Comparison of accredited person and medical officer discharge decisions under the Mental Health Act of NSW: A cohort study of deliberate self-poisoning patients

2021 ◽  
pp. 000486742110096
Author(s):  
Katie McGill ◽  
Matthew J Spittal ◽  
Jennifer Bryant ◽  
Terry J Lewin ◽  
Ian M Whyte ◽  
...  
Keyword(s):  
Mental Health ◽  
Propensity Score ◽  
General Hospital ◽  
Psychiatric Hospital ◽  
Propensity Score Analysis ◽  
Medical Officer ◽  
Patient Characteristics ◽  
Risk Difference ◽  
Discharge Destination ◽  
Mental Health Act

Background: The Accredited Persons Programme was introduced in 2003. The relevant Mental Health Acts (NSW) authorised reviews by appropriately credentialed non-medical health professionals as part of the process of detaining and treating a person without consent: an authority previously held by medical officers. Evaluations of the Programme are needed. Objective: To compare discharge decisions for hospital-treated deliberate self-poisoning patients made by an Accredited Person and Medical Officers. Methods: For a 10-year cohort (2003–2012) of index hospital-treated deliberate self-poisoning admissions at the Calvary Mater Newcastle, we compared Accredited Person and Medical Officer discharge decisions from the general hospital. We specifically examined discharges to the psychiatric hospital under a Mental Health Act certificate (used as an index of the Accredited Person’s use of the authority under the Accredited Persons Programme) compared to any other discharge destination. Unadjusted and adjusted logistic regression models and a propensity score analysis were used to explore the relationship between clinician type and discharge destination. Results: There were 2237 index assessments (Accredited Person = 884; Medical Officer = 1443). One-quarter (27%) were referred for assessment under the Act at the psychiatric hospital, with the Accredited Person significantly more likely (32%) to require this compared to the Medical Officers (24%); Risk Difference: 8.3% (4.5 to 12.1). However, after adjusting for patient characteristics; Risk Difference: −3.0% (−5.9 to −0.1) and for propensity score, Risk Difference: −3.3% (−6.7 to 0.1), the Accredited Person and Medical Officer likelihood of discharging for an assessment under the Act was similar. Conclusions: The Accredited Person assessed more clinically complex patients than the Medical Officers. After adjusting for clinical complexity and propensity score, the likelihood of referral for involuntary psychiatric hospital care was similar for Accredited Person and Medical Officers. Our evaluation of the Accredited Person programme in the general hospital was favourable, and wider implementation and evaluation is warranted.

scholarly journals A survey of general hospital in-patients detained under Section 5(2) of the 1983 Mental Health Act

1996 ◽  
Vol 20 (12) ◽  
pp. 733-735 ◽  
Author(s):  
Christopher Buller ◽  
David Storer ◽  
Rachel Bennett
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Conversion Rate ◽  
Psychiatric Hospitals ◽  
Patient Characteristics ◽  
Rare Occurrence ◽  
General Hospitals ◽  
Code Of Practice ◽  
Mental Health Act

Detention of general hospital in-patients under Section 5(2) is a rare occurrence. This study of the use of Section 5(2) in general hospitals uncovered a frequent neglect in following the guidelines of The Mental Health Act and The Code of Practice. Surprisingly the conversion rate of Section 5(2) to Section 2 or 3 was similar to that seen in a number of other studies conducted in the quite different setting of large psychiatric hospitals. A number of patient characteristics were identified that appeared to influence whether 5(2)s were converted to an admission Section. Each general hospital needs to develop guidelines to be followed when staff feel that a patient should be detained under Section 5(2) – an example of such a policy is included.

scholarly journals Effects of Occupational Hazards on Job Stress and Mental Health of Factory Workers and Miners: A Propensity Score Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yaoqin Lu ◽  
Zhe Zhang ◽  
Huan Yan ◽  
Baoling Rui ◽  
Jiwen Liu
Keyword(s):  
Mental Health ◽  
Propensity Score ◽  
Job Stress ◽  
Propensity Score Analysis ◽  
Coal Dust ◽  
Health Examination ◽  
Occupational Hazards ◽  
Occupational Hazard ◽  
Factory Workers ◽  
Score Analysis

