Pub Date : 2014-08-01DOI: 10.1192/S1749367600004677
G. Ikkos
While in a general sense both Canada and Malta belong to the Anglo-Saxon tradition of case law, with respect to Canada this is only partially so, because the country’s federal structure necessitates 13 different mental health laws and Quebec, one of the federal provinces, follows the French tradition of basing law in statute. This diversity notwithstanding and despite the fact that there are differences between the federal provinces’ laws, the authors have performed impressively in summarising these various laws and demonstrating the fundamental unity that underlies them, namely giving primacy to universally agreed human rights. Canadian law, as summarised here, appears to reflect a historically conservative but politically/philosophically liberal approach to human rights, the emphasis of which is on protection of the citizen from undue intrusion from the state. The new Mental Health Act in Malta, while maintaining this focus, also aims to move a step further forwards by addressing issues of social inclusion and well-being as well. This is one of the remits of the newly created post of Commissioner in that country. Such a widening of perspective seems wise in view of the repeated reports in previous papers in this series, that often law protective of human rights is enacted but services – both to provide safe and secure care and to support social inclusion – are lacking. The project identified a large need, with around 50% of prisoners experiencing psychiatric distress over the study period. The project was implemented without additional cost, but with increasing use of nursing input over time. Prison officers, with training, were able to identify psychiatric morbidity, a finding previously recognised in other countries (Birmingham, 1999). We were surprised by the large number of people admitted to prison at the request of relatives. We hope this number will fall, following the opening of the first in-patient unit in Borama during the study period. Treatment of prisoners, in addition to the prohibition of khat at the prison, led to a noticeable reduction in violence and allowed prisoners to spend additional time out of their cells. The use of chaining and physical coercion reduced. Once engaged, prisoners were offered out-patient follow-up on release. The project also had some unintended positive consequences. Medical conditions among prisoners were identified and treated and prison staff were supported in their own mental health needs, leading to improvements in management and economic benefits. There appeared to be improvements in attitudes to mental disorder among staff and families, although this was not measured. The project seemed to lead to improvements in the legal assessment and disposal of prisoners with mental health problems and led to the release of six inmates who were arrested while acutely mentally ill. We hope this model can be used as a template to introduce similar services in other low-income countries. Cooperation with prison
{"title":"Mental health law profiles","authors":"G. Ikkos","doi":"10.1192/S1749367600004677","DOIUrl":"https://doi.org/10.1192/S1749367600004677","url":null,"abstract":"While in a general sense both Canada and Malta belong to the Anglo-Saxon tradition of case law, with respect to Canada this is only partially so, because the country’s federal structure necessitates 13 different mental health laws and Quebec, one of the federal provinces, follows the French tradition of basing law in statute. This diversity notwithstanding and despite the fact that there are differences between the federal provinces’ laws, the authors have performed impressively in summarising these various laws and demonstrating the fundamental unity that underlies them, namely giving primacy to universally agreed human rights. Canadian law, as summarised here, appears to reflect a historically conservative but politically/philosophically liberal approach to human rights, the emphasis of which is on protection of the citizen from undue intrusion from the state. The new Mental Health Act in Malta, while maintaining this focus, also aims to move a step further forwards by addressing issues of social inclusion and well-being as well. This is one of the remits of the newly created post of Commissioner in that country. Such a widening of perspective seems wise in view of the repeated reports in previous papers in this series, that often law protective of human rights is enacted but services – both to provide safe and secure care and to support social inclusion – are lacking. The project identified a large need, with around 50% of prisoners experiencing psychiatric distress over the study period. The project was implemented without additional cost, but with increasing use of nursing input over time. Prison officers, with training, were able to identify psychiatric morbidity, a finding previously recognised in other countries (Birmingham, 1999). We were surprised by the large number of people admitted to prison at the request of relatives. We hope this number will fall, following the opening of the first in-patient unit in Borama during the study period. Treatment of prisoners, in addition to the prohibition of khat at the prison, led to a noticeable reduction in violence and allowed prisoners to spend additional time out of their cells. The use of chaining and physical coercion reduced. Once engaged, prisoners were offered out-patient follow-up