scholarly journals Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Ruth Stuart ◽  
Syeda Ferhana Akther ◽  
Karen Machin ◽  
Karen Persaud ◽  
Alan Simpson ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Bibliographic Databases ◽  
Emotional Impact ◽  
Involuntary Admission ◽  
Policy And Practice ◽  
Accessible Information ◽  
Care And Support ◽  
Mental Health Legislation ◽  
Health Legislation

Background Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. Aims We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. Method We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. Results The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. Conclusions Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.

scholarly journals Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

BJPsych Open ◽  
2019 ◽  
Vol 5 (3) ◽  
Author(s):  
Syeda Ferhana Akther ◽  
Emma Molyneaux ◽  
Ruth Stuart ◽  
Sonia Johnson ◽  
Alan Simpson ◽  
...  
Keyword(s):  
Mental Health ◽  
Negative Impact ◽  
Patient Experiences ◽  
Bibliographic Databases ◽  
Emotional Impact ◽  
Reference List ◽  
Policy And Practice ◽  
Mental Health Legislation ◽  
Health Legislation ◽  
The Impact

Background Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. Aims To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. Method Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. Results The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. Conclusions Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. Declaration of interest None.

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.

Co-production and involuntary psychiatric settings

2018 ◽  
Vol 23 (4) ◽  
pp. 269-279 ◽  
Author(s):  
David Pilgrim
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Critical Realism ◽  
Content Type ◽  
Production Of Knowledge ◽  
Mental Health Legislation ◽  
Immanent Critique ◽  
Health Legislation

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.

scholarly journals Murmurs of discontent: treatment and treatability of personality disorder

2001 ◽  
Vol 7 (6) ◽  
pp. 407-415 ◽  
Author(s):  
Gwen Adshead
Keyword(s):  
Mental Health ◽  
White Paper ◽  
Involuntary Admission ◽  
Department Of Health ◽  
Legal Term ◽  
Mental Health Legislation ◽  
It Department ◽  
Health Legislation ◽  
Legal Sense ◽  
Considerable Discussion

“They murmured, as they took their fees ‘There is no cure for this disease’.”Hilaire BellocTreatability is a confused and confusing concept in psychiatry. In its legal sense, it is a measure that limits the involuntary admission of patients with some particular types of mental disorder. The legal term itself has generated considerable discussion and dissent (e.g. Mawson, 1983; Grounds, 1987), and the Government's White Paper on reforming mental health legislation in England and Wales proposes to abolish it (Department of Health, 2000).

scholarly journals Psychiatrists’ attitudes towards the procedure of involuntary admission to mental hospitals in China

2011 ◽  
Vol 58 (4) ◽  
pp. 440-447 ◽  
Author(s):  
Yang Shao ◽  
Bin Xie ◽  
Zhiguo Wu
Keyword(s):  
Mental Health ◽  
Mentally Ill ◽  
National Level ◽  
Mainland China ◽  
Education Level ◽  
Involuntary Admission ◽  
Mental Hospitals ◽  
Mental Health Legislation ◽  
Low Education ◽  
Health Legislation

Background: In order to protect the rights of the mentally ill, legislation on the standards and procedures of compulsory detention has been made at the local and national level in China. Aims: This study aims to examine psychiatrists’ attitudes towards seeking involuntary admission in mainland China. Method: Three hundred and fourteen (314) qualified members of the Chinese Psychiatrist Association (CPA) were surveyed using a questionnaire to assess their attitudes about the procedure of involuntary admission to mental hospitals. Data were analysed using χ2 and logistic regression. Results: Some psychiatrists in the CPA had several arbitrary attitudes towards the process of admission. Females, aged under 35, with a low education level and a low position in the institution showed stricter attitudes in the procedure of involuntary admission. Areas with mental health legislation showed significant positive relationships with stricter attitudes. Conclusions: Every effort needs to be made to minimize these arbitrary attitudes to prevent potential negative outcomes. There is still a long way to go in protecting the rights of people diagnosed with mental illness.

scholarly journals Dignity, human rights and the limits of mental health legislation

2014 ◽  
Vol 31 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Brendan D. Kelly
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Disorder ◽  
Mental Health Policy ◽  
Best Interests ◽  
Involuntary Admission ◽  
Economic Rights ◽  
Mental Health Legislation ◽  
Health Legislation ◽  
Social And Economic Rights

