scholarly journals Coercive Measures and Stigmatization in the Psychiatric Medical Care

2020 ◽  
Vol 11 (3sup1) ◽  
pp. 137-145
Author(s):  
Petronela Nechita ◽  
◽  
Liliana Luca ◽  
Alina-Ioana Voinea ◽  
Codrina Moraru ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Disorders ◽  
Psychiatric Hospital ◽  
Treatment Compliance ◽  
Mental Illnesses ◽  
Internal Conflict ◽  
Involuntary Admission ◽  
Coercive Measures ◽  
Self Harm ◽  
The Law

The involuntary commitment of psychiatric patients has been done for almost a decade under the Law 487/2002, the law of mental health and protection for people with psychiatric disorders. Frequent involuntary psychiatric hospitalizations have led to stigma attitudes and discriminatory acts towards patients with mental disorders. The coercive medical measures are applied in the psychiatric institutions of the mental health protection agencies. Coercion gives rise to serious ethical debates in the psychiatric assistance. The individual who was hospitalized in a psychiatric hospital anticipates social rejection becoming defensive, withdraws socially, experiences a complex internal conflict. The goal for this study is to illustrate aspects linked to coercive measures, mechanical restraint at involuntary admission of patients with mental illnesses in the psychiatric medical assistance. Material and method: This study is a retrospective one, and the data was taken from the charts with involuntary admissions during the period of October 2002 to July 2012. The studied lot was comprised of 202 patients admitted involuntarily in a psychiatric hospital according to the Law 487/2002, the law of mental health and protection for people with psychiatric disorders. Results: Of the 25.7% patients admitted involuntarily, that required coercive measures during admission, 58% were contained for symptoms like self-harm. The mechanical contention measures were especially necessary in the acute cases with symptoms as self-harm and/or harm of others, but also in situations with hallucinatory-delirium symptoms. The ratio of male sex subjects was significantly higher in the subject lot that needed coercive measures during hospitalization, of those admitted involuntarily (86.5% vs. 72%) (p = 0.036). Conclusions: Involuntary admission and mandatory treatment remains in psychiatry a medical, legal and ethical problem. The required measures can lead mainly to clinical benefits, implying a paternal attitude from the psychiatry specialists by defying the patients’ autonomy. Treatment compliance is directly proportional to the overall level of functioning and inversely proportional to the level of self-stigmatization.

scholarly journals Social services Interventions and the Mental Health and Mortality of care leavers: a population based data linkage study in Northern Ireland and Finland

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Aideen Maguire ◽  
Anne Kouvonen ◽  
Dermot O'Reilly ◽  
Hanna Remes ◽  
Joonas Pitkänen ◽  
...  
Keyword(s):  
Mental Health ◽  
Northern Ireland ◽  
Health Outcomes ◽  
Social Services ◽  
Psychiatric Hospital ◽  
Poor Mental Health ◽  
Mental Health Outcomes ◽  
Care Intervention ◽  
Increased Risk ◽  
Self Harm

BackgroundResearch has highlighted the poor mental health of looked after children compared to those never in care. However, little is known on what becomes of these children and their mental health trajectories after they leave the care of social services. In addition, previous studies are limited in their ability to differentiate between type of social care intervention received; kinship care, foster care or residential care. AimTo utilise nationwide social services data from two countries (Northern Ireland (NI) and Finland), with similar populations but different intervention policies, linked to a range of demographic and health datasets to examine the mental health outcomes of young adults in the years following leaving care. MethodsData from both countries on children born 1991-2000 were linked to social services data, hospital admissions, prescribed medication data and death records. Mental health outcomes were defined after the age of 18years (when statutory care provision ends) examined by care intervention and included admissions to psychiatric hospital, for self-harm and death by suicide. ResultsThe gender split in care in Finland is reflective of the population but more males are in care in NI. Initial results from Finnish data suggest those exposed to care in childhood have an increased risk of self-harm, psychiatric hospital admission and suicide after the age of 18years compared to those never in care. After adjusting for gender, age of entry to care and deprivation at birth those exposed to any care intervention had 3 times the risk of suicide (HR=3.06, 95% CI 1.18,7.98). Risk increased with duration in care but was equivalent across care intervention types. Analysis on the NI data is underway. ConclusionFull results will be available December 2019 and will explore which care pathways are most associated with poor mental health outcomes informing discussion around intervention opportunities and policy.

