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.

Consultant Psychiatrists' Knowledge of Mental Health Legislation in Scotland

1998 ◽  
Vol 38 (3) ◽  
pp. 237-241 ◽  
Author(s):  
Martin Humphreys
Keyword(s):  
Mental Health ◽  
Health Law ◽  
Apparent Lack ◽  
Mental Health Law ◽  
Medical Practitioners ◽  
Mentally Disordered ◽  
Mental Health Legislation ◽  
Localized Patterns ◽  
Level Of Understanding ◽  
Health Legislation

There has been increasing concern recently over an apparent lack of knowledge of mental health law among psychiatrists and other medical practitioners involved in its use. This has been particularly highlighted by the introduction of new and complex legislation intended to facilitate care in the community. As a result of findings from previous studies of other groups of medical practitioners in Scotland, a national survey of consultant psychiatrists working there was undertaken to determine their level of understanding of the statutory provision for the care of the mentally disordered. A purpose-designed instrument was used at interview with 72 consultants chosen at random from all psychiatric specialties. Their knowledge of even the most basic definitions and fundamental areas was limited, with only just over half being able to give the correct title of one relevant piece of legislation and only one in 10 being able to define mental disorder in terms of the Act. Otherwise knowledge was generally patchy. Greater emphasis should be placed upon training in mental health law for consultant psychiatrists in general, as the findings are unlikely to reflect purely localized patterns. Attitudes to the use of compulsory measures also need to be addressed.

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 Race equality, human rights and mental health legislation: Recent developments in England and Wales

2007 ◽  
Vol 13 (3) ◽  
pp. 3
Author(s):  
Lord Patel Of Bradford ◽  
Chris Heginbotham
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Disorder ◽  
Community Treatment ◽  
Mental Health Legislation ◽  
Recent Developments ◽  
Definition Of ◽  
Health Legislation ◽  
Treatment Order ◽  
Community Treatment Order

<p>England now has revised mental health legislation following the passage of a mental health Bill through both Houses of Parliament following protracted discussions over seven years. The Mental Health Bill 2006, amending the Mental Health Act 1983, eventually received Royal Assent on 19 July 2007. There is much that could be said about the new Act, which makes a number of important changes to the present legislation. These changes include a new single definition of mental disorder; the abolition of the so-called ‘treatability test’; and the extension of compulsion into the community through a supervised community treatment order.</p>

scholarly journals A comparison of mental health legislation in five developed countries: a narrative review

2017 ◽  
Vol 34 (4) ◽  
pp. 261-269 ◽  
Author(s):  
T. Cronin ◽  
P. Gouda ◽  
C. McDonald ◽  
B. Hallahan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Disorder ◽  
Developed Countries ◽  
International Standards ◽  
Mental Health Legislation ◽  
Patient Consent ◽  
The Republic ◽  
Definition Of ◽  
Health Legislation

ObjectivesTo describe similarities and differences in mental health legislation between five jurisdictions: the Republic of Ireland, England and Wales, Scotland, Ontario (Canada), and Victoria (Australia).MethodsAn in-depth examination was undertaken focussing on the process of involuntary admission, review of Admission Orders and the legal processes in relation to treatment in the absence of patient consent in each of the five jurisdictions of interest.ResultsAll jurisdictions permit the detention of a patient if they have a mental disorder although the definition of mental disorder varies between jurisdictions. Several additional differences exist between the five jurisdictions, including the duration of admission prior to independent review of involuntary detention and the role of supported decision making.ConclusionsAcross the five jurisdictions examined, largely similar procedures for admission, detention and treatment of involuntary patients are employed, reflecting adherence with international standards and incorporation of human rights-based principles. Differences exist in relation to the criteria to define mental disorder, the occurrence of automatic review hearings in a timely fashion after a patient is involuntarily admitted and the role for supported decision making under mental health legislation.

