scholarly journals When all else fails

1999 ◽  
Vol 23 (11) ◽  
pp. 654-656 ◽  
Author(s):  
Stephen Pereira ◽  
Dominic Beer ◽  
Carol Paton
Keyword(s):  
Mental Health ◽  
Treatment Option ◽  
Oral Treatment ◽  
Clinical Implications ◽  
Small Minority ◽  
Clozapine Treatment ◽  
Blood Tests ◽  
Mental Health Act ◽  
Valuable Treatment ◽  
Treatment Refractory

Aims and methodA small minority of treatment-refractory patients who could benefit from treatment with clozapine, refuse to comply with blood tests or oral treatment. Treatment with clozapine can be enforced under the Mental Health Act.ResultsAn aide memoire was developed locally to guide clinicians through the process of enforcing clozapine treatment.Clinical implicationsIt is possible to enforce treatment with clozapine under the Mental Health Act and so offer a valuable treatment option.

scholarly journals Adolescent units: a need for change?

2003 ◽  
Vol 27 (8) ◽  
pp. 292-294 ◽  
Author(s):  
Tim Calton ◽  
Jon Arcelus
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
General Purpose ◽  
Clinical Implications ◽  
Violent Behaviour ◽  
Mental Health Act

Aims and MethodTo describe the characteristics and diagnoses of patients admitted to a general adolescent psychiatric in-patient unit. We describe the age, gender and psychiatric diagnosis of the patient, as well as whether the patient exhibited violent behaviour in the ward, whether he/she needed to be transferred to a different service and whether he/she was admitted under a section of the Mental Health Act 1983.ResultsPatients were evenly distributed in terms of gender, with most being 14–16 years old. Diagnoses were varied with adjustment disorder predominating, but could be separated into four main groups. Levels of violence were high, being associated with detention under the Mental Health Act 1983, and often resulted in transfer to another service.Clinical ImplicationsThe needs of certain adolescents admitted to a general-purpose adolescent unit may not be best met in this environment. Current services must change to meet the needs of their patients. There may be a need for greater specialisation.

scholarly journals Workload implications of the proposed new Mental Health Act – an audit

2003 ◽  
Vol 27 (02) ◽  
pp. 54-57
Author(s):  
Sean Whyte ◽  
Clive Meux
Keyword(s):  
Mental Health ◽  
Clinical Care ◽  
White Paper ◽  
Law Reform ◽  
Clinical Implications ◽  
Health Law ◽  
Forensic Patients ◽  
Mental Health Act ◽  
The Government ◽  
Time Required

Aims and Method To estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government's white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated. Results The amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected. Clinical Implications If the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time – or other services for patients will suffer.

scholarly journals Place of safety orders in England: changes in use and outcome, 1984/5 to 2010/11

2013 ◽  
Vol 37 (3) ◽  
pp. 89-93 ◽  
Author(s):  
Patrick Keown
Keyword(s):  
Mental Health ◽  
Annual Rate ◽  
Clinical Implications ◽  
Absolute Rate ◽  
Annual Change ◽  
Mental Health Act ◽  
Real Increase ◽  
The Absolute

Aims and methodTo detail changes in the use of place of safety orders in England, including the outcome of these detentions, using publicly available data.ResultsThere was a sixfold increase in the rate of the Mental Health Act Section 136 detentions to places of safety in hospitals between 1984 and 2011. The use of Section 135 and the rate of subsequent detention under Section 2 or 3 also increased, but the proportion of people detained fell as the absolute rate of detention increased. There was a wide variation between regions in the use of hospitals or police stations as places of safety. The change in the annual rate of detention under Section 136 was associated with the annual change in the population of England.Clinical implicationsThe increase in detentions to places of safety in hospitals may in part reflect their move from police cells. It may also reflect a real increase in overall rate of detention and possibly a change in the threshold for the use of Section 136 detentions.

Mental health review tribunal medical reports

1998 ◽  
Vol 22 (10) ◽  
pp. 615-618 ◽  
Author(s):  
Khalida Ismail ◽  
Shubulade Smith ◽  
Tony Maden
Keyword(s):  
Mental Health ◽  
Forensic Psychiatry ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Mental Health Act ◽  
Acceptable Standard ◽  
Medical Reports ◽  
Health Review

Aims and methodMedical reports submitted to mental health review tribunals should be of a clinically acceptable standard. We examined 100 medical reports to assess whether they stated the four criteria for detention under Section 3 of the Mental Health Act 1983. We compared the standard of reports according to the seniority, qualifications and speciality of the doctor, and with the outcome from the tribunal.ResultsThe majority of the reports were written by junior doctors and did not fulfil the criteria laid down by the Mental Health Act 1983. Consultant and forensic psychiatry status were associated with completed reports.Clinical implicationsThis study was performed in one hospital only but highlights the ongoing need to review and improve the workings of the Mental Health Act before reform is considered.

scholarly journals The Mental Health Act 1983

1999 ◽  
Vol 23 (9) ◽  
pp. 534-536 ◽  
Author(s):  
Vijay Bhatti ◽  
Jeremy Kenney-Herbert ◽  
Rosemarie Cope ◽  
Martin Humphreys
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Practice ◽  
Random Sample ◽  
Clinical Implications ◽  
The West ◽  
Mental Health Act ◽  
West Midlands

