Involuntary Treatment Research Articles

Community-based Mental Health Services in Norway.

Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding. Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community. The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.

A Study into the Operation of the Queensland Mental Health Review Tribunal.

The Queensland Mental Health Review Tribunal makes difficult decisions regarding involuntary treatment of people with mental illness, applying strict legislative criteria against a backdrop of fundamental human rights considerations. This article reports on focus group research with lawyers and advocates for people with mental illness who appear before the Queensland Mental Health Review Tribunal. Participants expressed concerns regarding the manner in which decisions are made. For example, participants said that their clients' views on the side effects of treatment do not receive adequate consideration when involuntary treatment is authorised. We review these concerns in the light of applicable legal obligations, including those arising from human rights law. We conclude that if these concerns are accurate, some adjustments to the Queensland Mental Health Review Tribunal's decision-making processes are required.

Coercive interventions under the new Dutch mental health law: Towards a CRPD-compliant law?

The Netherlands became State Party to the United Nation Convention on the Rights of Persons with Disabilities (CRPD) in 2016, a treaty that holds great promise for promoting and protecting human rights of persons with mental disorders. Yet, the Dutch government also made explicit reservations to the Convention. On 1 January 2020, the Netherlands introduced a new mental health law, the Compulsory Mental Health Care Act (CMHCA), which aims to strengthen the legal status of persons with psychiatric illnesses. To which extent does the new Dutch mental health law comply with the regulations as outlined in the CRPD? In this article, we examine how coercive interventions, specifically the elements of competence, involuntary treatment and involuntary admission are regulated in the domestic legislation and compare them to the CRPD approach. A normative analysis combined with literature review helps to understand the law, reveal the gaps and uncover the barriers that remain. Is there a need to reassess the domestic legal provisions allowing for coercive treatment, and if so, what advancements are required? After all, should the CRPD be strictly adhered to at all times?

Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study.

Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the Clinical Global Impression-Severity (CGI-S) scale were administered. McNemar test was used for paired categorical variables and a binary logistic regression analysis was performed. A total of 234 patients were included in the analysis. Involuntary treatment rates were significantly higher in immigrants as compared to their matched natives (32% vs. 24% respectively; p < .001). Among immigrants, involuntary hospitalization was found to be more frequent in those patients whose length of stay in Italy was less than 2 years (OR = 4.2, 95% CI [1.4-12.7]). Recently arrived immigrants appear to be at higher risk of involuntary admission. Since coercive interventions can be traumatic and negatively affect outcomes, strategies to prevent this phenomenon are needed.

Effect of High Suspension and Low Incision Surgery Based on Traditional Ligation of Chinese Medicine in Treatment of Mixed Haemorrhoids: A Multi-centre, Randomized, Single-Blind, Non-inferiority Clinical Trial.

To observe the clinical effect of high suspension and low incision (HSLI) surgery on mixed haemorrhoids, compared with Milligan-Morgan haemorrhoidectomy. A multi-centre, randomized, single-blind, non-inferiority clinical trial was performed. Participants with mixed haemorrhoids from Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing Rectum Hospital, Air Force Medical Center of People's Liberation Army of China, and Puyang Hospital of Traditional Chinese Medicine were enrolled from September 2016 to March 2018. By using a blocked randomization scheme, participants were assigned to two groups. The experimental group was treated with HSLI, while the control group was treated with Milligan-Morgan haemorrhoidectomy. The primary outcome was the clinical effect evaluated at 12 weeks after operation. The secondary outcomes included the number of haemorrhoids treated during the operation, pain scores, use of analgesics, postoperative oedema, wound healing, incidence of anal stenosis, anorectal manometry after operation, as well as surgical duration, length of stay and total hospitalization expenses. A safety evaluation was also conducted. In total, 246 eligible participants were enrolled, with 123 cases in each group. There was no significant difference in the clinical effect between the two groups (100.00% vs. 99.19%, P>0.05). Compared with the control group, the number of external haemorrhoids treated during the operation and the pain scores after operation were significantly reduced in the experimental group (P<0.05 or P<0.01); the patient number with wound healing at 2 weeks after operation and the functional length of anal canal at 12 weeks after operation were significantly increased in the experimental group (P<0.05). There was no significant difference in the incidence of anal stenosis, the numbers of patients using analgesics and patients with postoperative oedema between the two groups after operation (P>0.05). The surgical duration and length of stay in the experimental group were significantly longer than those in the control group, and the total hospitalization expense was significantly higher than that in the control group (all P<0.05). No adverse events were reported in either group during the whole trial or follow-up period. HSLI had the advantages of preserving the skin of anal canal completely, alleviating postsurgical pain and promoting rapid recovery after operation. (Registration No. ChiCTR1900022883).