A right is an entitlement that one may legally or morally claim. Human rights are of particular importance in mental health care owing to the existence of laws that permit involuntary admission and treatment under certain circumstances, and compelling evidence of persistent social exclusion of some individuals with mental disorder. Ireland’s mental health legislation, which is currently under review, meets most international human rights standards in areas of traditional concern (involuntary admission and treatment) but not in other areas (especially social and economic rights). These deficits would be addressed, at least in part, by replacing the principle of ‘best interests’ with the principle of ‘dignity’ as the over-arching principle in Irish mental health legislation. Such a change would help ensure that decisions made under the legislation actively facilitate individuals with mental disorder to exercise their capabilities, help promote human rights and protect dignity. Even following such a reform, however, it is neither practical nor realistic to expect mental health legislation alone to protect and promote all of the broader rights of individuals with mental disorder, especially social and economic rights. Some rights are better protected, and some needs better met, through social policy, mental health policy and broader societal awareness and reform.

Stigma, inclusion and India’s Mental Healthcare Act 2017

2019 ◽  
Vol 18 (3) ◽  
pp. 199-205
Author(s):  
Richard M. Duffy ◽  
Gautam Gulati ◽  
Niket Kasar ◽  
Vasudeo Paralikar ◽  
Choudhary Laxmi Narayan ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mentally Ill ◽  
Mental Healthcare ◽  
Indian States ◽  
Large Country ◽  
Content Type ◽  
Mental Health Legislation ◽  
Health Legislation

Purpose India’s Mental Healthcare Act 2017 provides a right to mental healthcare, revises admission and review procedures, effectively decriminalises suicide and has strong non-discrimination measures, among other provisions. The purpose of this paper is to examine Indian mental health professionals’ views of these changes as they relate to stigma and inclusion of the mentally ill. Design/methodology/approach The authors held nine focus groups in three Indian states, involving 61 mental health professionals including 56 psychiatrists. Findings Several themes relating to stigma and inclusion emerged: stigma is ubiquitous and results in social exclusion; stigma might be increased rather than remedied by certain regulations in the 2017 Act; stigma is not adequately dealt with in the legislation; stigma might discourage people from making “advance directives”; and there is a crucial relationship between stigma and education. Practical implications Implementation of India’s 2017 Act needs to be accompanied by adequate service resourcing and extensive education, including public education. This has commenced but needs substantial resources in order to fulfil the Act’s potential. Social implications India’s mental health legislation governs the mental healthcare of 1.3bn people, one sixth of the planet’s population; seeking to use law to diminish stigma and enhance inclusion in such a large country sets a strong example for other nations. Originality/value This is the first study of stigma and inclusion since India’s 2017 Act was commenced and it highlights both the potential and the challenges of such ambitious rights-based legislation.

Application and implications of Mental Health Act 2007 (NSW) certificate use in acute generalist settings

2016 ◽  
Vol 40 (2) ◽  
pp. 219 ◽  
Author(s):  
Scott Lamont ◽  
Scott Brunero ◽  
Swapnil Sharma
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Need For Treatment ◽  
Professional Groups ◽  
Mental Health Act ◽  
Body Of Knowledge ◽  
South Wales ◽  
Care And Support ◽  
Mental Health Legislation ◽  
Health Legislation