This study is to evaluate the effects of different occupational hazards on job stress and mental health of factory workers and miners. A total of 6120 workers from factories and mining enterprises in seven districts and one district of Urumqi were determined using the stratified cluster random sampling method. The Effort-Reward Imbalance (ERI) questionnaire and the Symptom Checklist-90 (SCL-90) were used to evaluate the effects of occupational hazard factors on job stress and mental health of workers. The propensity score analysis was used to control the confounding factors. The occupational hazards affecting job stress of workers were asbestos dust (OR=1.3, 95% CI: 1.09-1.55), benzene (OR=1.25, 95% CI: 1.10-1.41), and noise (OR=1.39, 95% CI: 1.22-1.59). The occupational hazards affecting the mental health of workers were coal dust (OR=1.19, 95% CI: 1.02-1.38), asbestos dust (OR=1.58, 95% CI: 1.32-1.92), benzene (OR=1.28, 95% CI: 1.13-1.47), and noise (OR=1.23, 95% CI: 1.07-1.42). Different occupational hazards have certain influence on job stress and mental health of factory workers and miners. The enhancements in occupational hazard and risk assessment, occupational health examination, and occupational protection should be taken to relieve job stress and enhance the mental health of factory workers and miners.

scholarly journals 1045. A Multicenter Propensity Score-Adjusted Retrospective Study for Comparison of the Outcome of Treatment With Third-Generation Cephalosporin vs. Broad-Spectrum Antibiotics for Enterobacter Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S312-S312
Author(s):  
Satoshi Hayano ◽  
Shungo Yamamoto ◽  
Ryota Hase ◽  
Akihiro Toguchi ◽  
Yoshihito Otsuka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Resistant Strain ◽  
Propensity Score Analysis ◽  
Risk Difference ◽  
Third Generation ◽  
Broad Spectrum Antibiotics ◽  
Score Analysis ◽  
Definitive Therapy

Abstract Background Enterobacter spp. can develop resistance during prolonged therapy with third-generation cephalosporins (3GC: ceftriaxone, cefotaxime, or ceftazidime) because of derepression of AmpC β-lactamase. However, the clinical significance of this phenomena remains undetermined. This study aims to assess the outcome of patients with 3GC-susceptible Enterobacter bacteremia (EB) who received definite therapy with 3GC or broad-spectrum antibiotics (BSA) using propensity score analysis. Methods In this retrospective, cohort study conducted at two tertiary care hospitals in Japan, we determined consecutive patients with EB identified from the laboratory databases between January 2010 and December 2017. We enrolled patients with 3GC-susceptible EB treated with 3GC or BSA (defined as fourth-generation cephalosporins, carbapenems, and piperacillin/tazobactam) as definitive therapy. The primary outcome was 28-day mortality. The secondary outcome was the emergence of antimicrobial-resistant strain during antimicrobial therapy. We compared outcomes using the propensity scores and inverse-probability-weighting (IPW) adjustment to decrease the confounding by indication. Results We identified 320 patients with EB; of these, 191 cases were eligible (86 treated with 3GC and 105 treated with BSA). All the measured covariates were well balanced after the IPW adjustment. We observed no significant differences in the unadjusted mortality [5.8% in the 3GC group vs. 13.3% in the BSA group; risk difference, −7.5%; 95% confidence interval (CI): −15.7–0.6; P = 0.09], and the IPW-adjusted mortality (5.1% vs. 9.4%; risk difference −4.3%; 95% CI: −12.2–3.5; P = 0.3) between the groups. The results of the propensity score-matched analysis and sensitivity analysis were similar. Furthermore, we did not observe the emergence of antimicrobial resistance during antimicrobial therapy in both groups. Conclusion Definitive therapy with 3GC for susceptible EB was not associated with an increased risk of the 28-day mortality after adjustment for potential confounders with the propensity score analysis or with the emergence of antimicrobial-resistant strain. Disclosures All authors: No reported disclosures.

