Pub Date : 2025-02-07DOI: 10.1016/j.ijlp.2025.102069
María Laura Serra
This study explores the gap between Spain's mental health legal framework and the lived experiences of users and survivors of psychiatry, including persons with psychosocial disabilities. Employing a socio-legal methodology, it critically contrasts domestic legislation with qualitative data from interviews, uncovering systemic issues that perpetuate coercive practices such as inadequate judicial oversight and the routine use of coercion and isolation. The findings highlight a significant failure to protect patient autonomy and dignity. This research advocates for comprehensive legal and structural reforms to align Spain's mental health care system with international human rights standards. It underscores the need for a person-centered, rights-based approach that prioritises autonomy, informed consent, and dignity, ultimately promoting a mental health care environment that fully upholds human rights.
{"title":"‘If someone had stopped to talk to me’: A human rights analysis of Spain's mental health system","authors":"María Laura Serra","doi":"10.1016/j.ijlp.2025.102069","DOIUrl":"10.1016/j.ijlp.2025.102069","url":null,"abstract":"<div><div>This study explores the gap between Spain's mental health legal framework and the lived experiences of users and survivors of psychiatry, including persons with psychosocial disabilities. Employing a socio-legal methodology, it critically contrasts domestic legislation with qualitative data from interviews, uncovering systemic issues that perpetuate coercive practices such as inadequate judicial oversight and the routine use of coercion and isolation. The findings highlight a significant failure to protect patient autonomy and dignity. This research advocates for comprehensive legal and structural reforms to align Spain's mental health care system with international human rights standards. It underscores the need for a person-centered, rights-based approach that prioritises autonomy, informed consent, and dignity, ultimately promoting a mental health care environment that fully upholds human rights.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102069"},"PeriodicalIF":1.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143324705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-16DOI: 10.1016/j.ijlp.2025.102068
Urszula Zaniewska-Chłopik , Marcin Zarzycki , Maria Załuska
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.
{"title":"Is this an underestimated problem? Using coercion before psychiatric hospitalization","authors":"Urszula Zaniewska-Chłopik , Marcin Zarzycki , Maria Załuska","doi":"10.1016/j.ijlp.2025.102068","DOIUrl":"10.1016/j.ijlp.2025.102068","url":null,"abstract":"<div><h3>Background</h3><div>The Mental Health Act (1994) specifies rules of use for direct coercion in Poland.</div><div>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.</div></div><div><h3>Objectives</h3><div>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.</div></div><div><h3>Material and methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102068"},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Coercive measures in disability and mental health care services: Mechanical restraints from a bioethical and legal perspective in Spain","authors":"Sergio Ramos-Pozón , Begoña Román-Maestre , Blas Blánquez","doi":"10.1016/j.ijlp.2024.102067","DOIUrl":"10.1016/j.ijlp.2024.102067","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"99 ","pages":"Article 102067"},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102061"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146231796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102039"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146231798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Reasons behind the rise in involuntary psychiatric treatment under mental health act 2016, Queensland, Australia – Clinician perspectives","authors":"Kimbali Wild , Jappan Sawhney , Marianne Wyder , Bernadette Sebar , Neeraj Gill","doi":"10.1016/j.ijlp.2024.102061","DOIUrl":"10.1016/j.ijlp.2024.102061","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102061"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ijlp.2024.102039
Lucy Series
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.
{"title":"No man's land: Troubling the borders of mental health and capacity law","authors":"Lucy Series","doi":"10.1016/j.ijlp.2024.102039","DOIUrl":"10.1016/j.ijlp.2024.102039","url":null,"abstract":"<div><div><em>Border thinking</em> 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 <em>jurisdictional borders</em> 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.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102039"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102038"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146231794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102043"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146231795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"98 ","pages":"Article 102057"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146231792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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