Psychiatry and the law

The Law ◽

Legal Frameworks ◽

Health Legislation ◽

In most of medicine, legal situations are rarely encountered, typically related to complaints or complex ethical issues. Unusually, psychiatry is closely connected with the law, with most psychiatrists dealing with legal issues on a daily basis. There are three main areas of law which are relevant to psychiatry: … 1 Civil law relating to the involuntary admission and treatment of patients with mental disorders (in the UK, this is outlined in the Mental Health Act (MHA) 2007). 2 Civil law concerning issues of consent, capacity, and deprivation of liberty (Mental Capacity Act 2005 including Deprivation of Liberty Safeguarding (DoLS)). 3 Criminal law as it relates to individuals with mental disorders. … There are various reasons why knowledge of mental health legislation is helpful to all clinicians: … ● Laws and official guidelines provide backing to some aspects of ethical decision- making within medicine. ● The law regulates the circumstances under which treatment can be given without patients’ consent. All doctors may encounter situations in which patients refuse essential treatment, and may have to decide whether to invoke powers of compulsory admission and/ or best interest treatments. ● Doctors may be asked for reports used in legal decisions, such as the capacity to make a will or claims for compensation for injury. They may be asked for reports that set out the relationship between any psychiatric disorder and criminal behaviour. ● A minority of patients behave in ways that break the law. Doctors need to understand legal issues as part of their management of care. ● Victims of crime may suffer immediate and long-term psychological or physical consequences. … This chapter will describe the main principles of mental health legislation with particular reference to UK law. While some of the detail discussed (e.g. particular definitions or legislative act numbers) may not be relevant to international readers, legal frameworks across the globe are broadly similar. Information of mental health legislation in most countries is now easily available online. The latter part of the chapter will provide an overview of the relationship between mental disorders and crime.

The application of mental health legislation in younger children

BJPsych Bulletin ◽

10.1192/pb.bp.114.048959 ◽

2015 ◽

Vol 39 (6) ◽

pp. 302-304 ◽

Cited By ~ 1

Author(s):

Victoria Thomas ◽

Barry Chipchase ◽

Lisa Rippon ◽

Paul McArdle

Keyword(s):

Mental Health ◽

Young Child ◽

Legal Issues ◽

Legal Authority ◽

Challenging Behaviour ◽

Health Unit ◽

History Of ◽

Health Legislation ◽

Mental Health Unit

SummaryWe review a case history of a young child who was admitted to an in-patient mental health unit due to extremely challenging behaviour and review the legal issues that had to be considered in ensuring that there was appropriate legal authority for the child's admission and treatment. In this particular case, the patient was detained for assessment under section 2 of the Mental Health Act 1983. This case demonstrates that all clinicians working in this area require a good understanding of the law in relation to treatment of children with mental disorder, which is extremely complex.

Mental health legislation in Botswana

BJPsych International ◽

10.1192/bji.2018.24 ◽

2018 ◽

Vol 16 (03) ◽

pp. 68-70

Author(s):

J. Maphisa Maphisa

Keyword(s):

Mental Health ◽

Human Rights ◽

Mental Disorders ◽

United Nations ◽

Persons With Disabilities ◽

United Nations Convention ◽

The United Nations ◽

The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.

Mental health law reforms in Uganda: lessons learnt

International Psychiatry ◽

10.1192/s1749367600004367 ◽

2014 ◽

Vol 11 (2) ◽

pp. 39-40 ◽

Cited By ~ 2

Author(s):

Joshua Ssebunnya ◽

Sheila Ndyanabangi ◽

Fred Kigozi

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Clinical Care ◽

Health Law ◽

Mental Health Law ◽

Work In Progress ◽

Lessons Learnt ◽

Ugandan mental health legislation, which dates from 1964, principally aims to remove persons with mental disorders from the community but also to protect their safety, by keeping them in confinement, although this has been without consideration for clinical care. In response to criticism from various stakeholders and advocates and the need to reflect modern clinical care, Uganda undertook to review and amend the mental health legislation, as part of the Mental Health and Poverty Project (MHaPP). We report on work in progress advancing new legislation.

Black robes and white coats: who will win the new mental health tribunals?

