International Journal of Law and Psychiatry最新文献

Background: The Mental Health Act (1994) specifies rules of use for direct coercion in Poland. Coercion in psychiatric wards may improve the safety of patients and surroundings but influences compliance and satisfaction with treatment. Legal (formal) coercion regulated by law isn't the one and only form of coercion used on people with mental disorders. Pressure, threats and orders from relatives and medical staff in relation to procedures of referral and admission to a psychiatric hospital can be described as informal coercion. In Poland there aren't many studies on the use of coercion before psychiatric hospitalization, which justifies the need to conduct this research.

Objectives: Assessment of the extent of coercive measures used prior to admission and the relationships between the use of direct coercion and selected demographic-clinical factors.

Material and methods: This study was conducted as part of statutory research at the 4th Clinic of the Institute of Psychiatry and Neurology at the Bielanski Hospital in Warsaw from 1.06.13. to 31.05.14. on all the patients admitted to the psychiatric ward in that period. We gathered data on the extent of coercion in the process of hospital referral, and demographic and clinical data was collected. The following tools were used: a specially prepared questionnaire on the extent of the coercion used prior to admission at the hospital, questionnaire on demographic and clinical data, the Brief Psychiatric Rating Scale (BPRS).

Results: Coercion prior to admission to the hospital was applied to 53 % of patients, 45 % received informal coercion, and 8 % were physically coerced. Man were more likely to be coerced than women, for people diagnosed with F10-F19 and F20-F29, physical coercion was used more frequently than in patients with other disorders. Patients undergoing informal coercion on the way to the hospital were significantly older than those who weren't exposed on coercion or experienced physical coercion. Higher severity of almost all BPRS subscales (without anxiety and depression subscale) be found in patients who were coerced on their way to hospital than in patients who were not coerced. In the analysis of the logistic regression use of coercion prior to admission to the hospital was positively associated with admission without consent, severity of negative symptoms as well as negatively associated with severity of depression symptoms.

Conclusions: The high probability of experience coercion before admission to the psychiatric hospital suggests more attention should be paid to procedures connected with referral and transport before psychiatric hospitalization.

This article explores the use of coercive measures, particularly mechanical and pharmacological restraints, in disability care settings and mental health services from a bioethical perspective, focusing on how these practices impact the human rights of individuals with mental disorder, focusing on how these practices impact the human rights of individuals with mental disorders. A robust bioethical framework is presented, advocating for principles of autonomy, beneficence, non-maleficence, dignity, dialogical justice, distributive justice, and vulnerability. These principles are integrated to reframe interventions and promote respect for patient rights. The article provides a detailed account of the legal framework governing these practices in Spain, addressing both national and regional legislation, and emphasizing its significance in protecting human rights. Finally, practical recommendations are offered, which have proven effective in significantly reducing the need for coercive interventions. The article concludes by advocating for a transformation in clinical practices, promoting dignified and respectful care in line with a human rights framework, and moving away from unnecessary coercive measures.

Border thinking is a de-colonial strategy that interrogates epistemic and biopolitical aspects of borders, and examines everyday bordering practices. Harrington and Hampton (2024) have recently argued for its utility for understanding national borders in health law. While border thinking has been traditionally used to interrogate national and geographical boundaries, I propose that border thinking can also be productive for understanding jurisdictional borders that co-exist within a national territory. Examining the complex and contested border between mental health and capacity law, I argue that jurisdictional borders, like national ones, are historically contingent, built on unstable epistemologies, and rooted in the politics of belonging. Focusing in particular on the situation of autistic people and people with intellectual disabilities, I show how the border between mental health and capacity law is rooted in stigma and stereotypes, with devastating biopolitical effects for those who are legally and materially stuck in a jurisdictional borderland between these regimes. I critique current proposals for reforming this border, as reinforcing these stigmas and stereotypes whilst failing to address the material needs and structural exclusion faced by disabled people.

Objective: Despite legislative reform to promote less restrictive treatment options, the rates of involuntary psychiatric treatment in Queensland, Australia continue to rise. This paper aims to investigate mental health clinicians' perspectives of reasons behind the high and increasing rates of involuntary psychiatric treatment in Queensland.

Method: Qualitative methodology was used to explore clinician perspectives by facilitating two face-to-face focus groups. Purposive sampling was used to select clinicians of multiple disciplines from inpatient and community adult mental health teams. Reflexive thematic analysis was utilised to analyse and interpret data.

Findings: The findings suggested a broad consensus that involuntary treatment is over-utilised in public mental health services. Six main themes were identified, including risk aversion, systemic service deficiencies, lack of voluntary alternatives, increased substance use in the community, legislative and policy shortcomings, and barriers to enacting criteria in the legislation.

