The conventional grounds for involuntary treatment are highly problematic

Assessment Measures ◽

Substantial problems attach to both of the fundamental criteria that need to be met for involuntary treatment in conventional mental health legislation—the presence of a ‘mental disorder’ and a risk of harm to self or others. The boundaries of ‘mental disorder’ are of necessity loosely drawn, with substantial blurring at the edges and contested views about where these should lie. ‘Values’—for example, when does ‘sadness’ become a ‘depressive illness’—play a significant role in determining when a diagnosis of a ‘disorder’ is warranted. Precision in the assessment of ‘risk’ is poor, especially for those infrequent or rare harms that we are most concerned to prevent. In general psychiatric practice, the prediction of suicide or serious acts of violence to others is of severely limited value. Even with ‘state-of-the-art’ risk assessment measures, ‘false positives’ overwhelm ‘true positives’. Significant costs attach to an emphasis on risk assessment.

Learning disability and the Scottish Mental Health Act

Advances in Mental Health and Intellectual Disabilities ◽

10.1108/amhid-11-2016-0038 ◽

2017 ◽

Vol 11 (2) ◽

pp. 74-82

Author(s):

Heather Welsh ◽

Gary Morrison

Keyword(s):

Mental Health ◽

Mental Illness ◽

Learning Disabilities ◽

Mental Disorder ◽

Learning Disability ◽

Psychotic Disorders ◽

Content Type ◽

Scottish Government ◽

Purpose The purpose of this paper is to investigate the use of the Mental Health (Care and Treatment) (Scotland) Act 2003 for people with learning disabilities in Scotland, in the context of the recent commitment by the Scottish Government to review the place of learning disability (LD) within the Act. Design/methodology/approach All current compulsory treatment orders (CTO) including LD as a type of mental disorder were identified and reviewed. Data was collected on duration and type of detention (hospital or community based) for all orders. For those with additional mental illness and/or personality disorder, diagnoses were recorded. For those with LD only, symptoms, severity of LD and treatment were recorded. Findings In total, 11 per cent of CTOs included LD as a type of mental disorder. The majority of these also included mental illness. The duration of detention for people with LD only was almost double that for those without LD. A variety of mental illness diagnoses were represented, psychotic disorders being the most common (54 per cent). Treatment was broad and multidisciplinary. In all, 87 per cent of people with LD only were prescribed psychotropic medication authorised by CTO. Originality/value There has been limited research on the use of mental health legislation for people with learning disabilities. This project aids understanding of current practice and will be of interest to readers both in Scotland and further afield. It will inform the review of LD as a type of mental disorder under Scottish mental health law, including consideration of the need for specific legislation.

Compulsory admission and involuntary treatment in Portugal

BJPsych International ◽

10.1192/s2056474000000933 ◽

2016 ◽

Vol 13 (1) ◽

pp. 17-19 ◽

Cited By ~ 1

Author(s):

Telma Almeida ◽

Andrew Molodynski

Keyword(s):

Mental Health ◽

Emergency Department ◽

Patient Treatment ◽

Compulsory Treatment ◽

Compulsory Admission ◽

Involuntary Treatment ◽

This paper details the grounds for compulsory treatment, compulsory admissions in an emergency department and compulsory out-patient treatment in Portugal. Portuguese mental health legislation has improved significantly over recent years, with enhanced safeguards, rapid and rigorous review and clear criteria for compulsory treatment, although much remains to be done, especially in relation to the ‘move into the community’.