Assessment of Suicide Risk

1987 ◽  
Vol 150 (2) ◽  
pp. 145-153 ◽  
Author(s):  
K. Hawton
Keyword(s):  
Mental Health ◽  
Psychiatric Disorders ◽  
Psychiatric Hospital ◽  
Suicide Risk ◽  
Clinical Skills ◽  
Clinical Decisions ◽  
Suicide Attempters ◽  
Mental Health Act ◽  
Hospitalised Patients ◽  
The Many

Among the many clinical skills that psychiatrists must acquire, the ability to assess the risk of patients killing themselves is probably the most important and demanding. It is often a crucial factor when making clinical decisions, such as in the choice of treatments, when deciding whether admission to a psychiatric hospital is necessary and when implementing the Mental Health Act. This review first explores the problems in assessing suicide risk. Subsequently, the risks of suicide for patients with major psychiatric disorders and for particular clinical populations, including hospitalised patients and suicide attempters, are examined together with the findings from research investigations which can assist psychiatrists when making decisions about the risk of suicide.

scholarly journals Fractured minds to flourishing minds

2021 ◽  
Author(s):  
◽  
Rebecca Wallace
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
New Zealand ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Mental Illnesses ◽  
High Rate ◽  
Youth Suicide ◽  
Health And Wellbeing ◽  
Self Harm

<p>Youth suicide and self-harm are major public health concerns worldwide. The high rate of youth suicide and intentional self-harm in New Zealand, illustrates that there is a large amount of youth experiencing severe mental illness, as mental illness corresponds to suicidal/harmful behavior. Although more youth are seeking and receiving help, a large portion who are suffering are unwilling to engage in services, due to stigma surrounding mental health. Characteristics of the built environment can effect wellbeing and therefore architecture holds significant implications for the mental health of individuals.  Inpatient environments are an effective intervention for the treatment of a range of severe mental illnesses, however there is a definitive lack of acute inpatient facilities for youth in New Zealand. A shift in the way mental healthcare services are provided has meant that large psychiatric hospitals have been closed or downsized and compulsory inpatient treatment has given way to voluntary engagement with community mental health services. This has not eliminated the need for inpatient care and there still remains a need for these highly specialized environments. These current specialized environments are generally not designed to benefit the mental health and wellbeing of patients, but are just regarded as settings in which recovery takes place.  This thesis aims to explore how architecture can act therapeutically to support the wellbeing of individuals suffering mental illness. It looks at how architecture can retain the dignity of these patients, and challenge conventional norms of prior mental healthcare environments. This thesis aims to integrate Maori and Pacific models of health and wellbeing in order to allow improved care and treatment for Maori and Pacific groups. It responds to the lack and unsuccessful architectural responses for youth in New Zealand and in particular, the central region and aims to design a new mental health inpatient and outpatient facility specifically for youth suffering mental illness.</p>

scholarly journals Web-Based Graphic Representation of the Life Course of Mental Health: Cross-Sectional Study Across the Spectrum of Mood, Anxiety, Eating, and Substance Use Disorders

10.2196/16919 ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e16919 ◽  
Author(s):  
Robin Leora Aupperle ◽  
Martin P Paulus ◽  
Rayus Kuplicki ◽  
James Touthang ◽  
Teresa Victor ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Substance Use ◽  
Psychiatric Disorders ◽  
Mental Health Treatment ◽  
Mental Illnesses ◽  
Graphical Representations ◽  
Positive Events ◽  
Health Treatment ◽  
Web Based