Assessment of Suicide Risk

1987 ◽  
Vol 150 (2) ◽  
pp. 145-153 ◽  
Author(s):  
K. Hawton
Keyword(s):  
Mental Health ◽  
Psychiatric Disorders ◽  
Psychiatric Hospital ◽  
Suicide Risk ◽  
Clinical Skills ◽  
Clinical Decisions ◽  
Suicide Attempters ◽  
Mental Health Act ◽  
Hospitalised Patients ◽  
The Many

Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

scholarly journals Consent to Treatment: Legal and Ethical Aspects

1981 ◽  
Vol 5 (11) ◽  
pp. 207-209
Author(s):  
Paul Bowden
Keyword(s):  
Mental Health ◽  
Public Policy ◽  
Mental Disorder ◽  
Medical Officer ◽  
Working Party ◽  
Ethical Aspects ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Patient’S Will ◽  
Policy Committee

In anticipating the consultative paper A Review of the Mental Health Act, 1959 the College's Public Policy Committee prepared a report in 1974 (News and Notes, October, November 1974). The second of six points covered in the report related to compulsory detention and treatment. It reads:The Working Party are firmly of the view that compulsory powers should include the power to treat patients compulsorily for any form of mental disorder, but has doubts as to how far certain types of treatment should be applied on the sole authority of the Responsible Medical Officer against the patient's will or when he is incapable of giving consent.

scholarly journals Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035121 ◽  
Author(s):  
Wikus Barkhuizen ◽  
Alexis E Cullen ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Mortality Rate ◽  
Psychiatric Hospital ◽  
Mental Healthcare ◽  
Index Admission ◽  
Community Treatment ◽  
Lower Mortality ◽  
Community Treatment Orders ◽  
Electronic Health Record Data ◽  
Mental Health Act

ObjectivesLimited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a control group of patients discharged to voluntary community mental healthcare.Design and settingAn observational study using deidentified electronic health record data from inpatients receiving mental healthcare in South London using the Clinical Record Interactive Search (CRIS) system. Data from patients discharged between November 2008 and May 2014 from compulsory inpatient treatment under the Mental Health Act were analysed.Participants830 participants discharged on a CTO (mean age 40 years; 63% male) and 3659 control participants discharged without a CTO (mean age 42 years; 53% male).Outcome measuresThe number of days spent in the community until readmission, the number of days spent in inpatient care in the 2 years prior to and the 2 years following the index admission and mortality.ResultsThe mean duration of a CTO was 3.2 years. Patients receiving care from forensic psychiatry services were five times more likely and patients receiving a long-acting injectable antipsychotic were twice as likely to be placed on a CTO. There was a significant association between CTO receipt and readmission in adjusted models (HR: 1.60, 95% CI 1.42 to 1.80, p<0.001). Compared with controls, patients on a CTO spent 17.3 additional days (95% CI 4.0 to 30.6, p=0.011) in a psychiatric hospital in the 2 years following index admission and had a lower mortality rate (HR: 0.66, 95% CI 0.50 to 0.88, p=0.004).ConclusionsMany patients spent longer on CTOs than initially anticipated by policymakers. Those on CTOs are readmitted sooner, spend more time in hospital and have a lower mortality rate. These findings merit consideration in future amendments to the UK Mental Health Act.

Mental Health Act transfers from prison to psychiatric hospital over a six-year period in a region of England

2020 ◽  
Vol 10 (3) ◽  
pp. 219-231
Author(s):  
Laura Woods ◽  
Laura Craster ◽  
Andrew Forrester
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Psychiatric Hospital ◽  
Psychiatric Morbidity ◽  
England And Wales ◽  
Content Type ◽  
Mental Health Act ◽  
Medium Security ◽  
Hospital Transfer ◽  
Transfer Times

Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

Review of electronic discharge summaries from the general medicine, general surgery and mental health streams at a tertiary hospital: retrospective analysis of timeliness, brevity and completeness

