scholarly journals Making decisions in the management of perinatal depression and anxiety

2014 ◽  
Vol 20 (3) ◽  
pp. 175-183
Author(s):  
Anne P. F. Wand
Keyword(s):  
Mental Illness ◽  
Depressive Disorders ◽  
Treatment Options ◽  
Good Practice ◽  
Perinatal Period ◽  
List Type ◽  
Risks And Benefits ◽  
Mental Health Legislation ◽  
Potential Risks ◽  
Health Legislation

SummaryThe care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk-benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.LEARNING OBJECTIVES•Understand the potential risks and benefits of treating, or not treating, maternal mental illness at various stages in the perinatal period.•Understand the limitations of the literature in this field.•Be able to use different frameworks for deciding with patients about the management of mental illness in the perinatal period.

Learning disability and the Scottish Mental Health Act

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 ◽  
Mental Health Legislation ◽  
Scottish Government ◽  
Health Legislation

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.

scholarly journals Comparing legislation for involuntary admission and treatment of mental illness in four South Asian countries

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Sangeeta Dey ◽  
Graham Mellsop ◽  
Kate Diesfeld ◽  
Vajira Dharmawardene ◽  
Susitha Mendis ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
South Asian ◽  
Political Support ◽  
World Health ◽  
Involuntary Admission ◽  
Asian Countries ◽  
Persons With Disabilities ◽  
Mental Health Legislation ◽  
Health Legislation

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.

scholarly journals Use of mental health legislation in a regional adolescent unit

1996 ◽  
Vol 20 (12) ◽  
pp. 711-713
Author(s):  
Judith E. Nicholls ◽  
Carol A. Fernandez ◽  
Andrew F. Clark
Keyword(s):  
Mental Health ◽  
Professional Practice ◽  
Good Practice ◽  
Mental Health Legislation ◽  
Conversion Rates ◽  
Health Legislation ◽  
Over Time

The use of mental health legislation in a Regional Adolescent Unit over a 10 year period was reviewed. There was a trend of increasing use over time. This was thought to reflect changes in attitude and professional practice subsequent to the introduction of the Children Act 1989. Conversion rates of Section 5(2) were high and practitioners with appropriate training were involved in the majority of sections, indicating good practice.

Cognition in Schizophrenia Spectrum and Other Psychotic Disorders

2019 ◽  
pp. 290-306
Author(s):  
Martin Strassnig ◽  
Philip D. Harvey
Keyword(s):  
Mental Illness ◽  
Depressive Disorders ◽  
Psychotic Disorders ◽  
Cognitive Impairments ◽  
Treatment Options ◽  
Psychotic Episode ◽  
Schizophrenia Spectrum ◽  
Mental Illness Treatment ◽  
Bipolar Patients ◽  
The Impact

Cognitive impairments are present in patients with severe mental illness (SMI) at the time of the first psychotic episode. People with schizophrenia are more impaired across the lifespan compared to bipolar patients or patients with major depression. Although schizophrenia patients appear to generally function on a lower level than bipolar patients, the functional correlates of cognitive impairment are similar. There is much less research on cognition and its functional impact in depression, with the depression literature largely focusing on the impact of symptoms and only some recent studies examining cognition and functional capacity. Complicating both bipolar and major depressive disorders is the influence of mood states on cognition. Moreover, patients with SMI are often medically compromised, with higher rates of obesity and related comorbidities as well as poor lifestyles, which add further cognitive and functional implications. Cognitive impairments are known determinants of disability in SMI and a rate-limiting step in recovering from mental illness. Treatment options are reviewed in this chapter, and potential ways forward are discussed.

scholarly journals Mental health legislation in Chile

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 ◽  
Mental Health Legislation ◽  
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.

scholarly journals When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression

2020 ◽  
Vol 17 (4) ◽  
pp. 1139 ◽  
Author(s):  
Antonio Bruno ◽  
Laura Celebre ◽  
Carmela Mento ◽  
Amelia Rizzo ◽  
Maria Catena Silvestri ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Transition To Parenthood ◽  
Perinatal Depression ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Well Being ◽  
Perinatal Period ◽  
Life Transition ◽  
Behavioral Disturbances ◽  
Major Life

