Human Rights Act 1998 and mental health legislation: implications for the management of mentally ill patients.

In the management of mentally ill patients, there is a tension between protecting the rights of individual patients and safeguarding public safety. The Human Rights Act 1998 emphasises on the former while two recent white papers focus on the latter. This article first examines the extent to which the Mental Health Act 1983 is consistent with the Human Rights Act. It argues that while the recent white papers exploit the gaps in the judgments given by the European courts, its compatibility with human rights is very doubtful. The practical implications of the Human Rights Act for doctors are discussed.

Defensive practice among psychiatrists: a questionnaire survey.

OBJECTIVE: There has been little research on the prevalence of defensive practice within hospital settings. The aim of this report was to examine the extent of defensiveness among psychiatrists and to examine the relationship between defensiveness and seniority, as well as the effect of previous experiences on the level of defensiveness. DESIGN: A postal questionnaire survey on defensive practice. SETTING: Northern Region of England. SUBJECTS: 154 psychiatrists in the region. RESULTS: 96 responses were received from 48 equivalent consultants, 18 specialist registrars, and 23 equivalent senior house officers. Overall, 75% of those who replied had taken defensive actions within the past month. In particular, 21% had admitted patients overcautiously and 29% had placed patients on higher levels of observations. Junior psychiatrists were particularly prone to practise defensively. Important contributing factors included previous experience of complaints (against colleague or self), critical incidents, and legal claims. CONCLUSION: Almost three quarters of the psychiatrists who responded had practised defensively within the past month. The higher propensity of junior trainees to practise defensively may be attributable to their lack of confidence and experience. Experience of complaints (colleague or self) and critical incidents were important factors for defensive practice. Better and more structured training might reduce the high level of defensive practice and the way complaints and investigations are handled should be improved to maintain a truly "no blame" environment conducive to learning from past experience.

Is skin ageing in the elderly caused by sun exposure or smoking?

BACKGROUND: There is little clear evidence of a strong association between cumulative sun exposure and skin wrinkling. Contradictory findings also exist on the association between facial wrinkling and smoking status. OBJECTIVES: To identify the significant determinants of skin wrinkling in a cohort of older subjects and to assess whether skin wrinkling can be used as an objective measure of cumulative sun exposure. METHODS: This study was carried out in the South Glamorgan health district, Wales, U.K., between 1988 and 1991. A random sample of 792 older subjects (60 years and over) was obtained from the Health Authority register of patients registered with general practitioners. A range of phenotypic and environmental data was collected during a home visit by interview and examination by an experienced dermatology research fellow. Skin wrinkling/ageing was assessed by examining the face, neck and dorsum of the hand and scored on a 10-point ordinal scale. Cumulative sun exposure was assessed by asking subjects to estimate their average outdoor time during each of three periods of adult life. This measure showed acceptable repeatability (r = 0.64 for estimates obtained 1.4 years apart). RESULTS: The response rate was 71% and the mean age of participants was 71 years. The mean +/- SD skin ageing score was 5.5 +/- 1.5. In multiple logistic regression models only age and daily cigarette consumption were significantly associated with skin ageing. Cumulative sun exposure was significant on univariable analysis but this effect was removed by adjusting for age. Smoking 20 cigarettes per day was equivalent in effect to almost 10 years of chronological ageing. CONCLUSIONS: Smoking is an important determinant of macroscopic skin ageing/wrinkling in older subjects. This evidence suggests that skin ageing does not clearly provide an objective measure of cumulative ultraviolet exposure, and caution should be exercised before it is used in this way. The association between smoking and wrinkling provides important information for potential use in education campaigns to reduce smoking prevalence among young people.