scholarly journals Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

2021 ◽  
Author(s):  
◽  
Grace Liang

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

2021 ◽  
Author(s):  
◽  
Grace Liang

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>


2021 ◽  
Author(s):  
◽  
Darren Mills

<p>Recovery is a conceptual model that underpins New Zealand’s mental health service delivery in the 21st century. This thesis explores how recovery emerged historically as an influential philosophy and how representations of recovery have changed to meet the needs of different groups. An inquiry, based on Foucault’s genealogical method, investigates the historical and contemporary forces of power that have shaped the construction of mental illness, and the development of methods and techniques to support and manage persons labelled as mentally ill. The normalisation of knowledge developed during 19th century psychiatric practice provided a context for later critique and resistance from movements that highlighted the oppressive power of psychiatric discourse. Key to the critique were the antipsychiatry and service user movements, which provided the conditions for the possibility of the emergence of recovery as a dominant discourse. Since its emergence, recovery has moved through a number of representations as it was taken up by different groups. A significant shift in the 21st century has been the dominance of neo-liberal discourse based on consumerism, a rolling back of the state, and an emphasis on individual responsibility. The implications of this shift for users and providers of services and their effects on current representations of recovery conclude the inquiry.</p>


2021 ◽  
Author(s):  
◽  
Rebecca McLaughlan

<p>Thousands of New Zealanders were treated in the nation’s mental hospitals in the late nineteenth and twentieth centuries. Existing research has examined this history of institutionalisation from the perspectives of policy, psychiatric medicine and nursing culture, but to date little has been written about the built fabric of this type of institutional care. This dissertation asks what does the architectural approach taken to Seacliff Asylum (1878-84), Kingseat Hospital (1927-40) and Cherry Farm Hospital (1943-71) indicate about official attitudes to mental illness in New Zealand. Architecture was thought to be capable of performing a curative role in the treatment of mental illness; the administrators of New Zealand’s mental hospitals stated this belief publically in various press releases and reports to the government between 1878 and 1957. This dissertation examines Seacliff, Kingseat and Cherry Farm against current thought regarding the treatment of mental illness and against best architectural practice in mental hospital design.   While these three institutions were the jewels in the crown of New Zealand’s mental hospital network, only Kingseat could be considered an exemplary hospital of its time. The compromises that occurred in the construction of Seacliff, Kingseat and Cherry Farm hospitals indicate that meeting the needs of the mentally ill was only one of a number of agendas that were addressed by the officials involved in the design of these institutions. Many of these agendas were peripheral to the delivery of mental health care, such as the political desire for colonial propaganda and professional concerns of marginalisation, and conflicted with the attainment of ideal environments for the treatment of mental illness. The needs of the mentally ill were a low priority for successive New Zealand governments who exhibited a reluctance to spend taxpayer funds on patients who were not considered curable. The architects and medical advisors involved in the design of these facilities did attempt to meet the needs of these patients; however, they were limited by a design and procurement process that elevated political and operational concerns over the curative potential of these hospitals.   This dissertation also examines the role of individuals in the design of these institutions. Architect Robert Lawson was reproached for deficiencies in the curative potential of Seacliff Asylum. Similarly, medical administrator Theodore Gray has received criticism for limiting the development of New Zealand’s wider network of mental hospital care. This dissertation establishes that Lawson and Gray deserve greater recognition for their relative contributions to the architecture created, within New Zealand, for the treatment of mental illness.</p>


2005 ◽  
Vol 186 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Michaela Amering ◽  
Peter Stastny ◽  
Kim Hopper

BackgroundEstablished legal mandates and high expectations for psychiatric advance directives are not matched by empirical evidence documenting their actual implementation.AimsTo explore the interests, concerns and planning activities of informed mental health service users contemplating such directives.MethodStandard qualitative research techniques were used: field observations, interviews, focus groups, archival research and key informant interviews; 33 persons participated in the interviews and focus groups. Transcripts were coded and analysed for thematic content, and results were member-checked.ResultsTraining set in motion labour-intensive projects: conceptualising how a psychiatric advance directive would work in one's life, mobilising resources, reviewing past experiences and assessing risks. Especially meaningful was the prospect of being treated as a responsible agent in future interactions with the mental health system.ConclusionsAdvance directives are best thought of as complex planning tools for future psychiatric crisis management, rather than focal interventions to enhance compliance. Research is needed to explore the institutional response to this prospective decision-sharing initiative.


2020 ◽  
Vol 68 ◽  
pp. 101537
Author(s):  
Jessie Lenagh-Glue ◽  
Katey Thom ◽  
Anthony O'Brien ◽  
Johnnie Potiki ◽  
Heather Casey ◽  
...  