Background Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations, termed life charts, for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (ie, bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization. Objective This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a Web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders. Methods The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depressive, anxiety, substance use, or eating disorders and healthy comparisons (HCs). All data were entered electronically, and a 1-page electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For 8 distinct life epochs (periods of approximately 5-10 years), the TLC assessed the following factors: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used generalized linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and Web-based interactive graphs to visualize data. Results GLMM analyses revealed main or interaction effects of epoch and diagnosis for all domains. Epoch by diagnosis interactions were identified for mood ratings and the number of negative-versus-positive events (all P values <.001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than HCs. These differences were most robust at different epochs, depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P<.001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (mean 3.07, SD 1.26) and useful for understanding their mental health (mean 3.07, SD 1.26), and that they were likely to recommend it to others (mean 3.42, SD 0.85). Conclusions The TLC provides a structured, Web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, 1-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members.

scholarly journals The attitudes and feelings of mental health nurses towards adolescents and young adults with nonsuicidal self-injuring behaviors

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Matejka Pintar Babič ◽  
Branko Bregar ◽  
Maja Drobnič Radobuljac
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Psychiatric Hospital ◽  
Negative Emotions ◽  
Statistical Significance ◽  
Working Environment ◽  
Self Report ◽  
Adolescents And Young Adults ◽  
Supervisory Support ◽  
Self Harm

Abstract Background Attitudes towards patients with self-harm behaviors are decisive for the quality of the relationship of healthcare professionals towards them, which is further linked to successful treatment. In mental health settings, nurses are the ones spending the longest time caring for these patients. Nurses often experience negative emotions while delivering care which may lead to professional burnout and suboptimal patient care. The purpose of this study was to explore the feelings and attitudes of nurses working in different psychiatric hospital settings toward adolescents and young adults with non-suicidal self-injury (NSSI). Subjects and methods The subjects were nurses from the tertiary psychiatric hospital who deliver mental health care to patients with NSSI on a daily basis (n = 76; 20 males, 56 females; average age 42 ± 8 years; average working experience 20 ± 9 years). Data were collected via a self-report questionnaire consisting of three parts (sociodemographic data, Emotional Burden, Adapted Self-Harm Antipathy-Scale). In the latter two parts of the questionnaire, the subjects rated their level of agreement with the emotions and statements on a five-point Likert scale. Nonparametric tests were used for statistical analysis. The statistical significance was set to p < 0.05. Results The emotions of nurses towards patients with NSSI were not very negative and the attitudes were positive. Powerlessness was the most prevalent (3.55 ± 1.038) of the studied emotions, followed by uncertainty (3.21 ± 1.225). The subjects disagreed with feeling anger (2.34 ± 1.17) and despair (2.07 ± 1.09) and were undecided about being afraid (3.07 ± 1.2). The nurses with higher education felt more negative emotions than those with medium education. Education did not affect nurses’ attitudes. The nurses from non-psychotherapeutic units felt more negative emotions and less positive attitudes than those from psychotherapeutic units. Gender did not affect the emotions felt towards patients, but the female nurses held more positive and less negative attitudes. Conclusions The respondents expressed low levels of negative emotions and positive and caring attitudes towards patients with NSSI, indicating a good predisposition for empathetic work and long-term burnout prevention. However, the differences observed with regards to education, gender and especially working environment indicate the different needs for environmental, educational and supervisory support.

Controlled assessment of alcoholics admitted involuntarily to a general psychiatric hospital

1996 ◽  
Vol 13 (4) ◽  
pp. 140-143
Author(s):  
Fionnula O'Loughlin ◽  
Marcus Webb
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Alcohol Dependence ◽  
Psychiatric Hospital ◽  
Involuntary Admission ◽  
Compulsory Admission ◽  
Mental Health Act ◽  
Mental Treatment

