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1.
Eur Psychiatry ; 56: 97-104, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30654319

RESUMO

BACKGROUND: Outpatient civil commitment (OCC) provisions, community treatment orders (CTOs) in Australia and Commonwealth nations, are part of mental health law worldwide. This study considers whether and by what means OCC provides statutorily required "needed-treatment" addressing two aspects of its legal mandate to protect the safety of self (exclusive of deliberate-self-harm) and others. METHOD: Over a 12.4-year period, records of hospitalized-psychiatric-patients, 11,424 with CTO-assignment and 16,161 without CTO-assignment were linked to police-records. Imminent-safety-threats included perpetrations and victimizations by homicides, rapes, assaults/abductions, and robberies. "Need for treatment" determinations were validated independently by Health of the Nations Scale (HoNOS) severity-score-profiles. Logistic regressions, with propensity-score- adjustment and control for 46 potential confounding-factors, were used to evaluate the association of CTO-assignment with occurrence-risk of perpetrations and victimizations. RESULTS: CTO-assignment was associated with reduced safety-risk: 17% in initial-perpetrations, 11% in initial-victimizations, and 22% for repeat-perpetrations. Each ten-community-treatment-days in interaction with CTO-assignment was associated with a 3.4% reduced-perpetration-risk. CTO-initiated-re-hospitalization was associated with a 13% reduced-initial-perpetration-risk, a 17% reduced-initial-victimization-risk, and a 22% reduced-repeat-victimization-risk. All risk-estimates appear to be the unique contributions of the CTO, CTO-initiated-re-hospitalization, or the provision of ten-community-treatment-days-i.e. after accounting for the influence of prior crimes and victimizations, ethnic-bias, neighborhood disadvantage and other between-group differences in the analysis. CONCLUSIONS: CTO assignment's association with reduced criminal-victimization and perpetration-risk, in conjunction with requiring participation in needed-treatment via re-hospitalization and community-service, adds support to the conclusion that OCC is to some extent fulfilling its legal objectives related to protecting safety of self (exclusive of deliberate-self-harm), and others.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Austrália , Internação Compulsória de Doente Mental/normas , Serviços Comunitários de Saúde Mental/normas , Crime/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade
2.
Encephale ; 45(2): 139-146, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30126611

RESUMO

OBJECTIVES: The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. METHODS: A descriptive study was carried out through a survey of the nine facilities. RESULTS: All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. CONCLUSION: Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration.


Assuntos
Medicina Geral , Hospitais Especializados , Transtornos Mentais/terapia , Prisioneiros , Unidade Hospitalar de Psiquiatria , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Internação Compulsória de Doente Mental/estatística & dados numéricos , Psiquiatria Legal/métodos , Psiquiatria Legal/organização & administração , Psiquiatria Legal/normas , Psiquiatria Legal/estatística & dados numéricos , França/epidemiologia , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Hospitais Especializados/métodos , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Prisões/organização & administração , Prisões/normas , Prisões/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/organização & administração , Unidade Hospitalar de Psiquiatria/normas , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
3.
BMJ Open ; 8(10): e024193, 2018 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-30341141

RESUMO

INTRODUCTION: Supervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data. METHODS AND ANALYSIS: Four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use. ETHICS AND DISSEMINATION: Ethical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.


Assuntos
Internação Compulsória de Doente Mental/normas , Serviços Comunitários de Saúde Mental/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Tratamento Psiquiátrico Involuntário/organização & administração , Transtornos Mentais/terapia , Inglaterra , Humanos , Serviços de Saúde Mental/organização & administração , Projetos de Pesquisa
4.
Eur Psychiatry ; 54: 35-40, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30118917

RESUMO

BACKGROUND: The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication. METHODS: The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders' representatives. The national recommendations have been subsequently summarized into a European shared document. RESULTS: Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients' dignity, privacy and safety shall be preserved at all times. CONCLUSION: The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.