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

2003 ◽  
Vol 27 (04) ◽  
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 Method A 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. Results There 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 Implications This 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 Capacity-based mental health legislation and its impact on clinical practice: 1) admission to hospital

2014 ◽  
pp. 9
Author(s):  
John Bellhouse ◽  
Anthony Holland ◽  
Isabel Clare ◽  
Michael Gunn ◽  
Peter Watson
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Hospital Admission ◽  
Men And Women ◽  
England And Wales ◽  
Capacity To Consent ◽  
Mental Health Legislation ◽  
Definition Of ◽  
False Imprisonment ◽  
Health Legislation

<p>In this study, as capacity is ‘decision-specific’, we have assessed the capacity of men and women to make decisions about admission and treatment separately, using the Law Commission’s definition of incapacity. In this paper, we focus on a person’s capacity to consent to admission. Surprisingly, the courts in England and Wales have not directly explored the nature of the information relevant to a decision about admission to hospital. Admission without consent constitutes false imprisonment, which is both a civil tort, and a crime.</p>

Civil detentions of older adults under successive Scottish mental health legislation: a comparative analysis

2011 ◽  
Vol 23 (8) ◽  
pp. 1344-1353
Author(s):  
Gary S. Stevenson
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Disorders ◽  
Working Hours ◽  
Fold Increase ◽  
Short Term ◽  
Legal Intervention ◽  
Mental Health Legislation ◽  
The Common ◽  
Health Legislation

ABSTRACTBackground:Many countries have adopted new mental health legislation, with the detention of adults for treatment of mental disorders remaining an integral part of such policies. However, there are relatively few publications on the use of mental health legislation in the detention of older adults. This paper examines the civil detention of older adults in one Scottish region under successive mental health legislation.Method:This prospective study collected data primarily by clinician-based interviews on all emergency detentions under the Mental Health (Scotland) Act 1984 of older adults in 1994 and compared these with all emergency and initial short-term detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 of older adults during 2008 in the same Scottish region.Results:There were a total of 124 detentions, with an initial rate of 68 increasing to 141 detentions per 100,000 of the respective over-65 year age populations, a two-fold increase. Compared to the 1994 patient cohort, the 2008 cohort had higher rates of over 85-year-olds (18.4% v 5.4%) and organic mental disorders (74.7% v 56.8%) and were significantly more likely to be detained by consultant psychiatrists (73.6% v 18.9%) during working hours (87.4% v 48.6%) and proceed to six-month detention orders (31% v 10.8%).Conclusion:The observed higher rates and longer periods of detention in the 2008 cohort may reflect changes in clinical attitudes and legal requirements from a previous reliance on the common law doctrine of necessity to the requirements of a more legalistic framework, and may signal future clinical requirements, given the aging population, pointing towards the need for earlier recognition and management of clinical issues in an attempt to minimize the “necessity” of clinico-legal intervention.

scholarly journals Before and after: introduction of the Mental Health (Care and Treatment) (Scotland) Act 2003

2007 ◽  
Vol 31 (10) ◽  
pp. 374-377 ◽  
Author(s):  
Helen Smith ◽  
Tom White
Keyword(s):  
Mental Health ◽  
Health Care ◽  
De Novo ◽  
Clinical Implications ◽  
Royal Hospital ◽  
Mental Health Legislation ◽  
Before And After ◽  
Adult Psychiatry ◽  
Health Legislation ◽  
The Impact

Aims and MethodThe aim of the study was to assess the impact of the introduction of new mental health legislation in October 2005 on general adult psychiatry admissions. Patients were included in the study if they were admitted to Murray Royal Hospital, Perth from December 2004 to July 2005 and December 2005 to July 2006.ResultsFewer patients were detained but they were more likely to progress to longer-term detentions. Overall detained patients remained in hospital for shorter periods.Clinical ImplicationsThe change in de novo detention procedures reduced the number of de novo detentions. The new power to enforce medication in the community may have contributed to the reduced length of detention in hospital.

scholarly journals Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health

2016 ◽  
Vol 62 (4) ◽  
pp. 361-367 ◽  
Author(s):  
César Augusto Trinta Weber ◽  
Mario Francisco Juruena
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Care Center ◽  
Psychosocial Care ◽  
Models Of Care ◽  
Partial Hospitalization ◽  
Mental Health Legislation ◽  
Day Hospitals ◽  
Definition Of ◽  
Health Legislation

Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

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.

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