on release. The project also had some unintended positive consequences. Medical conditions among prisoners were identified and treated and prison staff were supported in their own mental health needs, leading to improvements in management and economic benefits. There appeared to be improvements in attitudes to mental disorder among staff and families, although this was not measured. The project seemed to lead to improvements in the legal assessment and disposal of prisoners with mental health problems and led to the release of six inmates who were arrested while acutely mentally ill. We hope this model can be used as a template to introduce similar services in other low-income countries. Cooperation with prison","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 1","pages":"64 - 64"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66154687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-08-01DOI: 10.1192/S1749367600004471
D. Skuse
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Pub Date : 2014-08-01DOI: 10.1192/S1749367600004501
J. Handuleh, Ronan J. Mclvor
Prison in-reach mental health services are reasonably well developed in advanced economies, but virtually nonexistent in low- and middle-income countries. We describe the development of a small prison in-reach project in Somaliland, a self-declared independent state which has experienced conflict and poverty in equal measure. After careful planning and cooperation with local agencies, the service provides sessional input to a regional prison, including assessment and treatment of a wide range of psychiatric conditions. The project has had some unexpected benefits, which are described. The success of the project reflects the effectiveness of collaboration between local stakeholders and international agencies, and could be used as a model for the development of in-reach services in other low-income countries.
{"title":"A novel prison mental health in-reach service in Somaliland: a model for low-income countries?","authors":"J. Handuleh, Ronan J. Mclvor","doi":"10.1192/S1749367600004501","DOIUrl":"https://doi.org/10.1192/S1749367600004501","url":null,"abstract":"Prison in-reach mental health services are reasonably well developed in advanced economies, but virtually nonexistent in low- and middle-income countries. We describe the development of a small prison in-reach project in Somaliland, a self-declared independent state which has experienced conflict and poverty in equal measure. After careful planning and cooperation with local agencies, the service provides sessional input to a regional prison, including assessment and treatment of a wide range of psychiatric conditions. The project has had some unexpected benefits, which are described. The success of the project reflects the effectiveness of collaboration between local stakeholders and international agencies, and could be used as a model for the development of in-reach services in other low-income countries.","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 1","pages":"61 - 64"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66154293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sub-Saharan Africa has a wide mental health treatment gap, with low levels of access to mental health services. This paper presents the findings of systematic situation analyses carried out in five Francophone countries in West Africa, which are among the poorest in the world. The findings showed low levels of budgetary allocation to mental health, poor health infrastructure (especially at primary level) and unequal distribution of human and financial resources. In this challenging context, there are signs of reform of services, based on international best-practice guidelines and practical considerations such as decentralisation of services, task-sharing and strengthening stakeholder skills to advocate for change.
{"title":"A survey of the mental healthcare systems in five Francophone countries in West Africa: Bénin, Burkina Faso, Côte d'Ivoire, Niger and Togo.","authors":"Djibo Douma Maiga, Julian Eaton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sub-Saharan Africa has a wide mental health treatment gap, with low levels of access to mental health services. This paper presents the findings of systematic situation analyses carried out in five Francophone countries in West Africa, which are among the poorest in the world. The findings showed low levels of budgetary allocation to mental health, poor health infrastructure (especially at primary level) and unequal distribution of human and financial resources. In this challenging context, there are signs of reform of services, based on international best-practice guidelines and practical considerations such as decentralisation of services, task-sharing and strengthening stakeholder skills to advocate for change.</p>","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 3","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/85/IP-11-69.PMC6735152.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CORRESPONDENCE.","authors":"A Mukherjee, R Bhandarkar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 2","pages":"50"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/39/IP-11-50.PMC6735129.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/S1749367600004409
T. Turner
Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, ‘“Freedom is more important than health”: Thomas Szasz and the problem of paternalism’, by Joanna Moncrieff.
