A retrospective cohort study describing characteristics of those repeatedly detained under Section 136 of the Mental Health Act over a 5-year period and the association with past abuse

2021 ◽  
pp. 002580242110454
Author(s):  
Laureen Adewusi ◽  
Isabel Mark ◽  
Paige Wells ◽  
Aileen O’Brien
Keyword(s):  
Mental Health ◽  
Past History ◽  
Significant Proportion ◽  
Community Support ◽  
White Ethnicity ◽  
Demographic Profiles ◽  
Mental Health Act ◽  
History Of ◽  
Self Harm ◽  
The Uk

Individuals repeatedly detained under Section 136 (S136) of the Mental Health Act account for a significant proportion of all detentions. This study provides a detailed analysis of those repeatedly detained (‘repeat attenders’) to a London Mental Health Trust, identifying key demographic profiles when compared to non-repeat attenders, describing core clinical characteristics and determining to what degree a past history of abuse might be associated with these. All detentions to the S136 suite at South West London and St George's Mental Health NHS Trust over a 5-year period (2015–2020) were examined. Data were collected retrospectively from electronic records. A total of 1767 patients had been detained, with 81 patients identified as being a ‘repeat attenders’ (having had > = 3 detentions to the S136 suite during the study period). Repeat attenders accounted for 400 detentions, 17.7% of all detentions. Repeat attenders included a higher proportion of females (49.4%, p = 0.0001), compared to non-repeat attenders, and a higher proportion of them were of white ethnicity (85.2%, p = 0.001). 52 (64%) patients reported being a victim of past abuse or trauma. Of repeat attenders who reported past abuse or trauma, a high proportion had diagnoses of personality disorders, with deliberate self-harm as the most common reason for detention. They were more commonly discharged home with community support, rather than considered for hospital admission. In light of these findings, this paper discusses support potential strategies for those most vulnerable to repeated S136 detention, thereby minimising the ever-growing number of S136 detentions in the UK.

7. Mental Health Law

Medical Law ◽  
2019 ◽  
pp. 351-419
Author(s):  
Emily Jackson
Keyword(s):  
Mental Health ◽  
Community Treatment ◽  
Health Law ◽  
Persons With Disabilities ◽  
Mental Health Law ◽  
Mental Health Act ◽  
Independent Review ◽  
History Of ◽  
Human Rights Act ◽  
The Uk

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses mental health law in the UK. It begins with a brief history of mental health law and policy. This is followed by discussions of: admission to the mental health system; treatment of the mentally ill under the Mental Health Act 1983; Deprivation of Liberty Safeguards (DoLS) and Cheshire West, and Community Treatment Orders. It also looks at the implications of the Human Rights Act and the UN Convention on the Rights of Persons with Disabilities (UNCRPD) for mental health law. It also considers the conclusions of the Independent Review of the Mental Health Act 1983.

scholarly journals Acute military psychiatric casualties from the war in Iraq

2005 ◽  
Vol 186 (6) ◽  
pp. 476-479 ◽  
Author(s):  
Mark A. Turner ◽  
Mathew D. Kiernan ◽  
Andrew G. McKechanie ◽  
Peter J. C. Finch ◽  
Frank B. McManus ◽  
...  
Keyword(s):  
Mental Health ◽  
Military Personnel ◽  
Mental Health Problems ◽  
Significant Proportion ◽  
Combat Stress ◽  
Stress Reactions ◽  
Aeromedical Evacuation ◽  
Military Psychiatry ◽  
History Of ◽  
The Uk

BackgroundThe view that most military personnel evacuated from war zones are suffering from combat stress reactions, or are otherwise traumatised by the horrors of war, has an impact on all aspects of military psychiatry.AimsTo delineate the reasons for psychiatric aeromedical evacuation from Iraq from the start of build-up of UK forces in January 2003 until the end of October that year, 6 months after the end of formal hostilities.MethodA retrospective study was conducted of field and in-patient psychiatric assessments of 116 military personnel evacuated to the UK military psychiatric in-patient facility in Catterick Garrison.ResultsEvacuees were mainly non-combatants (69%). A significant proportion were in reserve service (21%) and had a history of contact with mental health services (37%). Only 3% had a combat stress reaction. In over 85% of cases evacuation was for low mood attributed to separation from friends or family, or difficulties adjusting to the environment.ConclusionsThese findings have implications especially for screening for suitability for deployment, and for understanding any longer-term mental health problems arising in veterans from Iraq.