1969 ◽  
pp. 810
Author(s):  
Aman S. Patel

This article explores the current schemes for sentencing guilty mentally ill offenders in Canada and the United Kingdom. The author highlights the deficiencies of the current Canadian scheme, arguing both that it is limited to the traditional sentencing smorgasbord and that principles of sentencing are difficult to balance with respect to guilty mentally ill offenders. In his analysis of the mental health sentencing dispositions available in the United Kingdom, the author assesses how such a scheme could be implemented in Canada and what modifications are necessary in order to better conform with Canadian law and policy, in particular, the areas concerning disposition thresholds, consent to treatment and discharge are examined. The author concludes that implementation of a hospital disposition in the Canadian sentencing regime is necessary to overcome conflicting sentencing principles and correctional aims, to address the lack of correctional programs and infrastructure courts encounter when sentencing guilty mentally ill offenders, and to enhance the protection of society — the primary goal in sentencing.


2021 ◽  
Author(s):  
◽  
Rebecca McLaughlan

<p>Thousands of New Zealanders were treated in the nation’s mental hospitals in the late nineteenth and twentieth centuries. Existing research has examined this history of institutionalisation from the perspectives of policy, psychiatric medicine and nursing culture, but to date little has been written about the built fabric of this type of institutional care. This dissertation asks what does the architectural approach taken to Seacliff Asylum (1878-84), Kingseat Hospital (1927-40) and Cherry Farm Hospital (1943-71) indicate about official attitudes to mental illness in New Zealand. Architecture was thought to be capable of performing a curative role in the treatment of mental illness; the administrators of New Zealand’s mental hospitals stated this belief publically in various press releases and reports to the government between 1878 and 1957. This dissertation examines Seacliff, Kingseat and Cherry Farm against current thought regarding the treatment of mental illness and against best architectural practice in mental hospital design.   While these three institutions were the jewels in the crown of New Zealand’s mental hospital network, only Kingseat could be considered an exemplary hospital of its time. The compromises that occurred in the construction of Seacliff, Kingseat and Cherry Farm hospitals indicate that meeting the needs of the mentally ill was only one of a number of agendas that were addressed by the officials involved in the design of these institutions. Many of these agendas were peripheral to the delivery of mental health care, such as the political desire for colonial propaganda and professional concerns of marginalisation, and conflicted with the attainment of ideal environments for the treatment of mental illness. The needs of the mentally ill were a low priority for successive New Zealand governments who exhibited a reluctance to spend taxpayer funds on patients who were not considered curable. The architects and medical advisors involved in the design of these facilities did attempt to meet the needs of these patients; however, they were limited by a design and procurement process that elevated political and operational concerns over the curative potential of these hospitals.   This dissertation also examines the role of individuals in the design of these institutions. Architect Robert Lawson was reproached for deficiencies in the curative potential of Seacliff Asylum. Similarly, medical administrator Theodore Gray has received criticism for limiting the development of New Zealand’s wider network of mental hospital care. This dissertation establishes that Lawson and Gray deserve greater recognition for their relative contributions to the architecture created, within New Zealand, for the treatment of mental illness.</p>


2021 ◽  
Author(s):  
◽  
Darren Mills

<p>Recovery is a conceptual model that underpins New Zealand’s mental health service delivery in the 21st century. This thesis explores how recovery emerged historically as an influential philosophy and how representations of recovery have changed to meet the needs of different groups. An inquiry, based on Foucault’s genealogical method, investigates the historical and contemporary forces of power that have shaped the construction of mental illness, and the development of methods and techniques to support and manage persons labelled as mentally ill. The normalisation of knowledge developed during 19th century psychiatric practice provided a context for later critique and resistance from movements that highlighted the oppressive power of psychiatric discourse. Key to the critique were the antipsychiatry and service user movements, which provided the conditions for the possibility of the emergence of recovery as a dominant discourse. Since its emergence, recovery has moved through a number of representations as it was taken up by different groups. A significant shift in the 21st century has been the dominance of neo-liberal discourse based on consumerism, a rolling back of the state, and an emphasis on individual responsibility. The implications of this shift for users and providers of services and their effects on current representations of recovery conclude the inquiry.</p>


2000 ◽  
Vol 5 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Luigi Leonori ◽  
Manuel Muñoz ◽  
Carmelo Vázquez ◽  
José J. Vázquez ◽  
Mary Fe Bravo ◽  
...  

This report concerns the activities developed by the Mental Health and Social Exclusion (MHSE) Network, an initiative supported by the Mental Health Europe (World Federation of Mental Health). We report some data from the preliminary survey done in five capital cities of the European Union (Madrid, Copenhagen, Brussels, Lisbon, and Rome). The main aim of this survey was to investigate, from a mostly qualitative point of view, the causal and supportive factors implicated in the situation of the homeless mentally ill in Europe. The results point out the familial and childhood roots of homelessness, the perceived causes of the situation, the relationships with the support services, and the expectations of future of the homeless mentally ill. The analysis of results has helped to identify the different variables implicated in the social rupture process that influences homelessness in major European cities. The results were used as the basis for the design of a more ambitious current research project about the impact of the medical and psychosocial interventions in the homeless. This project is being developed in 10 capital cities of the European Union with a focus on the program and outcome evaluation of the health and psychosocial services for the disadvantaged.


1991 ◽  
Author(s):  
Joel A. Dvoskin ◽  
Patricia A. Griffin ◽  
Eliot Hartstone ◽  
Ronald Jemelka ◽  
Henry J. Steadman ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document