Association of Nonmedical Switches in Inhaled Respiratory Medications with Disruptions in Care: A Retrospective Prescription Claims Database Analysis.

IntroductionThere are limited data on the effects of forced medication switching for a nonmedical reason in patients with obstructive airway conditions. This study evaluated disruption in care resulting from a nonmedical medication switch for patients with asthma and/or chronic obstructive pulmonary disease who previously received the inhaled corticosteroid/long-acting β2-agonist budesonide/formoterol.MethodsThis retrospective pharmacy benefit prescription claims analysis evaluated Medicare Part D patients who filled a prescription for budesonide/formoterol as their last inhaled corticosteroid/long-acting β2-agonist in 2016 and were affected by a formulary block of budesonide/formoterol in 2017. Changes to respiratory maintenance therapy, length of gaps in care during which a patient was not in possession of a respiratory controller medication, acute medication use indicative of disease exacerbations, and medication adherence were assessed.ResultsA total of 42,553 patients were included in the analysis. Following the formulary block, 30,016 patients (71%) switched to another controller; 20,628 of these patients (69%) switched to a new inhaled corticosteroid/long-acting β2-agonist, 7081 (23%) stepped down to a monotherapy, and 2307 (8%) switched to a non-inhaled corticosteroid-containing controller. Despite the formulary block, 22,903 patients (54%) attempted to fill budesonide/formoterol as their first postblock controller, and 6624 patients (16%) attempted to return to budesonide/formoterol after switching to another controller. On average, patients experienced a gap in care of approximately 4 months without a controller medication. Also, 9674 (23%) did not fill any controller over the 1-year postblock period. Of those patients who experienced a gap in care, 14,926 (47%) filled a prescription indicative of a possible exacerbation during the gap period (i.e., oral corticosteroids for patients with asthma and oral corticosteroids and/or antibiotics for patients with chronic obstructive pulmonary disease).ConclusionsThe Medicare Part D formulary block was associated with disruption in the management of patients’ respiratory conditions and may have adversely impacted disease control.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00147-8.

A Comparative Analysis of Zambia's Mental Health Legislation and the World Health Organisation's Resource Book on Mental Health, Human Rights and Legislation

Background: Mental Health Legislation plays an important role in the promotion and protection of the rights of persons living with mental illness and mental disability. Many Countries are making attempts to bring these legislations in line with the major international guidelines like the WHO-RB. Zambia’s Mental Health Act No.6 of 2019 challenges the community, caregivers, mental health practitioners and policy makers to rethink the ‘Medical Model’ of Mental illness and existing services. Objective: The objective of this study was to analyse and compare Zambia’s Mental Health Act No.6 of 2019 and the WHO-RB.&#x0D; Method: This study was a comparative analysis of two documents: Zambia’s Mental Health Act No.6 of 2019 and the WHO-RB, which contains a checklist of human rights specifications that are expected to be met at national level. This study scrutinized each component on the checklist and established the pertinent areas in Zambia’s Mental Health Act No.6 of 2019 that relate to each component of WHO-RB.&#x0D; Results: The Zambia’s Mental Health Act No.6 of 2019 attempted to include many legislative issues from the WHO-RB checklist. Analysis of the 27 checklist items showed that 44.4% (12/27) were adequately covered, 33.3% (9/27) were covered to some extent with missing and problematic areas clearly outlined for each of these items and 22.2% (6/27) components from the WHO-RB checklist were not covered at all in Zambia’s Mental Health Act No.6 of 2019. The items not covered at all related to rights of families or other carers, involuntary treatment in the community setting, police responsibility, housing for patients with mental illness, social security and protection of vulnerable groups.&#x0D; Conclusion: The Mental Health Act No.6 of 2019 makes an important contribution to mental health legislation in Zambia by bringing about the promotion, protection, respect of the rights and dignity of persons with mental illness. However, some efforts need to be made to respectively amend and include the problematic and completely absent components so as to produce a mental health act that is complete and inclusive.

