Preserving Control: Understanding People's Experiences Before, During and After Detention Under the Irish Mental Health Act 2001

IntroductionThe Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.ObjectiveTo develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.MethodsFifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.ResultsThe theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.ConclusionsWhilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Reforming the Mental Health Act 1983: ‘Joined Up Compulsion’

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v1i5.350 ◽

2014 ◽

Vol 1 (5) ◽

pp. 5

Author(s):

Philip Fennell

Keyword(s):

Mental Health ◽

Learning Disabled ◽

Legal Framework ◽

White Paper ◽

Best Interests ◽

Mentally Disordered ◽

Mental Health Act ◽

Risk Patients ◽

The Government ◽

Personality Disordered

This article discusses the two volume White Paper Reforming the Mental Health Act issued by the Government in December 2000. The two volumes are separately titled The New Legal Framework and High Risk Patients. The foreword to the White Paper appears above the signatures of the Secretary of State for Health, Alan Milburn, and the Home Secretary, Jack Straw. This is heralded as an example of ‘joined up government’, and indeed one of the themes of the White Paper is the need for closer working between the psychiatric and criminal justice systems. The primary policy goal of the proposals is the management of the risk posed to other people by people with mental disorder, perhaps best exemplified in Volume One of the White Paper which proclaims that ‘Concerns of risk will always take precedence, but care and treatment should otherwise reflect the best interests of the patient.’ This is a clear reflection of the fact that the reforms are taking place against the background of a climate of concern about homicides by mentally disordered patients, whether mentally ill, learning disabled, or personality disordered.

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‘Offenders, Deviants or Patients’ - Comments on Part Two of the White Paper

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v1i5.355 ◽

2014 ◽

Vol 1 (5) ◽

pp. 21

Author(s):

Herschel Prins

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Good Deal ◽

Legal Framework ◽

White Paper ◽

Green Paper ◽

Expert Committee ◽

The Past ◽

Mental Health Act ◽

The Government

The Government White Paper Reforming the Mental Health Act follows closely on the heels of the Green Paper - Reform of the Mental Health Act, 1983 which derives from (but also departs from in many respects) the Report of the Expert Committee chaired by Professor Genevra Richardson. One could say, with some justification, that mental health professionals have been ‘deluged’ with paper in this area in the past year or two, so that trying to discern trends has become very difficult. In particular, the material in the White Paper is somewhat closely written and needs to be read with a good deal of care (or, so it seemed to me). To complicate matters further, offender-patients are also discussed in Part I of the White Paper (The Legal Framework) whereas it would have been more logical to have dealt with the proposed provisions for them in Part II. For clarity, I propose to deal with all these matters under one heading.

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The mental capacity tribunal under the model law: what are we arguing about?

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i20.243 ◽

2014 ◽

pp. 55

Author(s):

Robert Robinson

Keyword(s):

Mental Health ◽

Psychiatric Treatment ◽

Dental Health ◽

Legal Framework ◽

Mental Illnesses ◽

Health Law ◽

Mental Health Law ◽

Mental Health Act ◽

Model Law ◽

Serious Mental Illnesses

It would be a mistake to think of mental health law as a generic form of law directed at a particular class of people, those described as suffering from mental disorders. If a person who has a mental disorder will accept treatment, whether or not they have the capacity to consent to it, there is in general no need to have recourse to mental health law. The Mental Health Act 1983 (‘MHA’) exists for the specific purpose of regulating, and ultimately adjudicating upon, the conflict between a person who objects to receiving psychiatric treatment and the professionals on whom the law confers powers of compulsion. But, as advocates of a capacity-based legal framework would surely agree, it is not the existence of mental health law that gives rise to this conflict. That we have a Mental Health Act but not, say, a Dental Health Act is explained by features characteristic of serious mental illnesses which are not, by and large, found in other medical conditions.

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Foreword

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i3.297 ◽

2014 ◽

pp. 4

Author(s):

Charlotte Emmett

Keyword(s):

Mental Health ◽

Health Care ◽

Legal Framework ◽

Green Paper ◽

Health Law ◽

Special Issue ◽

Mental Health Act ◽

Department Of Health ◽

Review Team ◽

Key Issues

This special issue of the Journal of Mental Health Law has been prompted by the recent publication of the Government’s Green Paper Review of the Mental Health Act 1983: Proposals for Reform. The Green Paper aims to "modernise the legal framework within which mental health care is delivered" by proposing a number of reforms to the current regime established under the Mental Health Act 1983.We have aimed in this edition to highlight some of the key issues arising from both the Green Paper and the Report submitted to the Department of Health by the Scoping Study Review Team, in July 1999.