Objective This retrospective study aimed to explore the appropriate application and implications of Mental Health Act 2007 (NSW) (MHA) certificate use in a metropolitan generalist hospital in New South Wales. Methods A de-identified MHA certificate review was undertaken within acute generalist medical and surgical specialties between June 2012 and May 2013. To assess differences, data were separated into two categories according to whether certificates were completed by psychiatry trainees or generalist medical officers. Analysis of indications for detention was also undertaken and qualitatively matched against legislative criteria. Results A total of 43 MHA certificates were included in the review, which highlighted missing elements in most certificates. Differences were found when professional consensus by the researchers was used to match documentation to legislative criteria. The researchers disagreed with nine of the 16 indications (mental illness/mental disorder) by the generalist medical officers and only one indication by a psychiatry trainee. Six of the certificates appeared to be related to lack of capacity and need for treatment of medical conditions, thus more related to Guardianship Act 1987 (NSW) applications. Conclusion This study highlights inconsistencies in legislative knowledge and requirements between professional groups. Education and training opportunities have been identified to ensure greater consistency in application of the MHA, preservation of patient rights and avoidance of stigma. MHA use in this setting should be exercised with caution and by appropriately trained individuals. What is known about the topic? The MHA and its state and territory counterparts provide for the treatment, care and support of people who have a mental illness and the protection of a person’s rights therein. Despite not being intended for application in generalist facilities, mental health legislation is widely used in generalist facilities and certificates are completed by generalist health professionals with limited training in this area of practice. What does this paper add? This study adds to the limited body of knowledge in relation to MHA detention in acute generalist facilities. Disparate preparation of medical officers in the use of this legislation has been identified, which has potential wider implications for patients beyond immediate care. What are the implications for practitioners? Inadequate attention to correct completion of MHA certificates and associated documentation could potentially invalidate detention, leaving healthcare professionals and institutions open to litigious claims that restrictive or coercive practices subsequent to the certificate’s completion were technically unlawful. Further, detention under the MHA, albeit temporarily, has potential human rights issues attached and wrongful detention could lead to longstanding issues relating to stigma.

scholarly journals Advance statements: survey of patients' views and understanding

2007 ◽  
Vol 31 (9) ◽  
pp. 339-341 ◽  
Author(s):  
Jane Foy ◽  
Alison Macrae ◽  
Alex Thom ◽  
Ajay Macharouthu
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Treatment Preferences ◽  
Clinical Implications ◽  
Loss Of Control ◽  
Mental Health Legislation ◽  
Advance Statements ◽  
Types Of Information ◽  
Health Legislation

Aims and MethodA survey of patients was undertaken to determine their knowledge and understanding of advance statements (a new addition to Scottish mental health legislation introduced with the Mental Health (Care and Treatment) (Scotland) Act 2003). Few patients have taken up this facility and this study attempts to identify potential explanations.ResultsA minority of the initial 58 participants had heard of advance statements prior to the survey (5 of 58, 8.6%). After issuing information about advance statements, awareness and understanding increased significantly among those who completed the study, with 59% (16 of 27) now understanding the concept. The types of information that patients wished to be documented in an advance statement fell into two broad groups: treatment preferences and statements regarding loss of control and autonomy. Out of 27 participants 19 (70%) stated they would now consider drawing up an advance statement.Clinical ImplicationsA lack of knowledge among patients about the existence of advance statements is highlighted. After a brief intervention, awareness, understanding and interest increased significantly, suggesting that poor uptake could be because of lack of awareness. Most participants would consult mental health professionals when drawing up an advance statement, therefore we have a responsibility to be fully informed about the process.

Procedures for involuntary admission to public and private psychiatric facilities

1992 ◽  
Vol 9 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Conor Farren ◽  
Declan McLoughlin ◽  
Anthony Clare
Keyword(s):  
Mental Health ◽  
Private Hospital ◽  
Formal Method ◽  
Demographic Data ◽  
Psychiatric Hospitals ◽  
Initial Assessment ◽  
Involuntary Admission ◽  
Public And Private ◽  
Mental Health Legislation ◽  
Health Legislation

AbstractObjective: The aims of this study were to assess the procedures for involuntary admission to both public and private psychiatric hospitals as determined by the Mental Treatment Act, 1945 which is one of the oldest pieces of mental health legislation in the EC. Method: Over a prospective five month period all involuntary admissions to both a public and a private hospital in Dublin were studied. Social-demographic data and clinical features of 54 involuntary admissions were recorded and analysed. Results: 11.2% of public admissions were involuntary as were 3.4% of admissions to the private hospital. The most common diagnoses were schizophrenia and mania. 74.1% of the patients had been previously admitted. 81.5% of the patients were detained in hospital for less than three months although they were committed for a potential six months. There was no formal method of decertification. Conclusions: There appears to be little need nowadays for differentiating between legislation for public and private patients. The duration of the initial reception order should be reduced from six months to a period of forty-eight hours for initial assessment and treatment. If necessary this could be extended to three months. Formal methods for decertification are required. Mental health legislation in Ireland needs to be modernised.

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