Mental health legislation in Luxembourg, a small country in Western Europe

The article provides a brief overview of the legislation governing involuntary admissions to psychiatric hospitals in Luxembourg. The legislation was completely overhauled in 2009 and several human rights principles are enshrined into it. Emphasis is placed on voluntary, community-based treatment, and where compulsory treatment is required, it uses the least restrictive treatment option. Mentally ill offenders are dealt with through separate specialist legislation. Young people under the age of 18 are often detained using family law.

Compulsory treatment of physical illness under MHA 1983

Taken together, Sections 145 and 63 of the Mental Health Act 1983 (MHA) provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and that it should be applied. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancillary treatment of physical illness, the assistance of a court may be sought. In so doing, the law (and thence the courts) may justify compulsion but never prescribes it; the clinician is presented with authority that he or she could use but is left to decide whether it should be employed. This paper explores how the clinical question is set before the court, and whether the distinction between symptom, manifestation and consequence is sufficiently understood. This has important consequences in the context of self-neglect and its close cousin self-harm: the question whether the relevant ailment was attributable to or exacerbated by neglect or self- inflicted harm will determine whether compulsion under the MHA is applicable; and furthermore, whether or not compulsion is clinically acceptable.

Public Danger of a Person as a Basis for Applying Compulsory Medical Measures

The authors argue that the danger posed by a person, used by the court as a basis for authorizing compulsive medical measures, should be considered to be public danger because this person could commit a new infringement on public relations protected by criminal law. The analysis of the practice of court decisions on compulsory medical measures in 2010–2020 in Tomsk and Novosibirsk Regions is use to develop criteria for determining the content of public danger posed by such a person. These criteria are the features of a publicly dangerous act that has already been committed (its focus on relations protected by criminal law, the degree on harm inflicted on these relations, the number of previously committed identical or similar acts), as well as the symptoms of a mental disorder which testify that a person has got a violent, mercenary or violent-mercenary motivation. The differentiation of compulsory medical measures applied to a person is based on the degree of public danger that this person poses. It is suggested that the probability of a person’s committing a new publicly dangerous act with a violent or mercenary-violent motivation should be viewed as a basis for sending that person to a psychiatric hospital for compulsory treatment. As for using this treatment for persons who are likely to commit new publicly dangerous act with a mercenary motivation, it is suggested that the decision should depend on the regularity of committing actions with such a motivation because the public danger is posed not so much by the gravity of the action as by its repeat character.

Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm

Attempted suicide and deliberate self-harm are common and challenging presentations in the emergency department. A proportion of these patients refuse interventions and this presents the clinical, legal, and ethical dilemma as to whether treatment should be provided against their will. Multiple factors influence this decision. It is difficult to foresee the multitude and magnitude of complications that can arise once it has been decided to treat individuals who do not consent. This case illustrates a particularly complex chain of events that occurred after treating someone against their will who presented with self-harm and suicidal ideation. These consequences are contrasted with those of not intervening when similar situations arose with the same patient.

Tzar cloudy Ivan in thepsychiatric chambers

The article describes a clinical case of patient P., 43 years old, a political activist who conducted extravagant performances in the image of the Tsar, who called for a return to monarchical rule and, in connection with this, was hospitalized involuntarily in a psychiatric hospital. A comparative analysis with the actions of Pyotr Pavlenky and Pavel Krysevich is carried out, the contribution of the psychopathological to the creative activity of representatives of contemporary art is estimated. The validity of the psychiatric diagnoses exposed to patient P., the recognition of his social danger and the validity of the appointment of compulsory inpatient treatment to him are evaluated. It is concluded that freak behavior, presenting itself through actionism, performances and dissent, needs a serious psychological and psychopathological analysis. Often, such dissent becomes a way of self-realization or provocation (trolling), but psychopathology is also capable of hiding behind it. It is stated that this should in no way diminish the social significance and the creative component of the performances and actions of people considered to be freaks. In addition, it is argued that actionism should not be perceived as a socially dangerous act, and there is no reason to imprison a person or send a patient to a psychiatric hospital for compulsory treatment for performances.

Locked Up and Locked Out: Client Perspectives on Personal Relationships While in Compulsory Drug Treatment

This qualitative study explores clients’ perspectives on their personal relationships while in compulsory drug treatment. Interviews with 31 participants (14 female and 17 male) were conducted at four compulsory treatment institutions for adults who use drugs in Sweden. Taken together, our study reveals that clients in general had to struggle to maintain social relationships due to strict restrictions on their interpersonal contact and communication. Feelings of isolation and anxiety characterized much of their relationships during the treatment period, with emotional withdrawal commonly described as a way to cope. Moreover, some participants expressed shame and guilt over the pain and suffering they had subjected their family members to through their drug use, feelings that put additional strain on the contact. The emotionally and socially significant relationships described by our interviewees provide links to other personal roles and settings than those prescribed by the institution. At the studied institutions, however, little attention was given to this relational dimension of the clients’ situation. Based on the results of the present study, possibilities for improvement of compulsory drug treatment are discussed.

Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.