Learning disability and the Scottish Mental Health Act

2017 ◽  
Vol 11 (2) ◽  
pp. 74-82
Author(s):  
Heather Welsh ◽  
Gary Morrison

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.


2014 ◽  
Vol 11 (4) ◽  
pp. 90-92
Author(s):  
Andrea Bahamondes ◽  
Alvaro Barrera ◽  
Jorge Calderón ◽  
Martin Cordero ◽  
Héctor Duque

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.



2020 ◽  
Vol 14 (5) ◽  
pp. 149-167
Author(s):  
Fionnuala Williams ◽  
Mike Warwick ◽  
Colin McKay ◽  
Callum Macleod ◽  
Moira Connolly

Purpose This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA. Design/methodology/approach All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use. Findings Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%). Originality/value The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.



Author(s):  
Sangeeta Dey ◽  
Graham Mellsop ◽  
Kate Diesfeld ◽  
Vajira Dharmawardene ◽  
Susitha Mendis ◽  
...  

Abstract Background Involuntary admission or treatment for the management of mental illness is a relatively common practice worldwide. Enabling legislation exists in most developed and high-income countries. A few of these countries have attempted to align their legislation with the United Nations Convention on the Rights of Persons with Disabilities. This review examined legislation and associated issues from four diverse South Asian countries (Bangladesh, India, Pakistan and Sri Lanka) that all have a British colonial past and initially adopted the Lunacy Act of 1845. Method A questionnaire based on two previous studies and the World Health Organization checklist for mental health legislation was developed requesting information on the criteria and process for involuntary detention of patients with mental illness for assessment and treatment. The questionnaire was completed by psychiatrists (key informants) from each of the four countries. The questionnaire also sought participants’ comments or concerns regarding the legislation or related issues. Results The results showed that relevant legislation has evolved differently in each of the four countries. Each country has faced challenges when reforming or implementing their mental health laws. Barriers included legal safeguards, human rights protections, funding, resources, absence of a robust wider health system, political support and sub-optimal mental health literacy. Conclusion Clinicians in these countries face dilemmas that are less frequently encountered by their counterparts in relatively more advantaged countries. These dilemmas require attention when implementing and reforming mental health legislation in South Asia.



Author(s):  
Sarah Ashworth ◽  
Krista Jansen ◽  
Lydia Bullock ◽  
Paul Mooney

Purpose The purpose of this paper is to describe a feasibility study into the development and pilot of a psychoeducational group for people with intellectual disability and co-morbid mental disorder (including mental illness and personality disorder) within forensic settings. Design/methodology/approach “Mind Matters”, a psychoeducational programme for people with an intellectual disability and co-morbid mental disorders is a group based programme in a medium secure hospital, adapted and developed to be suitable for people with intellectual disability therapist multidisciplinary approach was key to its development. An open group on a 16-bedded ward for individuals with mild to moderate intellectual disability and co-morbid mental illness was delivered over a six-week period. Findings The group was positively received in pilot by participants and members of the clinical teams. Attendance and engagement of participants were key measures of the success of the programme. In addition to the apparent increased social skills and motivation to engage with future psychological intervention. Practical implications The authors believe that this approach benefitted both the group members and staff on ward, reinforcing strategies for maintaining positive mental health. It also stimulated engagement, discussion about mental disorders including mental illness, personality disorder and intellectual disabilities. Originality/value This paper shows how a psychoeducational approach to mental disorder and mental health in individuals with an intellectual disability is possible, beneficial and well received.



2003 ◽  
Vol 27 (4) ◽  
pp. 141-144 ◽  
Author(s):  
John R. Taylor ◽  
K. B. Idris

Aims and MethodA cross-sectional survey of the use of the Mental Health (Scotland) Act 1984 in a defined urban area. Patients initially detained under civil sections (Sections 24, 25, 26 and 18) between 1 April 1997 and 31 March 1998 were identified using the hospital information system and a hand search of section papers.ResultsThere were 283 detentions involving 204 patients that lasted a median of 6 days. A total of 98% of patients were initially detained on a 72-hour ‘emergency section’. A total of 61% had non-organic psychotic disorders (172/283). Less than half of detentions were during the working week. Consent was usually provided by the mental health officer or relatives, but was not provided for 11% of detentions. Patients detained after admission were more likely to be detained for a longer period (29 v. 3 days) and to have their detention extended over 72 hours (64% v. 41%) compared with those detained in the community.Clinical ImplicationsThis paper provides information on some of the gaps identified by recent reviews of mental health legislation in Scotland and discusses the possible impact of the changes proposed by the Millan Committee. The workload of general adult consultant psychiatrists is likely to increase and the proportion of patients detained without consent could also increase. The study supports the differentiation of patients detained after admission from those detained in the community, as the patterns of detention are different.



