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.

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.

scholarly journals Least restrictive alternative – advance statements and the new mental health legislation

2002 ◽  
Vol 26 (7) ◽  
pp. 246-247 ◽  
Author(s):  
J. M. Atkinson ◽  
H. C. Garner
Keyword(s):  
Mental Health ◽  
Home Office ◽  
Policy Makers ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
Advance Statements ◽  
Restrictive Environment ◽  
The Patient’S View ◽  
Health Legislation ◽  
Least Restrictive Alternative

Proposals for new mental health legislation make the case for using the ‘least restrictive alternative’ (Scottish Executive, 2001) and the ‘least restrictive environment’ (Department of Health & Home Office, 2000) as guiding principles in deciding the management and treatment of the patient. This appears to be the case made for introducing compulsory treatment in the community. The patient living in the community, while maintained on medication, rather than the hospital would appear to be defined as on the ‘least restrictive alternative’. This, however, takes only a limited approach to what is ‘restrictive’, which should be interpreted more widely, including the patient's view as well as that of clinicians and policy makers. Thus, a patient may see it as less restrictive during an acute phase to be in hospital and not on medication, than in the community but on medication. It is likely, given our knowledge of patients' attitudes to medication (Eastwood & Pugh, 1997), that many patients will prefer to be on oral medication rather than depot, which they see as less restrictive.

scholarly journals Medical certification of incapacity in guardianship applications: conceptualising capacity

2016 ◽  
Vol 40 (1) ◽  
pp. 41-44
Author(s):  
Tom C. Russ ◽  
Alison Thomson ◽  
Donald Lyons
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Due Process ◽  
Clinical Implications ◽  
Medical Practitioners ◽  
Medical Certification ◽  
Mental Health Legislation ◽  
Medical Reports ◽  
Definition Of ◽  
Health Legislation

Aims and methodTo examine how capacity is recorded in practice and compare this with the statutory definition, medical reports accompanying a random 10% sample (183 applications; 360 reports) of guardianship applications granted in 2011–2012 were examined.ResultsClinicians did not explicitly use the statutory definition of capacity in 47.5% of reports. Over half of applications (56.4%) did not explicitly link the powers sought with the patient's vulnerabilities; such a link was less common in older adults (P = 0.0175).Clinical implicationsGuardianship orders can justify deprivation of liberty. Therefore it is important that such cases involve a thorough assessment of the person and that due process is followed, including adherence to the statutory definition of capacity. Practice could be improved by altering the paperwork required of medical practitioners, in line with mental health legislation. In addition, these findings should inform current legislation reform.

Use of the Mental Health (Scotland) Act (1984) in south Glasgow

2003 ◽  
Vol 27 (4) ◽  
pp. 141-144 ◽  
Author(s):  
John R. Taylor ◽  
K. B. Idris
Keyword(s):  
Mental Health ◽  
Information System ◽  
Psychotic Disorders ◽  
Clinical Implications ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hand Search ◽  
Health Officer ◽  
Mental Health Legislation ◽  
Health Legislation

Aims and MethodA cross-sectional survey of the use of the Mental Health (Scotland) Act 1984 in a defined urban area. Patients initially detained under civil sections (Sections 24, 25, 26 and 18) between 1 April 1997 and 31 March 1998 were identified using the hospital information system and a hand search of section papers.ResultsThere were 283 detentions involving 204 patients that lasted a median of 6 days. A total of 98% of patients were initially detained on a 72-hour ‘emergency section’. A total of 61% had non-organic psychotic disorders (172/283). Less than half of detentions were during the working week. Consent was usually provided by the mental health officer or relatives, but was not provided for 11% of detentions. Patients detained after admission were more likely to be detained for a longer period (29 v. 3 days) and to have their detention extended over 72 hours (64% v. 41%) compared with those detained in the community.Clinical ImplicationsThis paper provides information on some of the gaps identified by recent reviews of mental health legislation in Scotland and discusses the possible impact of the changes proposed by the Millan Committee. The workload of general adult consultant psychiatrists is likely to increase and the proportion of patients detained without consent could also increase. The study supports the differentiation of patients detained after admission from those detained in the community, as the patterns of detention are different.

scholarly journals The Debt and Mental Health Evidence Form

2010 ◽  
Vol 34 (3) ◽  
pp. 95-100 ◽  
Author(s):  
Chris Fitch ◽  
Robert Chaplin ◽  
Simon Tulloch
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Qualitative Data ◽  
Mental Health Problems ◽  
Clinical Information ◽  
Relevant Information ◽  
Clinical Implications ◽  
Stakeholder Groups ◽  
Question Form

Aims and methodTo develop a standardised clinical information form which helps health professionals provide clear and relevant information about individuals who believe mental disorders affect their ability to repay debt and have consented to creditor organisations or money advisors approaching professionals for evidence. The six-question form was evaluated by three stakeholder groups.ResultsOverall, 35 responses were received from creditors/money advisors, 28 from mental health professionals and 29 from service users/carers. All questions scored acceptable levels of clarity and three questions scored acceptable relevance levels. Qualitative data were used to revise questions on the basis of concerns expressed by stakeholders about sharing diagnostic data, providing prognoses, and the risk of creditor misunderstanding.Clinical implicationsThe form is likely to be an acceptable standardised means by which health professionals can elicit information on debt from individuals with mental health problems, for use by creditor organisations or money advisors. The results of a pilot study are awaited.

scholarly journals Copying clinic letters to psychiatric patients

2005 ◽  
Vol 29 (9) ◽  
pp. 327-329 ◽  
Author(s):  
Tayyeb A. Tahir ◽  
Jonathan I. Bisson ◽  
Jodie Wilcox
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Therapeutic Relationship ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Local Community ◽  
Psychiatric Patients ◽  
Clinical Implications ◽  
Working Groups ◽  
Considerable Work

Aims and MethodTo assess the views of patients and mental health professionals on the practice of copying clinical letters to patients. Patients and professionals from local community mental health teams were asked to complete a questionnaire regarding their views.ResultsThe questionnaires were completed by 51 patients and 40 mental health professionals. Significantly more patients (83%) than staff (37%) thought that copying letters to patients was a good idea (OR=14.56, 95% CI 4.674 –45.158). Many staff appeared concerned that copying letters to patients could result in breakdown of the therapeutic relationship, causing distress and anxiety.Clinical ImplicationsConsiderable work is needed for clinicians to feel comfortable in copying letters to patients. The creation of working groups, including users, carers, managers and clinicians working in the field of mental health, would facilitate the development of guidelines for this practice.

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.

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 ‘We've got another one for you!’ Liaison psychiatry's experience of stigma towards patients with mental illness and mental health professionals

2012 ◽  
Vol 36 (12) ◽  
pp. 450-454 ◽  
Author(s):  
Jim Bolton
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
General Hospital ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Clinical Communication ◽  
The Impact

Aims and methodTo assess stigmatising attitudes towards mental illness and psychiatric professionals experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital.ResultsOut of 72 multidisciplinary respondents, over three-quarters had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least monthly. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services.Clinical implicationsLiaison psychiatry is well placed to both recognise and combat stigma in the general hospital. This can help to ensure that patient care is comprehensive, safe and respectful.

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