The British Journal of Psychiatry ◽

10.1192/bjp.186.2.96 ◽

2005 ◽

Vol 186 (2) ◽

pp. 96-98 ◽

Cited By ~ 8

Author(s):

Sameer P. Sarkar ◽

Gwen Adshead

Keyword(s):

Mental Health ◽

Civil Law ◽

Twilight Zone ◽

Health Law ◽

Medical Evidence ◽

Criminal Courts ◽

American Experience ◽

New Type ◽

Under current proposals for new mental health legislation, psychiatrists increasingly will be involved in tribunal processes examining the grounds for compulsory detention and treatment, both in hospitals and in the community. They will lose some authority over admission and discharge, with decision-making instead being given over to legal bodies that will regulate admission and discharge. The proposals for wholesale change in UK mental health law are an opportunity to devise a new type of legal hearing where all ‘sides' are properly represented. However, the new mental health tribunals proposed in the draft UK bill sit in a twilight zone of ‘quasi-criminal’ courts. The use of single joint experts or ‘expert panels', consistent with the recent civil law reforms, means that problems of undisputed medical evidence may become even more acute. American experience shows that judicial deference to clinical opinion, even in overtly adversarial commitment hearings, is considerable (Bursztajn et al, 1997). In this editorial, we argue that these proposals justify a re-examination of the values of law and psychiatry.

Mental health legislation in Algeria

BJPsych International ◽

10.1192/s2056474000001604 ◽

2017 ◽

Vol 14 (1) ◽

pp. 12-15 ◽

Cited By ~ 2

Author(s):

Zoubir Benmebarek

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Healthcare Providers ◽

Health Law ◽

Colonial Era ◽

Mental Health Law ◽

Delivery Of Care ◽

French Colonial ◽

Mental health law in Algeria originates from the French colonial era. Although several pieces of legislation deal with mental disorders, their implementation remains unsatisfactory and does not meet the real needs of healthcare providers. Amendment of the current mental health law is required to enhance the delivery of care but also to protect those with a mental disorder from abuse.

Ethnicity and outcome of appeal after detention under the Mental Health Act 1983

Psychiatric Bulletin ◽

10.1192/pb.bp.108.021360 ◽

2009 ◽

Vol 33 (8) ◽

pp. 288-290 ◽

Cited By ~ 1

Author(s):

Ramin Nilforooshan ◽

Rizkar Amin ◽

James Warner

Keyword(s):

Mental Health ◽

Ethnic Groups ◽

Ethnic Differences ◽

Success Rates ◽

Mental Health Act ◽

Black Caribbean ◽

Chi Squared ◽

Health Legislation ◽

Aims and MethodThere is insufficient research into the relationship between ethnicity and appeals against detention under mental health legislation. We sought to identify rates and success of appeals in different ethnic groups through a retrospective analysis of all detentions under the Mental Health Act 1983 over 1 year.ResultsWe found high rates of appeals overall, with substantial differences between ethnic groups (36 (39%) White British compared with 71 (63%) Black Caribbean (P = 0.0001) and 21 (68%) White Irish (P = 0.01) individuals (Yates corrected chi-squared)). Success rates on appeal were very low in all groups.Clinical ImplicationsThere are significant ethnic differences in appeals against detention under the Mental Health Act.

A new legislative framework for mental capacity and mental health legislation in Northern Ireland: an analysis of the current proposals

International Journal of Mental Health and Capacity Law ◽

10.19164/ijmhcl.v0i20.262 ◽

2014 ◽

pp. 84

Author(s):

Maura McCallion ◽

Ursula O'Hare

Keyword(s):