Assuntos
Antipsicóticos/uso terapêutico , Internação Compulsória de Doente Mental/normas , Adesão à Medicação/estatística & dados numéricos , Serviços de Saúde Mental/normas , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Coerção , Internação Compulsória de Doente Mental/legislação & jurisprudência , Europa (Continente) , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoas Mentalmente Doentes/estatística & dados numéricos , Estudos Multicêntricos como Assunto
5.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(2): 125-130, mar. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-174377

RESUMO

Clásicamente la asistencia sanitaria que han recibido los pacientes con enfermedad mental implicaba su ruptura con la sociedad, mediante su aislamiento en instituciones cerradas, configurando así una tendencia estigmatizadora sobre el enfermo, y por extensión sobre la enfermedad mental, hecho que en cierta manera ha llegado hasta nuestros días. Importantes han sido en el ámbito de la Psiquiatría las profundas reformas, que se vieron reflejadas tanto en el campo terapéutico, como en el legislativo, lo que ha contribuido a fijar un cambio en referencia a la imagen social del enfermo mental. El propósito del presente artículo tiene como objetivo revisar, desde la visión crítica, el marco legislativo vigente referente a la situación del internamiento involuntario psiquiátrico como medida terapéutica del paciente mental, ya que la práctica médico-legal nos indica la carencia de habilidades legales y ético-deontológicas que se plantean en el ámbito de la Atención Primaria


Traditionally, medical care received by psychiatric patients involved their separation from the society through their isolation in closed institutions, thereby setting a stigmatising trend on the sick, and by extension on mental illness, a practice that somehow has remained until now. The profound changes in the field of psychiatry have been important and are reflected in the therapeutic field, as well as in the legislative one, and have contributed to establish changes concerning the social opinion about psychiatric patients. The purpose of this article is to review, from the critical perspective, the current legislative framework concerning the situation of involuntary psychiatric commitment as a therapeutic measure in the psychiatric patient, as well as the legal medical practice which indicates the lack of legal skills and ethical and professional conduct arising in the field of primary care


Assuntos
Humanos , Internação Compulsória de Doente Mental/legislação & jurisprudência , Transtornos Mentais/epidemiologia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Atenção Primária à Saúde/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Saúde Mental/ética , Saúde Mental/legislação & jurisprudência
6.
J Am Acad Psychiatry Law ; 45(4): 447-451, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29282235

RESUMO

This article focuses on the development of a Forensic Mental Health Services Census (FMHSC), proposed to differentiate between five different patient populations institutionalized in state facilities. The FMHSC would comprise patients who are civilly committed for mental illness or sexual dangerousness, those found incompetent to stand trial, those committed after a verdict of not guilty by reason of insanity, and those voluntarily committed. The census would be performed by state mental health authorities for each of these populations within the particular jurisdiction and then would be reported to a national coordinating organization. These data are important because of the large number of persons involved and the significant resources devoted to the management and treatment of each involuntary group. The census is necessary for clinical, research, and policy purposes, to provide more rational management of these populations, both within and across jurisdictions.


Assuntos
Censos , Internação Compulsória de Doente Mental/normas , Transtornos Mentais/classificação , Serviços de Saúde Mental/normas , Comportamento Perigoso , Psiquiatria Legal/normas , Humanos , Transtornos Mentais/diagnóstico
8.
Psychiatr Serv ; 68(12): 1247-1254, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28760100