Defining mental disorder: Tautology in the service of sanity in British mental health legislation

Journal of Mental Health ◽

10.1080/09638230500270750 ◽

2005 ◽

Vol 14 (5) ◽

pp. 435-443 ◽

Cited By ~ 6

Author(s):

David Pilgrim

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Mental health legislation in Chile

International Psychiatry ◽

10.1192/s1749367600004689 ◽

2014 ◽

Vol 11 (4) ◽

pp. 90-92

Author(s):

Andrea Bahamondes ◽

Alvaro Barrera ◽

Jorge Calderón ◽

Martin Cordero ◽

Héctor Duque

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Criminal Code ◽

Standards Of Care ◽

Health Law ◽

Mental Health Law ◽

Health Legislation ◽

The 19Th Century

Chile does not have a mental health law or act, and no single legal body protecting those deemed to be afflicted by a mental disorder, setting standards of care and protecting and promoting their rights. Instead, pieces of mental health legislation are scattered about in different legal and administrative documents, including the country's Constitution, Health Code, Criminal Code and Civil Code. Remarkably, mental health legislation was the object of virtually no change or amendment from the middle of the 19th century until the year 2001. New pieces of legislation have been issued since but, despite improvements in the protection of people suffering from a mental illness, a mental health law in Chile is still needed.

New World of Mental Health Legislation England and Wales David Jolley and Reinhard Heun

European Psychiatry ◽

10.1016/s0924-9338(09)70393-1 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

D. Jolley ◽

R. Heun

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Mental Illnesses ◽

Community Treatment ◽

List Type ◽

Type Number ◽

England And Wales ◽

Use Of Resources ◽

After eight years of tortured negotiations between government, professional psychiatrists and lay pressure groups, England and Wales will begin to use new Mental Health Legislation November 2008. This will not be a new Mental Health Act, but a substantial modification of the 1983 act. There are nine key changes:1.A single definition of mental disorder: ‘any disorder of mind or brain’.2.Criteria for compulsion: ‘appropriate medical treatment’ test.3.Age-appropriate services: special arrangements for under 18 years.4.Professional roles: approved clinicians and responsible clinicians (non-medical).5.Nearest relative: recognises Civil Partnerships, allows displacement.6.Supervised Community Treatment Orders.7.Mental health Review Tribunal: unified.8.Advocacy: Independent Mental Health Advocates.9.ECT: new safeguards.The Code of Practice identifies five key principles:1.Purpose - to minimise adverse effects of Mental Disorder.2.Least Restriction.3.Respect - diverse needs, values and circumstances.4.Participation - involving patient in planning, developing and reviewing treatment and care.5.Effectiveness, efficiency and equity - optimal use of resources.Earlier drafts had been described as: ‘little more than a Public Oder Bill dressed up as Mental Health legislation’; ‘ethically unworkable and practically unworkable’. Much of the dissent related to suggestions that people with Personality Disorder behaving in a dangerous or antisocial way should be subject to compulsory detention. Fears included breach of liberties and Human Rights and transformation of Mental Health Services disadvantaging people with major mental illnesses.

A new Mental Health Act for Malta

International Psychiatry ◽

10.1192/s1749367600004537 ◽

2014 ◽

Vol 11 (3) ◽

pp. 67-69

Author(s):

Anthony Zahra ◽

Miriam Camilleri ◽

John Cachia

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Mental Health Act ◽

Until recently, the care of persons with mental disorder in Malta was regulated by mental health legislation enacted in 1976. This was closely modelled on the 1959 British Mental Health Act. Now, the Mental Health Act 2012 is being implemented in two steps, in 2013 and 2014. The paper reviews its provisions.

Race equality, human rights and mental health legislation: Recent developments in England and Wales

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v13i3.17 ◽

2007 ◽

Vol 13 (3) ◽

pp. 3

Author(s):

Lord Patel Of Bradford ◽

Chris Heginbotham

Keyword(s):

Mental Health ◽

Human Rights ◽

Mental Disorder ◽

Community Treatment ◽

Recent Developments ◽

Definition Of ◽

Health Legislation ◽

Treatment Order ◽

Community Treatment Order

England now has revised mental health legislation following the passage of a mental health Bill through both Houses of Parliament following protracted discussions over seven years. The Mental Health Bill 2006, amending the Mental Health Act 1983, eventually received Royal Assent on 19 July 2007. There is much that could be said about the new Act, which makes a number of important changes to the present legislation. These changes include a new single definition of mental disorder; the abolition of the so-called ‘treatability test’; and the extension of compulsion into the community through a supervised community treatment order.