Mental Health ◽

Northern Ireland ◽

Mental Capacity ◽

Law Reform ◽

Health Law ◽

Legislative Framework ◽

The Law ◽

The Uk ◽

When the Bamford Review of Mental Health and Learning Disability completed its work in the autumn of 2007, it drew to a close an extensive consultation and analysis of mental health and learning disability services and the law in Northern Ireland. Its last report on A Comprehensive Legislative Framework made a compelling case for a major overhaul of the law that the Review team itself described as ‘quite radical’. The Review identified the case for reform in the need to ensure that mental health law conforms to the requirements of human rights law, reflects changes to professional practice, reflects the needs of service users and their carers, and keeps pace with reform elsewhere in the UK. Alone of all the jurisdictions in the UK, Northern Ireland has been operating largely in a legislative vacuum in relation to mental capacity law. The Review’s proposals for reform therefore extended to reform of mental health law and the introduction of mental capacity law.In the autumn of 2008 the NI Executive published its response to the Bamford Review indicating that it intended to develop the law sequentially: reform of the Mental Health (NI) Order 1986 by 2011 followed by the introduction of mental capacity law in 2014. Responses to the Executive’s consultation resulted in the Department of Health Social Services and Public Safety (DHSSPS) revising its approach and it signalled its intention to bring forward mental capacity and mental health legislation together. This reated a unique opportunity in Northern Ireland for fusion of incapacity and mental health legislation. A further consultation paper was issued in January 2009, setting out the key approaches to the content of two bills. However as a result of the consultation, the Health Minister Michael McGimpsey announced in September 2009 that there would be a single bill with an overall principle of autonomy. His press statement noted: “ A strong body of opinion, particularly from professional groups and lead voluntary organisations, which considered that separate mental health legislation continues to be stigmatising and recommended that mental capacity and mental health provisions should instead be encompassed into a single piece of legislation”This short paper provides an overview of the current direction of travel on law reform in Northern Ireland. It comments on the policy climate and arguments for a fusion of mental capacity and mental health legislation. It also highlights some of the key policy issues that will need to be further explored as the Department develops its law reform proposals and concludes with some hopes and fears for the new legislation.

Suicide in secure psychiatric facilities

Advances in Psychiatric Treatment ◽

10.1192/apt.8.6.408 ◽

2002 ◽

Vol 8 (6) ◽

pp. 408-417 ◽

Cited By ~ 8

Author(s):

Harvey Gordon

Keyword(s):

Mental Health ◽

Potential Hazard ◽

Time Of Death ◽

Self Harm ◽

Harm To Others ◽

The Subject ◽

Health Legislation ◽

Suicide may be defined as intentional self-killing, although the definition has been the subject of critical review (Fairbairn, 1995). As the determination of whether intent was present at the time of death by suicide can be difficult, coroner's inquests tend to underestimate the number of suicides. At the time of suicide, the vast majority of people are suffering from some form of mental disorder, although there may, exceptionally, be a few rational suicides. Suicide is a relatively uncommon event, but the possibility of suicide by those with mental disorders is always a potential hazard faced by health and allied professionals responsible for their care. Detention of a patient in hospital under mental health legislation is often precipitated by concern regarding risk of self-harm and/or risk of harm to others and potential for absconding and, at times, admission to a locked or secure facility is necessary. Detained patients in secure facilities include both offender patients, admitted through the courts or transferred during sentence from prison, and patients on civil orders under sections 2 or 3 of the Mental Health Act 1983. The relationship between suicidal behaviour and that which is violent or homicidal is complex but relevant to an understanding of the phenomenon of suicide in secure conditions.

An overview of mental health legislation in Singapore

BJPsych International ◽

10.1192/s2056474000000283 ◽

2015 ◽

Vol 12 (2) ◽

pp. 42-44 ◽

Cited By ~ 1

Author(s):

Roger C. Ho ◽

Cyrus S. Ho ◽

Nusrat Khan ◽

Ee Heok Kua

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

Mental Health Care ◽

Mental Capacity ◽

Mental Capacity Act ◽

Health Legislation ◽

This article summarises the development of mental health legislation in Singapore in three distinctive periods: pre-1965; 1965–2007 and 2007 onwards. It highlights the origin of mental health legislation and the relationship between mental health services and legislation in Singapore. The Mental Health (Care and Treatment) Act 2008 and Mental Capacity Act 2008 are described in detail.

Mental health legislation in Nigeria: current leanings and future yearnings

International Psychiatry ◽

10.1017/s1749367600003234 ◽

2012 ◽

Vol 9 (3) ◽

pp. 62-64

Author(s):

Adegboyega O. Ogunlesi ◽

Adegboyega Ogunwale

Keyword(s):

Mental Health ◽

World Health ◽

Recent Attempt ◽

Ministry Of Health ◽

The World ◽

The Status ◽

The Law ◽

Nigeria's current mental health legislation stems from a lunacy ordinance enacted in 1916 that assumed the status of a law in 1958. The most recent attempt to reform the law was with an unsuccessful Mental Health Bill in 2003. Currently, though, efforts are being made to represent it as an executive Bill sponsored by the Federal Ministry of Health. The present paper reviews this Bill, in particular in light of the World Health Organization's recommendations on mental health legislation.