2014 ◽  
Vol 9 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Susan Patterson ◽  
Pauline Ford

Purpose – The purpose of this paper is to inform education of non-mental health professionals who provide care to people with severe mental illness; to describe dentistry students’ knowledge and views about mental illness, including willingness to engage in various social situations with a person hospitalised for mental illness; and to assess and understand the impact of a targeted lecture on views and attitudes. Design/methodology/approach – The paper employed mixed methods to examine dental students’ knowledge and views about mental disorder before and after a seminar covering mental disorder, disadvantage and oral health. Findings from a bespoke questionnaire administered to third-year dental students were triangulated with qualitative data gathered in interviews with a subsample. Findings – Students understood mental disorder broadly, employing diverse causal models. Although knowledge was typically grounded in media stereotypes, attitudes were benevolent and most students reported willingness to provide dental care to affected individuals. The seminar, especially the consumer delivered section, was valued and associated with increased appreciation of the impact of mental disorder on oral health and need for assertive action to promote access to care. However, students reported being reluctant to disclose their own mental health problems for fear of being considered a professional or personal failure. A minority knew how to seek support if a friend talked of suicide. Research limitations/implications – This study highlights the need for further investigation of the knowledge and attitudes of dentistry students pertinent to provision of care to people with mental illness and to examine the links between attitudes and practice. The paper also provides a useful foundation for development of brief educational interventions, particularly the value in integrating the service user perspective, and their evaluation. Research should also examine the impact of mental health education on practice. Practical implications – A single inexpensive educational session, such as the one the paper developed may support reconsideration of often unconscious views of mental illness which might affect practice. Social implications – If people with mental illness are to receive equitable access to health care, non-mental health professionals should be supported to develop knowledge and attitudes which are conducive to inclusive treatment. An education session such as this could be helpful. Originality/value – There is scant literature examining attitudes of dentistry students and no reports of mental health-specific education with this population.



2017 ◽  
Vol 11 (1) ◽  
pp. 2-7
Author(s):  
Peter Cronin ◽  
Liam Peyton ◽  
Eddie Chaplin

Purpose The purpose of this paper is to offer a perspective on depression and self-help from two experts with lived experience of learning disabilites. Design/methodology/approach This paper outlines the authors’ presentation and experiences at the recent Learning Disability Today conference. Findings The paper shares some things we can do to help our mental wellbeing. Originality/value This paper offers the view of two people with learning disabilities lived experience of depression. The paper also offers and insight into some of the strategies they use to manage and encourage positive mental health.



2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Jolley ◽  
R. Heun

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.



2018 ◽  
Vol 23 (4) ◽  
pp. 269-279 ◽  
Author(s):  
David Pilgrim

Purpose The purpose of this paper is to examine whether the popular policy assumption of co-production is feasible in secure psychiatric settings. Design/methodology/approach The assumptions of co-production are listed and then used as a basis for an immanent critique to test the feasibility described in the purpose of the paper. An explanatory critique exploring consumerism in the welfare state then follows. These forms of critique are derived from the philosophy of critical realism. Findings A distinction is made between the co-production of knowledge about mental health services and the actual co-production of those services. It is concluded that the former has emerged but the latter is not feasible, given the limitations on citizenship imposed by psychiatric detention. Research limitations/implications Evidence for the co-production of mental health services (rather than the co-production of knowledge about those services) remains sparse. Practical implications The contradictions about citizenship created by the existence of mental health legislation and the social control role of mental health services requires ongoing honest reflects by mental health professionals and those responsible for the development of mental health services. Social implications As described above, mental health legislation pre-empts confidence in the co-production of mental health services. Originality/value Whilst there is a small literature on co-production and mental health services, alluded to at the outset, this paper uses immanent and explanatory critiques to deepen our understanding of the topic.



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