scholarly journals Profile, referral pathways and re-attendance of psychiatric patients attending the emergency department: focus on suicidality & self-harm

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S339-S340
Author(s):  
Haridha Pandian ◽  
Nilamadhab Kar
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Substance Misuse ◽  
Psychiatric Patients ◽  
Significant Proportion ◽  
Treatment Team ◽  
Electronic Patient Records ◽  
Number Of Patients ◽  
Self Harm ◽  
The Uk

AimsThe number of patients presenting to Emergency Departments (EDs) in the UK with acute psychiatric issues is a major concern. This project aimed to explore the outcome of patients assessed by Mental Health Liaison Services (MHLS) in a large district general hospital ED in the UK, with a focus on patients with self-harm or suicidality.MethodData were extracted from electronic patient records on 100 consecutive attendees to MHLS in July 2020. Data were collected on demographics, index of multiple deprivation (IMD) by postcode, time and reason for attendance, known ICD-10 diagnoses, self-harm history, alcohol/substance misuse at time of presentation, recent psychosocial stressors and outcome of MHLS assessment. Assessments by MHLS in the preceding 12 months and reattendance to the service within 3 months following this assessment were also recorded.ResultThe sample included 44 male and 56 female patients, with a mean age of 35.3 years. 80.0% of patients were Caucasian. 67.0% lived in areas classed within the top 30% most deprived in the country, whilst 2.0% had no fixed abode. The majority (79.0%) of patients self-presented; outside of normal working hours (70.0%). The most common reasons for attendance were thoughts/intent of self-harm/suicide (50.0%), overdose (29.0%) and self-harm by laceration (7.0%).The majority (73.0%) of patients had a known psychiatric diagnosis, with the most frequent being depressive disorder (36.0%) and emotionally unstable personality disorder (15.0%). Almost half (48.0%) had a history of self-harm, and 40.0% were under the influence of alcohol/illicit substances upon presentation to ED. The most common psychosocial triggers were conflict with partner (26.0%) and stress due to the COVID-19 pandemic (19.0%).Following assessment, 24.0% of patients were discharged to their General Practitioner, 18.0% to the community mental health team; and 17.0% to the Crisis & Home Treatment Team. A minority (13.0%) were admitted to a psychiatric hospital (10.0% informally, 3.0% under the Mental Health Act 1983).Approximately one in five (21.0%) patients re-attended to MHLS within 3 months. Out of 37 patients that had previously been assessed by MHLS in the preceding 12 months; 37.8% were reassessed within 3 months (p < 0.01).ConclusionIn the studied sample, most (90%) of psychiatric patients attended ED for self-harm or suicide, and a significant proportion had repeat attendance. Socioeconomic deprivation, substance misuse, relationship difficulties and stress due to the COVID-19 pandemic were major issues, alongside diagnosed depression and personality disorder. Focussed support for these issues may decrease ED attendance due to self-harm/suicidality.

scholarly journals Do patients who have been on ‘sections' get refused visas?

1994 ◽  
Vol 18 (4) ◽  
pp. 216-217 ◽  
Author(s):  
Danny Allen ◽  
Karen Allen
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hospital Treatment ◽  
Mental Health Act ◽  
History Of ◽  
The Uk ◽  
First Time

A reason sometimes given for not applying a section off the Mental Health Act 1983 to patients for the first time is that this may stigmatise them in some way. A practical example off stigmatisation is that patients who have previously been ‘sectioned’ may be refused tourist or immigration visas to other countries. Since no information on this subject is available in the psychiatric literature this paper attempts to clarify the policy of diplomatic missions in the UK in relation to visa applicants who report a history of mental illness and compulsory hospital treatment.

Psychiatry

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
Mental Health ◽  
Mental Health Patient ◽  
Self Mutilation ◽  
Cry For Help ◽  
Mental Health Patients ◽  
Health Expert ◽  
Self Harm ◽  
Mental Health Expert ◽  
The Uk ◽  
Suicidal Patients