AbstractObjective:As the provision for the involuntary admission to hospital of alcoholics is likely to be discarded in a new Irish Mental Health Act, the characteristics of patients committed under the 1945 Irish Mental Treatment Act were explored and compared with those alcoholics admitted voluntarily.Method:All alcoholics admitted compulsorily from 1989-1992 to a general psychiatrichospital in Dublin were compared retrospectively with voluntarily admitted alcoholics. Data was taken from case notes.Results:Results showed that patients admitted compulsorily were older (t = 3.74, df = 62, p < 0.001) and had more physical complications (X2= 8.4, df = 1, p < 0.004) than those admitted voluntarily. Although results did not reach a statistically significant level, there were proportionately more females in the compulsorily admitted group compared with the voluntary group. The outcome of admission overall was better in those admitted voluntarily, although this was influenced both by length of stay and previous admissions for treatment of alcohol dependence. One particularly interesting finding, regardless of admission category, was that duration of admission was statistically significantly longer for women when compared with men.Conclusions:Compulsory admission of alcoholics to a psychiatric hospital for very brief periods was not shown to be strikingly helpful, but this study cannot decide whether or not longer periods of compulsory admission would be valuable.

scholarly journals Rates and Correlates of Involuntary Hospitalization in a Large Psychiatric Hospital 2014-2017 under China’s Mental Health Law introduced in 2013

2020 ◽  
Author(s):  
Yarong Ma ◽  
Robert Rosenheck ◽  
Hongbo He
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Psychiatric Hospital ◽  
Logistic Regression Analysis ◽  
Mental Illnesses ◽  
Health Law ◽  
Involuntary Hospitalization ◽  
Mental Health Law ◽  
Adjusted Risk

Abstract Background: Involuntary hospitalization (IH) is a controversial issue in psychiatry as it risks violation of the human right to autonomy. This study aimed to examine the rates and correlates of IH in a large psychiatric hospital from 2014-2017 after China’s Mental Health Law (MHL) was implemented in 2013 specifying criteria for IH and a structured assessment was required for IH.Methods: Unduplicated electronic medical records concerning all inpatients admitted to the Guangzhou Psychiatric Hospital with primary psychiatric diagnoses were examined and trends in annual IH rates were examined. We extracted medical, sociodemographic and socioeconomic data from these records to identify correlates of IH using bivariate chi square tests followed by logistic regression analysis. Results: Of 11,086 hospitalized patients, there was a significant but small increase from 71.6% to 74.9% in rates of IH in the years after the structured assessment was implemented. Logistic regression analysis showed IH was positively associated with being younger, having a local residence, and a diagnosis of bipolar disorder, schizophrenia spectrum disorders or a substance abuse disorder as compared to those diagnosed with major depressive disorder.Conclusions: Adjusting for these factors those with IH had a longer length of stays. Under China’s Mental Health Law in 2013, and a locally implemented checklist, the adjusted risk of IH increased significantly, but by only 3.3% from 2014 to 2017. IH was greatest younger patients with severe mental illnesses, and those with local access to psychiatric hospital services.

Psychiatric emergencies

2010 ◽  
pp. 669-690
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir Sam
Keyword(s):  
Mental Health ◽  
Alcohol Withdrawal ◽  
Common Law ◽  
Deliberate Self Harm ◽  
Psychiatric Emergencies ◽  
Confusion Assessment ◽  
Mental Health Act ◽  
Self Harm ◽  
Acute Confusion ◽  
The Law

Acute confusion: assessment 670 Acute confusion: management 672 Acute alcohol withdrawal 674 Dealing with violent patients 676 Deliberate self-harm 678 The Mental Health Act and common law 680 Treating patients against their will 682 The law on consent and capacity 683 Patients who do not wish to stay in hospital ...

scholarly journals Psychiatric effects of cannabis

2001 ◽  
Vol 178 (2) ◽  
pp. 116-122 ◽  
Author(s):  
Andrew Johns
Keyword(s):  
Mental Health ◽  
At Risk ◽  
General Population ◽  
Adverse Effects ◽  
Psychiatric Disorders ◽  
Health Workers ◽  
Developed Countries ◽  
Mental Illnesses

BackgroundCannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.AimsTo re-evaluate the adverse effects of cannabis in the general population and among vulnerable individuals, including those with serious psychiatric disorders.MethodA wide-ranging review of the topics related to these issues.Results and conclusionsAn appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.

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