2020 ◽  
Vol 44 (5) ◽  
pp. 699
Author(s):  
Keith Potent ◽  
Benjamin Levy ◽  
Andrew Porritt
Keyword(s):  
Mental Health ◽  
Patient Education ◽  
Medical Officer ◽  
General Medicine ◽  
Tertiary Hospital ◽  
Discharge Destination ◽  
Officer Training ◽  
Critical Elements ◽  
Standard Training ◽  
Discharge Summaries

ObjectiveThis retrospective study identified and compared the performance of electronic discharge summaries (EDSs) from three hospital in-patient streams (surgical, medical and mental health) with Australian standards. MethodsAn audit was performed of 120 EDSs extracted from a tertiary hospital. Auditors evaluated each EDS using an adaptation of the Australian Commission on Safety and Quality in Health Care’s EDS toolkit. ResultsEDSs from all in-patient streams were lengthy and most did not include information regarding discharge destination, patient education or recommendations. General Medicine EDSs were most timely, averaging within 1 day of discharge. ConclusionsKey areas of improvement remain for improving the timeliness, brevity and completeness of EDSs. Key areas identified for improvement include page length, discharge destination, alerts, patient education and recommendations. Variability in audit results between streams suggests the need for speciality-specific templates, standards and medical officer training. What is known about the topic?The literature suggests that an EDS is timely if it is completed within 2 days of discharge. A complete and brief EDS should also include key details of the care in two (or fewer) pages. What does this paper add?This paper evaluated 120 EDSs, compared them against a standard and stratified the EDSs according to three core clinical in-patient streams that produced them (surgical, medical and mental health). What are the implications for practitioners?Although broad guidelines for timeliness, brevity and completeness have been established for EDSs, each in-patient stream will require different standards. A hospital or health service should have established standards relevant to each in-patient stream. Before commencing a term in any of the three in-patient streams, medical officers who are to generate EDSs should be trained in the required standard. Training should highlight critical elements of a speciality stream to ensure EDS authors are aware of the nuances of the stream in which they are rotating. In addition, general practitioners should liaise with local hospitals to ensure ongoing dialogue and improvement of clinical handover documents.

scholarly journals Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis

2018 ◽  
Vol 06 (05) ◽  
pp. E568-E574 ◽  
Author(s):  
So Nakaji ◽  
Nobuto Hirata ◽  
Hiroki Matsui ◽  
Toshiyasu Shiratori ◽  
Masayoshi Kobayashi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Endoscopic Sphincterotomy ◽  
Outcome Measure ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Risk Difference ◽  
Secondary Outcome ◽  
Bleeding Rate ◽  
Score Analysis

Abstract Background and study aims Hemodialysis (HD) is considered one of the risk factors for post-endoscopic sphincterotomy (ES) bleeding. Therefore, we conducted a retrospective study to evaluate HD as a risk factor for post-ES bleeding in patients with choledocholithiasis. Patients and methods We used the post-ES bleeding rate as the main outcome measure. To evaluate the influence of HD on the risk of post-ES bleeding, logistic regression and propensity score analyses were conducted. In addition, univariate analysis-based comparisons of various clinical parameters (as secondary outcome measures) were performed between the patients in the HD and non-HD groups that experienced post-ES bleeding. Results A total of 1518 patients were enrolled. In the multivariate analysis, a platelet count of < 50,000, anticoagulant therapy, bleeding during ES, and HD were found to be significantly associated with post-ES bleeding (odds ratio [OR]: 35.30, 95 % confidence interval [CI]: 3.81 – 328.00; OR: 4.39, 95 % CI: 1.53 – 12.60; OR: 4.28, 95 % CI: 2.30 – 7.97; and OR: 13.30, 95 % CI: 5.78 – 30.80, respectively). Propensity score matching created 28 matched pairs. Propensity score analysis showed that the risk difference between the groups was 0.214 (95 % CI: 0.022 – 0.407). In a comparison between the patients in the HD and non-HD groups that suffered post-ES bleeding, it was found that the post-ES bleeding was significantly more severe in the HD group (p = 0.033), and massive blood transfusions and long periods of hospitalization were more frequently required in the HD group (p = 0.008 and p < 0.001, respectively). Conclusion HD is an independent risk factor for post-ES bleeding and makes post-ES bleeding more serious.

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