Some troubling observations about involuntary treatment

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Social Order ◽  
Psychiatric Treatment ◽  
Significant Degree ◽  
Health Law ◽  
Involuntary Treatment ◽  
The Social ◽  
Over Time

The huge variations in the rates of the use of detention and involuntary treatment between similar countries, as well as between regions in a country, and even between mental health services within a region, are deeply troubling. Large changes in rates over time, perhaps in different directions at the same time in different places, and between ethnic groups in some societies have also been evident. These findings suggest a significant degree of arbitrariness in the use of compulsion. History offers many examples of abuses and misuses of psychiatric treatment, without consent, sometimes to control threats to the social order, at other times as a result of unwarranted faith in what turn out to be ineffective but harmful treatments. The structure of mental health law may offer a relatively undemanding passage to such abuses and misuses.

Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS)

2021 ◽  
pp. 135910452199970
Author(s):  
Naomi Gibbons ◽  
Emma Harrison ◽  
Paul Stallard
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Completion Rates ◽  
Making Sense ◽  
North East ◽  
Over Time

Background: There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. Method: We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 ( n = 1074) and April to September 2019 ( n = 1172). Results: Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Conclusion: Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

scholarly journals Improving medical residents’ utilisation of integrated mental health in primary care

2021 ◽  
Vol 10 (3) ◽  
pp. e001388
Author(s):  
Jenna Palladino ◽  
Deirdra Frum-Vassallo ◽  
Joanne D Taylor ◽  
Victoria L Webb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Medical Home ◽  
Medical Resident ◽  
Improvement Project ◽  
Mental Health Integration ◽  
Integrated Mental Health ◽  
Over Time

BackgroundIntegration of mental health services allows for improved prevention and management of chronic conditions within the primary care setting. This quality improvement project aimed to increase adherence to and functioning of an integrated care model within a patient-centred medical home. Specifically, the project focused on improving collaboration between Primary Care Mental Health Integration (PC-MHI) and the medical resident Patient Aligned Care Teams (PACT) at a Veterans Affairs Medical Center in Northport,New York (VAMC Northport).MethodThe project used increased education, training and relationship building among the medical resident PACTs, and the establishment of regularly occurring integrated team meetings for medical and mental health providers. Education of residents was measured with a self-assessment pre-training and post-training, while utilisation was measured by the percentage of patients currently on a PACT’s panel with at least one PC-MHI encounter in the last 12 months (known in VAMC Northport as PACT-15 metric).ResultsTwo resident PACTs that received both training and weekly integrated meetings increased their utilisation of integrated mental health services by 3.8% and 4.5%, respectively. PACTs that participated in training only, with no regular meetings, showed an initial improvement in utilisation that declined over time.ConclusionsTraining alone appeared beneficial but insufficient for increased integration over time. The addition of a regularly occurring integrated weekly meeting may be a critical component of facilitating sustained mental health integration in a primary care medical home model.

scholarly journals How shortcomings in the mental health system affect the use of involuntary community treatment orders

2017 ◽  
Vol 41 (3) ◽  
pp. 351 ◽  
Author(s):  
Edwina M. Light ◽  
Michael D. Robertson ◽  
Philip Boyce ◽  
Terry Carney ◽  
Alan Rosen ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Involuntary Treatment ◽  
Community Settings ◽  
Community Treatment Orders

Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

scholarly journals Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey

2021 ◽  
Vol 2 (3) ◽  
pp. 174-184
Author(s):  
Derek Chen ◽  
Ryan J. Watson ◽  
Theodore L. Caputi ◽  
Chelsea L. Shover
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Panel Study ◽  
Community Mental Health Centers ◽  
Mental Health Clinics ◽  
Health Clinics ◽  
National Mental Health ◽  
Mental Health Centers ◽  
Over Time

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.

Kenworthy, Marion Edwena

2013 ◽  
Author(s):  
Rebecca L. Sperling
Keyword(s):  
Mental Health ◽  
Social Work ◽  
Mental Health Services ◽  
Health Services ◽  
Child Psychiatry ◽  
Armed Forces ◽  
The Social

Marion Edwena Kenworthy (1891–1980) was a psychiatrist who introduced psychoanalytic concepts into the social work curriculum. She was influential in the professionalization of social work and specialized in child psychiatry and mental health services for the armed forces.

scholarly journals Kenya's mental health law

2017 ◽  
Vol 14 (4) ◽  
pp. 96-97 ◽  
Author(s):  
David M. Ndetei ◽  
Job Muthike ◽  
Erick S. Nandoya
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Health Law ◽  
Mental Health Law ◽  
Legal Provisions ◽  
People With Mental Illness ◽  
International Rights ◽  
State Protection

Kenya's Mental Health Act 1989 is now outdated. It is a signatory to international rights conventions that provide for state protection of the rights of people with mental illness, their property and their treatment. There is, however, a glaring failure to implement the existing legal provisions. A new Mental Health Bill that aims to respond comprehensively to the challenges affecting mental health services in Kenya is awaiting enactment.

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