The transition to parenthood is considered to be a major life transition that can increase the vulnerability to parental depressive disorders, including paternal perinatal depression (PPND). Although it is known that many fathers experience anxiety and depression during the perinatal period, PPND is a recent diagnostic entity and there are not enough published studies on it. Accordingly, its prevalence and epidemiology are still not well defined, although the majority of studies agree that PPND is less frequent than maternal perinatal depression and postpartum depression. Nevertheless, PPND is different from maternal perinatal mental health disorders, usually, fathers have less severe symptoms, and mood alterations are often in comorbidity with other affective disorders. Despite the absence of DSM-5 diagnostic criteria and the fluctuation of prevalence rates, clinical symptoms have been defined. The main symptoms are mood alterations and anxiety, followed by behavioral disturbances and concerns about the progress of pregnancy and the child’s health. Moreover, PPND negatively impacts on family functioning, on couples’ relationships, and on family members’ well-being. The aim of this paper is to present an overview of the current understandings on PPND and the potential screening, prevention, and treatment options.

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

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 ◽  
Mental Health Legislation ◽  
Health Legislation

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.

scholarly journals Blasphemy laws and mental illness in Pakistan

2014 ◽  
Vol 38 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Muzaffar Husain
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mentally Ill ◽  
Mental Health Legislation ◽  
Health Legislation

SummaryThere is emerging evidence that individuals who are mentally ill are over-represented in the group of defendants prosecuted under the blasphemy laws of Pakistan. This article discusses the background of blasphemy legislation in Pakistan, and proposes causal interactions between underlying mental illness in the defendant and prosecution for blasphemy. It sketches possible legal safeguards for such blasphemy defendants with mental illness in mental health legislation.

scholarly journals Reaching women with perinatal mental illness at the booking-in appointment

2018 ◽  
Vol 23 (1) ◽  
pp. 38-45
Author(s):  
Emma Haynes
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Design Methodology ◽  
Treatment Options ◽  
Perinatal Period ◽  
Postnatal Period ◽  
Economic Costs ◽  
Content Type ◽  
Suitable Treatment ◽  
Additional Service

Purpose The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period. Design/methodology/approach A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point. Findings The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family. Research limitations/implications Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running. Originality/value This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.

Response to Szasz

1999 ◽  
Vol 23 (9) ◽  
pp. 520-521 ◽  
Author(s):  
George Szmukler ◽  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Brain Injury ◽  
Physical Illness ◽  
Best Interests ◽  
Incompetent Patient ◽  
Mental Health Legislation ◽  
The Status ◽  
Health Legislation ◽  
Thomas Szasz

Thomas Szasz is justifiably famous for his critique of psychiatry. He was instrumental in focusing an important debate on the status of ‘mental illness' and its social implications for which we are all deeply indebted. However times have moved on. Holloway and I seek to cast different “skeletons from the closet” to those of Szasz. We seek to destigmatise mental illness, so it no longer constitutes a secret source of shame or pain to a family or person. We ask that mental illness be treated neither better nor worse than physical illness. Only if a person suffers from mental incapacity, whatever the cause – brain injury, exsanguination, schizophrenia, learning disability, stroke, toxic infection – and it is in that person's ‘best interests', carefully defined, should they be treated against their will. Szasz seems oblivious that every day, many more patients with a physical illness (associated with incapacity) are treated non-consensually than those with mental illness. It is just that we don't draw attention to it, and society accepts it is right. A little bit of homework on his part would have told him that in this country, exactly opposite to his assertion, the law does justify the “medical treatment of incompetent persons, say one who has a stroke or is unconscious as a result of an accident” (if it is in the patient's ‘best interests’). Again, exactly opposite to his claims, in this country no other person can consent on behalf of an incompetent patient. We argue that all patients in this position should have similar safeguards. Mental illness does not automatically confer incapacity, nor does it raise special issues requiring specific mental health legislation. But of course Szasz does not believe mental illness exists.

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