the need for punishment.
METHOD: A qualitatively thematic analysis based on semi-structured interviews with eight judges. Themes were based on relevant literature and case reports.
RESULTS: The majority of the judges considered judging intramural incidents complicated because of: 1. insufficient information on possible exclusion of guilt, 2. the fear that punishment will lead to recidivism, and 3. ambiguity on the impact of the crime on the victim. They emphasized that they needed more up-to-date information from the institution. Judges wanted to avert punishment as this may lead to discontinuity of care or worsening of the mental health of the suspect.
CONCLUSION: A verdict can also support a (clinical) mental health treatment. With the arrival of the 'bopz-brigades' (Law bopz: Law on Compulsory Admission to Psychiatric Hospitals) at the Public Prosecution Service, all relevant information from mental health care, police and Public Prosecution can be combined into a claim, leading to a verdict in which care and punishment serve each other optimally.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Crime , Psiquiatria Legal , Transtornos Mentais/terapia , Humanos , Pacientes Internados , Saúde Mental , Prisioneiros/psicologia
18.
J Med Ethics ; 45(11): 742-745, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31413156

RESUMO

Psychiatric inpatients with capacity may be treated paternalistically under the Mental Health Act 1983. This violates bodily autonomy and causes potentially significant harm to health and moral status, both of which may be long-lasting. I suggest that such harms may extend to killing moral persons through the impact of psychotropic drugs on psychological connectedness. Unsurprisingly, existing legislation is overwhelmingly disliked by psychiatric inpatients, the majority of whom have capacity. I present four arguments for involuntary treatment: individual safety, public safety, authentic wishes and protection of autonomy. I explore these through a case study: a patient with schizophrenia admitted to a psychiatric hospital under the Mental Health Act 1983 after an episode of self-poisoning. Through its discussion of preventative detention, the public safety argument articulates the (un)ethical underpinnings of the current position in English law. Ultimately, none of the four arguments are cogent-all fail to justify the current legal discrimination faced by psychiatric inpatients. I conclude against any use of involuntary treatment in psychiatric inpatients with capacity, endorsing the fusion approach where only psychiatric patients lacking capacity may be treated involuntarily.


Assuntos
Coerção , Hospitais Psiquiátricos/ética , Hospitais Psiquiátricos/organização & administração , Psiquiatria/ética , Psiquiatria/organização & administração , Internação Compulsória de Doente Mental/ética , Internação Compulsória de Doente Mental/legislação & jurisprudência , Hospitais Psiquiátricos/legislação & jurisprudência , Humanos , Pacientes Internados , Tratamento Involuntário/ética , Competência Mental , Autonomia Pessoal , Psiquiatria/legislação & jurisprudência , Segurança/normas
19.
J Nerv Ment Dis ; 207(9): 805-814, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31464992

RESUMO

The diagnosis of moral insanity was primarily used through the best part of the 19th century to define and justify the psychiatric treatment of a particular type of conduct in which the patient seemed otherwise rational but displayed certain inexplicable and undesirable behaviors deemed socially perverse or "unfit." This article traces the history of this highly contested concept, which mirrors a historical arc in which psychiatry emerges as a discipline and stakes territorial claims on defining and regulating moral behavior. As illustration, I focus on the Hinchman Conspiracy Trial of 1849 as a less known case of wrongful confinement that hinged on proving the diagnosis of moral insanity in court. Moral insanity is a case study of the efforts to medicalize human ethical conduct, an effort starkly resisted by both the courts and the public. Some of the legacies of the term are the contemporary use of insanity as a legal defense, and the ability of patients to dispute psychiatric ward confinement orders in court.


Assuntos
Internação Compulsória de Doente Mental , Defesa por Insanidade , Transtornos Mentais , Pessoas Mentalmente Doentes , Princípios Morais , Psiquiatria , Internação Compulsória de Doente Mental/história , Internação Compulsória de Doente Mental/legislação & jurisprudência , História do Século XIX , Humanos , Defesa por Insanidade/história , Transtornos Mentais/história , Pessoas Mentalmente Doentes/história , Psiquiatria/história
20.
Encephale ; 45(5): 405-412, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31421813

RESUMO

BACKGROUND: The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party. METHODS: An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016. RESULTS: One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder. CONCLUSION: Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços de Emergência Psiquiátrica/legislação & jurisprudência , Internação Involuntária/legislação & jurisprudência , Transtornos Mentais/terapia , Adulto , Internação Compulsória de Doente Mental/estatística & dados numéricos , Comportamento Perigoso , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Feminino , Humanos , Masculino , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Paris , Readmissão do Paciente/legislação & jurisprudência , Readmissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Encaminhamento e Consulta/legislação & jurisprudência , Encaminhamento e Consulta/estatística & dados numéricos , Adulto Jovem
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