RESUMO

OBJECTIVES: This study examined whether psychiatric patients assigned to community treatment orders (CTOs), outpatient commitment in Victoria, Australia, have a greater need for treatment to protect their health and safety than patients not assigned to CTOs. It also considered whether such treatment is provided in a least restrictive manner-that is, in a way that contributes to reduced use of psychiatric hospitalization. METHODS: The sample included 11,424 patients first placed on a CTO between 2000 and 2010, and 16,161 patients not placed on a CTO. Need for treatment was independently assessed with the Health of the Nation Outcome Scales (HoNOS) at hospital admission and at discharge. Ordinary least-squares and Poisson regressions were used to assess savings in hospital days attributable to CTO placement. RESULTS: HoNOS ratings indicated that at admission and discharge, the CTO cohort's need for treatment exceeded that of the non-CTO cohort, particularly in areas indicating potential dangerous behavior. When analyses adjusted for the propensity to be selected into the CTO cohort and other factors, the mean duration of an inpatient episode was 4.6 days shorter for the CTO cohort than for the non-CTO cohort, and a reduction of 10.4 days per inpatient episode was attributable to each CTO placement. CONCLUSIONS: CTO placement may have helped patients with a greater need for treatment to experience shorter hospital stays. Whether the CTO directly enabled the fulfillment of unsought but required treatment needs that protected patient health and safety is a question that needs to be addressed in future research.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Desinstitucionalização/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vitória
9.
Nervenarzt ; 88(Suppl 1): 1-29, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28776213

RESUMO

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Comunicação Interdisciplinar , Colaboração Intersetorial , Transtornos Mentais/reabilitação , Programas Nacionais de Saúde/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Assistência Ambulatorial/ética , Assistência Ambulatorial/legislação & jurisprudência , Assistência Ambulatorial/normas , Internação Compulsória de Doente Mental/ética , Ética Médica , Prova Pericial/ética , Prova Pericial/legislação & jurisprudência , Alemanha , Humanos , Programas Nacionais de Saúde/ética , Admissão do Paciente/legislação & jurisprudência , Admissão do Paciente/normas , Prisioneiros/legislação & jurisprudência , Prisioneiros/psicologia , Prognóstico
10.
Int J Law Psychiatry ; 52: 103-110, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28365036

RESUMO

Severely mentally ill jail detainees require an adequate spectrum of mental health services during detainment. For some this means a limited period of treatment in a mental hospital, just as some mentally ill individuals in the community occasionally require hospital treatment. Unfortunately, this appropriate level of treatment is often denied or neglected for jail detainees with adverse consequences for them. Among the reasons for this neglect, may be standards for hospital transfer that are no longer practical and can be easily skirted by policymakers and administrators with little interest in ensuring this level of care for mentally ill jail inmates. A more realistic standard and justification would recognize the need for hospitalization for the mentally disordered detainee who because of psychotic anosognosia refuses appropriate treatment including medications and/or whose severely decompensated condition is worsening or failing to improve despite attempts at treatment in the jail.


Assuntos
Internação Compulsória de Doente Mental/normas , Prisioneiros , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Psiquiatria Legal/normas , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Direitos do Paciente/legislação & jurisprudência , Direitos do Paciente/normas , Estados Unidos
12.
Psychiatr Prax ; 44(3): 163-171, 2017 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-27618173

RESUMO

Objective The study aimed to evaluate the applicability of a set of quality indicators to assess models of integrated care for patients with a diagnosis of schizophrenia. We report first values for these indicators in routine care in Germany. Methods The study is based on a cohort of adult patients with schizophrenia insured by one large German statutory health insurance company, which were assessed two times and gave consent to evaluate their routine claims data. The study tried to use 12 basic and 22 quality indicators from claims data. Results It was possible to estimate most structural indicators using available data, but only half of the quality indicators. This means that while assessment of quality indicators is feasible in general, routine claims data needs to be supplemented by additional (primary) data. Four of the calculated quality indicators had clear targets or red-flag values, which were not met in our cohort in all four indicators. None of the patients had an outpatient mental health related contact within one week (target > 90 %). The readmission rate within 30 days (21 %) was twice as high as the proposed red-flag value of 10 %. Similar figures were seen for antipsychotic polypharmacy (25 %, red-flag value > 10 %) and the proportion of patients with compulsory treatment (15 %) exceeded the red-flag value by 5 %. Conclusion The study shows that it is possible to measure quality indicators, but also demonstrates considerable limitations. There is a need to validate indicators in routine care.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Adulto , Idoso , Estudos de Coortes , Internação Compulsória de Doente Mental/normas , Estudos de Viabilidade , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente
13.
Psychiatr Serv ; 68(3): 291-294, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-27691377