A comparison of mental health legislation in five developed countries: a narrative review

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2017.48 ◽

2017 ◽

Vol 34 (4) ◽

pp. 261-269 ◽

Cited By ~ 4

Author(s):

T. Cronin ◽

P. Gouda ◽

C. McDonald ◽

B. Hallahan

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Disorder ◽

Developed Countries ◽

International Standards ◽

Patient Consent ◽

The Republic ◽

Definition Of ◽

ObjectivesTo describe similarities and differences in mental health legislation between five jurisdictions: the Republic of Ireland, England and Wales, Scotland, Ontario (Canada), and Victoria (Australia).MethodsAn in-depth examination was undertaken focussing on the process of involuntary admission, review of Admission Orders and the legal processes in relation to treatment in the absence of patient consent in each of the five jurisdictions of interest.ResultsAll jurisdictions permit the detention of a patient if they have a mental disorder although the definition of mental disorder varies between jurisdictions. Several additional differences exist between the five jurisdictions, including the duration of admission prior to independent review of involuntary detention and the role of supported decision making.ConclusionsAcross the five jurisdictions examined, largely similar procedures for admission, detention and treatment of involuntary patients are employed, reflecting adherence with international standards and incorporation of human rights-based principles. Differences exist in relation to the criteria to define mental disorder, the occurrence of automatic review hearings in a timely fashion after a patient is involuntarily admitted and the role for supported decision making under mental health legislation.

Dignity, human rights and the limits of mental health legislation

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2014.22 ◽

2014 ◽

Vol 31 (2) ◽

pp. 75-81 ◽

Cited By ~ 7

Author(s):

Brendan D. Kelly

Keyword(s):

Mental Health ◽

Human Rights ◽

Mental Disorder ◽

Mental Health Policy ◽

Best Interests ◽

Involuntary Admission ◽

Economic Rights ◽

Health Legislation ◽

Social And Economic Rights

A right is an entitlement that one may legally or morally claim. Human rights are of particular importance in mental health care owing to the existence of laws that permit involuntary admission and treatment under certain circumstances, and compelling evidence of persistent social exclusion of some individuals with mental disorder. Ireland’s mental health legislation, which is currently under review, meets most international human rights standards in areas of traditional concern (involuntary admission and treatment) but not in other areas (especially social and economic rights). These deficits would be addressed, at least in part, by replacing the principle of ‘best interests’ with the principle of ‘dignity’ as the over-arching principle in Irish mental health legislation. Such a change would help ensure that decisions made under the legislation actively facilitate individuals with mental disorder to exercise their capabilities, help promote human rights and protect dignity. Even following such a reform, however, it is neither practical nor realistic to expect mental health legislation alone to protect and promote all of the broader rights of individuals with mental disorder, especially social and economic rights. Some rights are better protected, and some needs better met, through social policy, mental health policy and broader societal awareness and reform.

Response to the Commentaries

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i20.266 ◽

2014 ◽

pp. 89

Author(s):

George Szmukler ◽

Rowena Daw ◽

John Dawson

Keyword(s):

Mental Health ◽

Northern Ireland ◽

Mental Disorder ◽

Model Fusion ◽

England And Wales ◽

We are immensely grateful to the commentators for their careful reading of the Model ‘Fusion’ Law (ML). The level of support for our proposal from most of the commentators is encouraging as is the news that Northern Ireland intends to introduce legislation along similar lines. The aim of the ML is to eliminate the unwarranted discrimination against people with mental disorder that is inherent in current mental health legislation in England and Wales and in many other jurisdictions. We remain convinced that the principles underlying the enterprise are right and that they can be translated into a practical form. At the same time, excellent points have been raised by the commentators that have stimulated us to think further and to propose a number of revisions.The editors have invited us to respond briefly to the commentaries. We should have liked to engage with each of the commentators on a number of specific issues, but in our response we must focus on the major themes that have emerged.