Conclusion: This paper highlights that legislative reform alone will be ineffective in reducing involuntary psychiatric treatment, and adequate resources, training, policy and culture change are necessary for successful implementation of less restrictive practices. The reforms require reorientation of the implementation of policy, as well as legislation to align the Queensland mental health system within a human rights framework.

The community treatment order (CTO) is a legally mandated approach to community based psychiatric care that has been in existence for over 20 years in the Canadian province of Saskatchewan. Changes to legislation of CTOs implemented in 2015, has resulted in bolstered use of this approach to treat substance induced psychosis (SIP). Treatment plans implemented with the use of CTOs in the present study include pharmacotherapy, in the form of long-acting injectable antipsychotics (LAI-AP). The purpose of this retrospective, observational study was to determine whether there is a benefit for the use of a CTO with LAI-AP to mandate treatment for individuals diagnosed with SIP, and rates of both readmission to hospital, and presentation to emergency departments. We observed that individuals diagnosed with SIP and assigned a CTO that included a LAI-AP demonstrated a significantly lower rate of presentations to emergency departments and a lower rate of readmissions to hospital in the first one year following diagnosis, compared to those diagnosed with SIP and not assigned a CTO. Our results suggest that use of legally mandated treatment in this diagnostic group may ease both fiscal and human resource burdens on the healthcare system. Our finding may also assist when planning treatment pathways and services for people with a diagnosis of SIP.

How should a society strike a balance between the objective of ensuring safety from dangers that may be posed by individuals believed to have a mental disorder and the deprivation of their liberty? How should police officers discharge their duties in apprehending such individuals with a view to conveying them to a medical practitioner at a psychiatric institution? These legal issues took centrestage in the Singapore High Court decision of Mah Kiat Seng v Attorney-General in which the apprehended individual brought claims in false imprisonment against a police officer. The decision examined the underlying purposes of the Singapore Mental Health (Care and Treatment) Act, the right of the person to be informed of the grounds of apprehension, the bases of the police officer's belief that the person posed a danger to himself or others, and the circumstances in which the police officers may be entitled to immunity from liability to civil or criminal proceedings. The High Court judgment led to statutory amendments to clarify police duties when apprehending such individuals and discussions about enhancements to police training and crisis support services for persons with mental illnesses. With reference to the law and/or policy in Australia and the UK, the paper critiques the judicial findings, the statutory amendments and policy alternatives.

Involving families in the planning and delivery of care to relatives living with a mental health disorder is beneficial to achieve optimal recovery and medication adherence, and to reduce decompensation and hospital readmission rates. However, in the specific context of forensic mental health, the involvement of families in the planning and dispensation of care to relatives has been difficult. The purpose of our study, which was conducted in Ontario, Canada, was to better understand the interactions between families and the forensic mental health system. To meet this objective, we used a qualitative methodology, namely interpretive phenomenology. We collected data from 17 family members of persons in the forensic mental health system through semi-structured interviews. Interviews were analysed using a three-pronged approach with a particular attention paid to the spatial, temporal, and interpersonal dimensions of families' lived experiences. In this article, we present our findings related to families' experiences with the Review Board, a mental health tribunal responsible for the legal management of patients in the forensic mental health system. We regrouped the experiences of family members in four overarching, and occasionally overlapping, categories: (1) Preparation for Review Board hearings; (2) Review Board hearing processes; (3) Information Discussed during Review Board hearings; and (4) Format of Review Board hearings. Among other things, our findings highlight that Review Boards are experienced by families as rubber-stamping exercises, and that Review Board panels lack sociodemographic diversity. These findings have implications for healthcare professionals and mental health tribunals in Canada and abroad.

Singapore implemented legal amendments that led to a transition from a mandatory death penalty to a discretionary death penalty in some cases of murder. This has granted judges greater leeway in the sentencing of homicide offenders, with a decade having now passed since the 2012 amendment. A notable scarcity of research exists to understand the relationship between mental illnesses and criminal culpability, as well as how diminished responsibility impacts sentencing outcomes. A quantitative study of all court judgments in all homicide cases recorded on LawNet (Singapore's legal database) from 2006 to 2020 was conducted to examine the relationship between mental illness, psychiatric disputes, and court outcomes. The findings revealed that the introduction of discretionary death penalty reduced death sentences by half. The study also confirmed the presence of a mental illness is correlated to a greater sentence length, and could even act as an aggravating factor in court outcomes. This research also baselined the typologies of psychiatric disputes among homicide cases in Singapore. Further research on mitigating and aggravating factors in Singapore homicide cases and their impact on sentencing outcomes is recommended.