RESUMO

The author discusses a pragmatic approach to decisions about coercive treatment that is based on four principles from principle-based ethics: respect for autonomy, nonmaleficence, beneficence, and justice. This approach can reconcile psychiatry's perspective with the U.N. Convention on the Rights of Persons With Disabilities. Coercive treatment can be justified only when a patient's capacity to consent is substantially impaired and severe danger to health or life cannot be prevented by less intrusive means. In this case, withholding treatment can violate the principle of justice. In the case of danger to others, social exclusion and loss of freedom can be seen as harming psychosocial health, which can justify coercive treatment. Considerable efforts are required to support patients' informed decisions and avoid allowing others to make substitute decisions. Mental disorder alone without impaired capacity does not justify involuntary treatment, which can be considered a misuse of psychiatry. Involuntary detention without treatment can be justified for short periods for assessment and to offer treatment options.


Assuntos
Internação Compulsória de Doente Mental/normas , Legislação Médica/ética , Psiquiatria/ética , Humanos
14.
Can J Psychiatry ; 61(1): 15-24, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27582449

RESUMO

OBJECTIVE: Community treatment orders (CTOs) exist in more than 75 jurisdictions worldwide. This review outlines findings from the international literature on CTO effectiveness. METHOD: The article draws on 2 comprehensive systematic reviews of the literature published before 2013, then uses the same search terms to identify studies published between 2013 and 2015. The focus is on what the literature as a whole tells us about CTO effectiveness, with particular emphasis on the strength and weaknesses of different methodologies. RESULTS: The results from more than 50 nonrandomized studies show mixed results. Some show benefits from CTOs while others show none on the most frequently reported outcomes of readmission, time in hospital, and community service use. Results from the 3 existing randomized controlled trials (RCTs) show no effect of CTOs on a wider range of outcome measures except that patients on CTOs are less likely than controls to be a victim of crime. Patients on CTOs are, however, likely to have their liberty restricted for significantly longer periods of time. Meta-analyses pooling patient data from RCTs and high quality nonrandomized studies also find no evidence of patient benefit, and systematic reviews come to the same conclusion. CONCLUSION: There is no evidence of patient benefit from current CTO outcome studies. This casts doubt over the usefulness and ethics of CTOs. To remove uncertainty, future research must be designed as RCTs.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/normas , Saúde Global , Humanos
17.
Behav Sci Law ; 34(2-3): 378-95, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27009428

RESUMO

The Forensic Monitoring System (FMS) of the Missouri Department of Mental Health considers and approves consumers committed under not guilty by reason of insanity (NGRI) status for release. The system extends to the outpatient sector to ensure that such persons maintain their mental stability and do not pose a danger to the community. The process of conditional release and the organization of the FMS are outlined, reasons for the low recidivism rate are discussed, and paternalism in requiring treatment compliance as a condition of individual liberty is explored. Case examples illustrate the success, in terms of revocation and rearrest rates, of the Missouri system, which typically sees an annual return to inpatient custody of only 7%, and a still lower rate of criminal recidivism. Cost-effectiveness is discussed in terms of resources spent so that recovered persons with dangerous mental illnesses may live in safety outside of an institution. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Criminosos/psicologia , Psiquiatria Legal/métodos , Saúde Mental/legislação & jurisprudência , Medição de Risco/métodos , Internação Compulsória de Doente Mental/normas , Crime , Comportamento Perigoso , Feminino , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/organização & administração , Humanos , Defesa por Insanidade , Masculino , Missouri , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Medição de Risco/legislação & jurisprudência , Fatores de Risco
18.
Nord J Psychiatry ; 70(5): 321-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26750532