It is estimated that 1 in 4 people in a year will have some kind of mental health problem, and that mixed anxiety and depression is the most common disorder in the UK. There is an increasing number of mental health patients attending the ED, and a new FY doctor in the ED will encounter such patients from their first shift onwards. The approach to a mental health patient is only marginally different from the approach to those presenting under other specialties. The assessment largely depends on careful history taking and attentively listening to the patient’s narrative. There are only a few situations in psychiatry in which a physical examination and investigations are required in the ED to make a diagnosis. As it would not be possible to cover all the areas of psychiatry which come through the doors of the ED in one chapter, only a few questions have been included here to provide a flavour of the common psychiatric situations that FY1/2s may come across in their early training period. The UK has the highest rate of self-harm in Europe and so one of the most important points is to recognize suicidal patients who can harm themselves seriously and manage them appropriately. If such patients are discharged following an inadequate assessment, they may go on to commit suicide and the attending doctors would have missed the opportunity to support and save them. In this category of patients, when they present to the ED, no matter how minimal is the level of their self-mutilation, it is a serious ‘cry’ for help. Our job is to listen to the patient and support them with the maximum help we can provide. As it may be difficult to occasionally get to the bottom of the problem, particularly within the time constraints in the ED, a low level of suspicion should be kept to ask for the assistance of the mental health expert. Self-harm and depression go almost hand in hand. The suicidal rate is higher in depressed patients than in the general population.

Non-governmental organizations and mental health

2018 ◽  
pp. 487-498
Author(s):  
Marguerite Regan ◽  
Jenny Edwards ◽  
Iris Elliott
Keyword(s):  
Mental Health ◽  
Health Needs ◽  
Current Policy ◽  
Health It ◽  
International Networks ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Policy Frameworks ◽  
History Of ◽  
The Uk

This chapter examines to contribution of non-governmental organizations (NGOs) to meeting the mental health needs of individuals, families, and communities. After providing an overview of the history of mental health NGOs, and the current policy frameworks within which they work, it then examines the scope of mental health NGOs, and maps the main international networks and within the UK context. It examines the contribution of NGOs, the key challenges they face working within mental health, and concludes with the steps NGOs can take when striving for parity for mental health. It includes examples of international mental health NGOs throughout.

Characteristics of persons who die on their first suicide attempt: results from the National Violent Death Reporting System

2019 ◽  
Vol 50 (8) ◽  
pp. 1390-1397 ◽  
Author(s):  
Joshua T. Jordan ◽  
Dale E. McNiel
Keyword(s):  
Mental Health ◽  
Law Enforcement ◽  
Suicide Attempt ◽  
Reporting System ◽  
Significant Proportion ◽  
Medical Examiner ◽  
Violent Death ◽  
Legal Problem ◽  
History Of ◽  
Life Circumstances

AbstractBackgroundMuch of suicide research focuses on suicide attempt (SA) survivors. Given that more than half of the suicide decedent population dies on their first attempt, this means a significant proportion of the population that dies by suicide is overlooked in research. Little is known about persons who die by suicide on their first attempt–and characterizing this understudied population may improve efforts to identify more individuals at risk for suicide.MethodsData were derived from the National Violent Death Reporting System, from 2005 to 2013. Suicide cases were included if they were 18–89 years old, with a known circumstance leading to their death based on law enforcement and/or medical examiner reports. Decedents with and without a history of SA were compared on demographic, clinical, and suicide characteristics, and circumstances that contributed to their suicide.ResultsA total of 73 490 cases met criteria, and 57 920 (79%) died on their first SA. First attempt decedents were more likely to be male, married, African-American, and over 64. Demographic-adjusted models showed that first attempt decedents were more likely to use highly lethal methods, less likely to have a known mental health problem or to have disclosed their intent to others, and more likely to die in the context of physical health or criminal/legal problem.ConclusionsFirst attempt suicide decedents are demographically different from decedents with a history of SA, are more likely to use lethal methods and are more likely to die in the context of specific stressful life circumstances.

scholarly journals Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

2019 ◽  
Vol 16 (23) ◽  
pp. 4786
Author(s):  
Claire Warrington
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Problems ◽  
Police Intervention ◽  
England And Wales ◽  
Mental Health Act ◽  
Self Harm ◽  
South East England ◽  
National Police

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

scholarly journals Civil and forensic patients in secure psychiatric settings: A comparison

2017 ◽  
Vol 41 (3) ◽  
pp. 156-159 ◽  
Author(s):  
Nuwan Galappathie ◽  
Sobia Tamim Khan ◽  
Amina Hussain
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Implications ◽  
Treatment Needs ◽  
Forensic Patients ◽  
Adult Services ◽  
Frequent Episodes ◽  
Self Harm ◽  
Male Patients ◽  
The Uk

Aims and methodTo evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.ResultsOverall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implicationsSecure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

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