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Referrals and outcomes of assessment for compulsory admission under the mental health act 1983 in Norfolk, England

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.333 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S353-S353

Author(s):

J.N. Beezhold ◽

D. Fothergill ◽

L. Jervis ◽

G. Mosa ◽

A. Pandey ◽

...

Keyword(s):

Mental Health ◽

Observational Study ◽

Social Services ◽

Living Alone ◽

Compulsory Admission ◽

Total Patient ◽

Admission Rates ◽

Mental Health Act ◽

Competing Interest ◽

Published Research

IntroductionA significant number of people are not detained in hospital following assessment under the Mental Health Act 1983 (MHA) for possible detention. However, since amendments in 2007, some studies show an increase in total patient detentions. There is currently a lack of published research describing both outcomes and their affecting variables.ObjectivesTo determine rates, outcomes and affecting variables of MHA assessments in Norfolk, 2001–2011.MethodsThis observational study involved data collection from all 11,509 referrals for detention assessment under the MHA. Data was collected by Norfolk Social Services from 2001–2011 including age, gender and marital status.ResultsFollowing assessment, 6903 (60.0%) were admitted; of those, 1157 (16.8%) were voluntary and 5746 (83.2%) were detained; 4606 (40%) were not admitted. Admission rates for males (50.4%) and females (49.5%) were similar. Detention rates increased with age: 37.6% of < 18s; 47.1% of 18–64s and 61.4% of 65+. A greater proportion of married (57.5%) and widowed patients (58.2%) were detained, compared with patients who were single (48%). Accommodation status showed 52% of those living with other were detained versus 43.9% of those with no fixed abode.ConclusionsThe finding that a higher proportion of married than single people, and of those living with others versus living alone, were detained following assessment is unexpected but significant and needs further investigation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.059782 ◽

2009 ◽

Vol 195 (3) ◽

pp. 257-263 ◽

Cited By ~ 25

Author(s):

Gareth S. Owen ◽

George Szmukler ◽

Genevra Richardson ◽

Anthony S. David ◽

Peter Hayward ◽

...

Keyword(s):

Mental Health ◽

Assessment Tool ◽

Structured Interview ◽

Cross Sectional Study ◽

Mental Capacity ◽

Best Interests ◽

Cross Sectional ◽

England And Wales ◽

Mental Health Act ◽

Mental Capacity Act

BackgroundIn England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians.AimsTo describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity.MethodCross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT–T).ResultsOf the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise.ConclusionsOur data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.

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The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Health Policy and Planning ◽

10.1093/heapol/czaa139 ◽

2020 ◽

Author(s):

Annemieke P Bikker ◽

Cokorda Bagus Jaya Lesmana ◽

Niko Tiliopoulos

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Local Level ◽

Healthcare Providers ◽

Mental Healthcare ◽

Implementation Process ◽

Structured Interview ◽

Evidence Base ◽

Political Issue ◽

Mental Health Act

Abstract In 2014, the Indonesian government passed the Mental Health Act (MHA) to address the country’s complex mental health situation. The implementation of the MHA has been slow, and little is known about how the MHA is perceived by mental healthcare providers within local settings. This study aimed to obtain insight into psychiatrists’ views on the MHA, including on how it affected their clinical practice and on challenges of translating the MHA into practice. The study was conducted in Bali, and 27 psychiatrists (15 men and 12 women) participated in a semi-structured interview. Thematic analysis indicated four overarching themes: raising the profile of mental health, developing a shared understanding of mental illness, integrating psychiatric practice with other services and views on implementation of the MHA into practice. Overall, the psychiatrists viewed the MHA as a step in the right direction to improve mental health services and to create awareness at local and national levels. However, there was consensus that the meaning of the MHA’s concepts of mental problems and disorders were not compatible with psychiatric everyday practice or their patients’ understandings. As a result, many assumed that the MHA was targeted at government and policy officials. Furthermore, there was a perceived lack of clarity on issues relating to collaborating with other services and unequal access to resources among regencies that impacted on their clinical practice in a negative way. Moreover, a few psychiatrists raised concerns that local beliefs and practices were not acknowledged in the MHA. According to the participants, mental health remained a highly political issue and without national support, mental health would remain a low priority. In conclusion, insights into providers’ perspectives contribute to developing an evidence-base that can inform the implementation process of the MHA in Indonesia, and possibly elsewhere, into local level guidelines and regulations.