RESUMO

Background Measuring patient satisfaction in mental health care potentially provides valuable information, but studies in acutely admitted psychosis patients are scarce. Aims The aims were to assess satisfaction among patients acutely admitted with psychosis, to compare satisfaction in voluntarily versus involuntarily admitted patients, and to assess the influence of symptom load and insight. Methods The UKU Consumer Satisfaction Rating Scale (UKU-ConSat) was used. A total of 104 patients completed the UKU-ConSat at discharge/follow-up (between 6-11 weeks after admittance if not discharged earlier) (mean duration of stay 4 weeks), thus corresponding to the end of the acute treatment phase. Results A total of 88.4% had total scores above zero (satisfied). Only three of the eight single items were statistically significantly different among patients admitted voluntarily versus involuntarily, and only the information item score remained significantly different in adjusted analyses. Insight level at admittance, and an increasing level of insight during the acute phase were positively associated with patient satisfaction, whereas levels and changes in positive and negative psychosis symptoms were indirectly related to satisfaction via this process of insight. Conclusions The vast majority of the acutely admitted patients were satisfied with treatment. There were few differences between the involuntarily and voluntarily admitted patient groups, except that the involuntary care group was clearly less satisfied with the information provided. Poor insight had a major negative impact on treatment satisfaction in psychosis. The provision of sufficient and adequate information is an important target for mental health care service improvement.


Assuntos
Internação Compulsória de Doente Mental/normas , Serviços de Saúde Mental/normas , Admissão do Paciente/normas , Satisfação do Paciente , Transtornos Psicóticos/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Australas Psychiatry ; 24(3): 264-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26400447

RESUMO

OBJECTIVES: To determine the appropriateness and utility of the certificates issued under the New South Wales Mental Health Act (MHA) and compliance with the requirements of the MHA. The analysis also compares MHA documentation by different groups of health professionals and police. METHODS: The MHA certificates associated with 100 consecutive involuntary Emergency Department presentations were audited. RESULTS: Considerable variability exists between professional groups in the level of detail, appropriateness, clinical utility and compliance of MHA certificates. Over 10% of Schedule 1s failed to meet the requirements of the MHA, potentially invalidating the involuntary detention of these patients. Information provided by police was typically superior in informing initial risk assessment and emergency management. CONCLUSIONS: A number of patients are presently being detained under incomplete MHA certificates. Educational initiatives that aim to improve awareness of the MHA's requirements, and the potential uses of the information contained in MHA certificates, could encourage professionals to complete these certificates in a more appropriate and clinically useful manner.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Tratamento Psiquiátrico Involuntário/estatística & dados numéricos , Auditoria Clínica , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Documentação/normas , Serviço Hospitalar de Emergência/legislação & jurisprudência , Serviço Hospitalar de Emergência/normas , Humanos , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Tratamento Psiquiátrico Involuntário/normas , Saúde Mental/legislação & jurisprudência , New South Wales , Guias de Prática Clínica como Assunto
20.
Subst Abus ; 37(1): 181-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25832824

RESUMO

Several states currently have enacted laws that allow for civil commitment for individuals diagnosed with severe substance use disorders. Civil commitment or involuntary commitment refers to the legal process by which individuals with mental illness are court-ordered into inpatient and/or outpatient treatment programs. Although initially civil commitment laws were intended for individuals with severe mental illness, these statutes have been extended to cover individuals with severe substance use disorders. Much of the recent legislation allowing for civil commitment of individuals with substance use disorders has come about in response to the heroin epidemic and is designed to provide an alternative to the unrelenting progression of opioid use disorders. Civil commitment also provides an opportunity for individuals with opioid use disorders to make informed decisions regarding ongoing or continued treatment. However, civil commitment also raises concerns regarding the potential violation of 14th Amendment rights, specifically pertaining to abuses of deprivation of liberty or freedom, which are guaranteed under the 14th Amendment to the United States Constitution. This commentary examines these issues while supporting the need for effective brief civil commitment legislation in all states.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Transtornos Relacionados ao Uso de Substâncias , Direitos Civis/legislação & jurisprudência , Direitos Civis/normas , Humanos , Estados Unidos
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