{"title":"The legacy – or not – of Dr Thomas Szasz (1920–2012)","authors":"T. Turner","doi":"10.1192/S1749367600004409","DOIUrl":"https://doi.org/10.1192/S1749367600004409","url":null,"abstract":"Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, ‘“Freedom is more important than health”: Thomas Szasz and the problem of paternalism’, by Joanna Moncrieff.","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 1","pages":"48 - 49"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66153607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When Thomas Szasz summed up his philosophical principles at the Royal College of Psychiatrists' annual meeting in Edinburgh in 2010, he declared that 'freedom is more important than health'. Psychiatry is the arena in which the conflict between freedom and health comes most sharply into focus, according to Szasz. This paper proposes some parallels with medicine in low-income countries for pointers towards a resolution of this conflict.
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Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, '"Freedom is more important than health": Thomas Szasz and the problem of paternalism', by Joanna Moncrieff.
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Pub Date : 2014-05-01DOI: 10.1192/S1749367600004392
J. Moncrieff
When Thomas Szasz summed up his philosophical principles at the Royal College of Psychiatrists’ annual meeting in Edinburgh in 2010, he declared that ‘freedom is more important than health’. Psychiatry is the arena in which the conflict between freedom and health comes most sharply into focus, according to Szasz. This paper proposes some parallels with medicine in low-income countries for pointers towards a resolution of this conflict.
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Pub Date : 2014-02-01DOI: 10.1192/s174936760000415x
D. Skuse
InternatIonal PsychIatry Volume 11 Number 1 FebruArY 2014 We are delighted to have a trio of papers from senior staff members of the World Health Organiz ation (WHO) on the strategic development plans for psychiatric services in the African Region, in Latin America and the Caribbean, and in the Western Pacific. We are truly privileged to publish these valuable documents, which reflect the current state of the WHO’s attempts to improve psychiatric services worldwide. Dr Carina FerreiraBorges reports from Africa, and draws attention to the WHO’s Comprehensive Mental Health Action Plan for 2013–20. This em phasises the importance of delivering care in the community and of consider ing the notion of re covery. Despite the emphasis in the plan on moving away from a purely medical model to a socially responsive model of care for people with mental health problems, there has been little movement in this direction in Africa. Unfortunately, in most African states, mental health has a low priority. It is considered to be a ‘small problem’ compared with the burden of communicable diseases, an attitude fostered by the big donors from the West. Strategic developments in the delivery of psychiatric services worldwide
{"title":"Strategic developments in the delivery of psychiatric services worldwide","authors":"D. Skuse","doi":"10.1192/s174936760000415x","DOIUrl":"https://doi.org/10.1192/s174936760000415x","url":null,"abstract":"InternatIonal PsychIatry Volume 11 Number 1 FebruArY 2014 We are delighted to have a trio of papers from senior staff members of the World Health Organiz ation (WHO) on the strategic development plans for psychiatric services in the African Region, in Latin America and the Caribbean, and in the Western Pacific. We are truly privileged to publish these valuable documents, which reflect the current state of the WHO’s attempts to improve psychiatric services worldwide. Dr Carina FerreiraBorges reports from Africa, and draws attention to the WHO’s Comprehensive Mental Health Action Plan for 2013–20. This em phasises the importance of delivering care in the community and of consider ing the notion of re covery. Despite the emphasis in the plan on moving away from a purely medical model to a socially responsive model of care for people with mental health problems, there has been little movement in this direction in Africa. Unfortunately, in most African states, mental health has a low priority. It is considered to be a ‘small problem’ compared with the burden of communicable diseases, an attitude fostered by the big donors from the West. Strategic developments in the delivery of psychiatric services worldwide","PeriodicalId":88529,"journal":{"name":"International psychiatry : bulletin of the Board of International Affairs of the Royal College of Psychiatrists","volume":"11 1","pages":"3 - 3"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66153037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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