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Audit of section 2 and section 3 mental health act paperwork in Derby inpatient psychiatric units using an audit tool by Mason et al. (2012)

BJPsych Open ◽

10.1192/bjo.2021.294 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S98-S98

Author(s):

Abigail Pearson ◽

Andrew Horton ◽

Mike Akroyd

Keyword(s):

Mental Health ◽

Mental Health Problem ◽

Health Problem ◽

Assessment Tool ◽

Health And Safety ◽

Clinical Situation ◽

Audit Tool ◽

Mental Health Act ◽

Psychiatric Units ◽

Medical Recommendations

AimsComplete an audit of Section 2 and Section 3 Mental Health Act Paperwork in Derby Inpatient psychiatric units using an audit tool developed in a study by Mason et al. (2012).BackgroundThe 1983 Mental Health Act enables doctors approved on behalf of the Secretary of State under Section 12 to be able to make recommendations for the detention of individuals with a mental health problem where the degree and/or nature, and associated risk to that person's health or safety, or that of others, makes inpatient care necessary. For the detention and the associated deprivation of their liberty to be lawful, it is necessary that the clinical situation meets certain criteria as outlined in the Mental Health Act.MethodWard status was reviewed for each inpatient ward in Derby and the first five patients alphabetically, who were detained under sections 2 or 3 were selected. The Mental Health Act medical recommendation documents were reviewed according to the necessary criteria, using an assessment tool generated from a study by Mason et al. in 2012 ‘Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations’. A junior colleague was trained to analyse Mental Health Act paperwork using the audit tool. Medical recommendations were reviewed and rated as ‘clear’, ‘implied’ or ‘none’ for each criterion.ResultEvidence of a mental health problem and the nature or degree of illness was well documented. Evidence regarding why informal admission was not appropriate was also reasonable but with room for improvement. Poor compliance was evident mostly in relation to the justification related to risk to health, safety or others, the lowest clearly documented percentage of these appear to be regarding health.ConclusionFrom analysing the documentation, often written justification incorporated general safety as a whole; however health and safety are identified by the mental health act as separate criterion requiring clear justification of each. In a number of occasions people failed to identify which of the three risk categories were relevant for the patient. Potential criticisms of this audit include the subjective nature of the interpretation of clearly explained and implied and that data analysis was completed by a non-section 12 approved doctor. Data were presented at the local weekly academic teaching to raise awareness of the results and a recommendation was made for the subject to be included in the junior doctor induction.

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Mental Health Guardianship—a Change for the Better?

Bulletin of the Royal College of Psychiatrists ◽

10.1192/s0140078900006982 ◽

1982 ◽

Vol 6 (10) ◽

pp. 176-177

Author(s):

Gareth W. Hughes

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Legal Framework ◽

Psychiatric Practice ◽

Mentally Disordered ◽

The Past ◽

Mental Health Act ◽

Compulsory Care ◽

The Uk ◽

As If

The 1959 Mental Health Act has provided the legal framework for psychiatric practice in the UK for the past two decades. The Mental Health (Amendment) Bill (DHSS, 1981) currently before Parliament proposes to update the Act by improving the safeguards for detained patients, clarifying the position of staff looking after them, and by the removal of uncertainties in the law. The Bill incorporates changes relating to the compulsory care of Mentally Disordered patients in the community whereby a person may be accepted into Guardianship on the grounds that he or she is suffering from a Mental Disorder. Once accepted into Guardianship, the person or body named as Guardian has the power to exercise control over the person as if he or they were the father of the patient, and the patient was under 14 years of age.

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Process of Care in General Hospital Psychiatric Units: National Survey In Italy

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670701341921 ◽

2007 ◽

Vol 41 (6) ◽

pp. 509-518 ◽

Cited By ~ 18

Author(s):

Antonella Gigantesco ◽

Rossella Miglio ◽

Giovanni Santone ◽

Giovanni de Girolamo ◽

Renata Bracco ◽

...

Keyword(s):

Mental Health ◽

Community Mental Health ◽

General Hospital ◽

Psychiatric Inpatient ◽

Physical Restraint ◽

Structured Interview ◽

Community Mental Health Service ◽

Process Of Care ◽

Italian Regions ◽

Psychiatric Units

Objective: To investigate the process of care in Italian public acute inpatient facilities. Method: Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Results: Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5±7.1 days, 37.0±55.3 days and 12.0±3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during mealtimes (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurst provision. Conclusions: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital–community mental health service interface.

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