Aims and methodA one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.ResultsEighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.Clinical implicationsThere was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.

scholarly journals Competency and use of the Mental Health Act – a matrix to aid decision-making

2002 ◽  
Vol 26 (3) ◽  
pp. 104-106
Author(s):  
Jacinta Tan ◽  
Martin Elphick
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Good Practice ◽  
Clinical Situation ◽  
Clinical Implications ◽  
Clear Understanding ◽  
Mental Health Act ◽  
Aid Decision

Aims and MethodCompetence in patients with mental illness is an issue of growing importance. We present a matrix that provides a new tool to separate the elements involved.ResultsThis matrix is compatible with, and makes explicit, the Richardson Committee's suggestions concerning the incorporation of a test of capacity in Mental Health Act assessments.Clinical ImplicationsWe suggest that use of this matrix may offer practical help to clinicians in arriving at a clear understanding of each clinical situation and guide good practice in the use of the Mental Health Act, particularly in problematic cases.

scholarly journals Managing restricted patients in acute, non-secure in-patient services: clinical, ethical and resource implications of long waits for a response from the Ministry of Justice

2021 ◽  
pp. 1-6
Author(s):  
Gunjan Sharma ◽  
Penelope Brown ◽  
Ijaz Ur Rehman ◽  
Edward Chesney
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Clinical Implications ◽  
Mental Health Act ◽  
The Mean ◽  
Using Data

Aims and method In-patients subject to Section 37/41 of the Mental Health Act 1983 (MHA) require permission from the Ministry of Justice (MoJ) for leave, transfer and discharge. This study aimed to quantify the time spent waiting for the MoJ to respond to requests, using data on restricted patients recalled to a non-forensic unit over 8 years. Results Eleven admissions were identified. The mean total time waiting for response was 95 days per admission, with an estimated cost of £40 922 per admission. Clinical implications Current procedures may contribute to considerable increases in length of stay. This goes against the principles of the MHA, as non-secure services rarely provide the range of interventions which justify prolonged admission. We suggest several ways to resolve this issue, including broadening the guidance for the use of voluntary admissions and civil sections, and allowing clinicians to make decisions on leave and transfer where there is little risk.

scholarly journals Haematological monitoring for clozapine: do patients know why?

1995 ◽  
Vol 19 (9) ◽  
pp. 536-537 ◽  
Author(s):  
Carol Paton ◽  
Paul Wolfson
Keyword(s):  
Mental Health ◽  
Side Effects ◽  
Small Proportion ◽  
Second Opinion ◽  
Treatment Resistant ◽  
Blood Tests ◽  
Mental Health Act ◽  
Education Of Patients ◽  
Consent To Treatment

Clozapine is effective in treatment resistant schizophrenia, but unfortunately is associated with a 3% incidence of neutropenia. Regular haematological monitoring is mandatory for all patients. We asked forty patients who had been taking clozapine for more than six months why they thought they had to have regular blood tests. Almost half did not know and only a small proportion were subject to a Mental Health Act (MHA) second opinion for consent to treatment. Initial explanations of the potentially serious side effects of clozapine may not be understood or retained. Ongoing education of patients is essential. The wider use of MHA second opinion doctors should also be considered.

scholarly journals The simulated mental health review tribunal – a valuable training tool for senior house officers?

2007 ◽  
Vol 31 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Asim Naeem ◽  
Bhanu Gupta ◽  
Joan Rutherford ◽  
Audrey Gachen ◽  
Sarah Roberts
Keyword(s):  
Mental Health ◽  
Formal Training ◽  
Clinical Implications ◽  
England And Wales ◽  
Training Tool ◽  
Confidence Levels ◽  
Mental Health Act ◽  
Health Review ◽  
Simulated Training ◽  
Academic Programme

Aims and MethodPsychiatric senior house officers currently receive little formal training in how to give testimony at mental health review tribunals. The development of a simulated tribunal workshop for trainees, which is group-based, interactive and experiential in nature, with meaningful user and carer input is described.ResultsWe have incorporated simulated mental health review tribunal workshops into our academic programme and these have been successfully evaluated. Feedback has shown a marked increase in the confidence levels of trainees regarding tribunals.Clinical ImplicationsThe new Mental Health Act (England and Wales) is likely to place increasing demands on psychiatrists, in terms of giving testimony at mental health review tribunals. Simulated training for senior house officers, incorporating user and carer perspectives, can improve their skills and confidence in presenting at actual tribunals.

scholarly journals Engaging patients as teachers of clinical interview skills

2003 ◽  
Vol 27 (08) ◽  
pp. 312-315 ◽  
Author(s):  
George Ikkos
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Vocational Training ◽  
Point Of View ◽  
Clinical Implications ◽  
Patient Relationship ◽  
Small Minority ◽  
Training Scheme ◽  
Overall Evaluation ◽  
Training Schemes

Aims and Method To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors' understanding of the patient point of view and of the complexity of the doctor–patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills' workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire. Results Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive. Clinical Implications Engagement of patients as teachers of psychiatrists in training and other new doctors in mental health services is desirable, feasible and welcomed by most doctors. With due attention to the legitimate sensitivities of participants, the practice of engaging patients as teachers of doctors working in psychiatry could be generalised in training schemes and services across the country.

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