The World Health Organization's QualityRights materials for training, guidance and transformation: preventing coercion but marginalising psychiatry.

The World Health Organization has developed training material to support its QualityRights Initiative. These documents offer excellent strategies to limit coercion. However, the negative portrayal of psychiatry, the absolute prohibition on involuntary treatment and the apparent acceptance of the criminalisation of individuals with mental illness are causes for concern.

Current practice of antibiotic prophylaxis in elective laparoscopic cholecystectomy among surgeons of the Armed Forces Medical Services of India

BackgroundLaparoscopic cholecystectomy (LC) is the most common surgery done in general surgical practice worldwide. Despite clear guidelines recommending against the routine use of antibiotic prophylaxis (ABP) for elective LC by professional entities such as the Scottish Intercollegiate Guidelines Network (SIGN), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) etc., most surgeons are not convinced about omitting ABP in low-risk LC. Thus, this study aimed at capturing the practice of administering ABP in elective LC among surgeons of Armed Forces Medical Services (AFMS). MethodsThis was a survey based on an electronic, cross-sectional, self-completion questionnaire that was designed and disseminated amongst 184 surgeons of the AFMS, online, and the data was collated centrally. Results64% of surgeons completed the survey. The majority (85%) of surgeons used ABP routinely in elective LC. In the univariate analysis, only the number of years of surgical experience and the total number of LC done in an entire career, and in the multivariate analysis age group of the surgeon, surgical experience and designation were significant factors for avoiding routine ABP in elective LC. Amongst the surgeons administering ABP, only 30% administered a single dose, 73% chose a single agent and Cefotaxime (57%) was the commonest antibiotic used. ConclusionThis study found that there is a high prevalence of use of antibiotic prophylaxis in elective laparoscopic cholecystectomy amongst the surgeons of the AFMS. There was a wide variation in terms of choice of antibiotics, administering single or multiple doses and as a single agent or combination therapy. Registered with clinical trials registry of IndiaCTRI/2019/03/018092.

The association between perceived coercion on admission and formal coercive practices in an inpatient psychiatric setting

Involuntary care is a feature of mental health services around the world. In addition to involuntary admission and treatment, specific coercive practices include seclusion and physical restraint. Our study aimed to determine the relationships, if any, between these practices and perceived coercion on admission among psychiatry inpatients in Ireland, as well as any relationships between perceived coercion on admission and variables such as age, gender and diagnosis. We included 107 psychiatry inpatients aged 18 years or over who were admitted to the acute psychiatry admission units in Tallaght University Hospital and Connolly Hospital, Dublin, Ireland over a 30-month period between September 2017 and February 2020. Over a quarter (27.1%) of participating patients had involuntary status; nine (8.4%) had experienced at least one episode of seclusion, and ten (9.3%) had experienced at least one episode of restraint. Perceived coercion on admission was significantly associated with involuntary status and female gender; perceived negative pressures on admission were significantly associated with involuntary status and positive symptoms of schizophrenia; perceived procedural injustice on admission was significantly associated with fewer negative symptoms, involuntary status, cognitive impairment and female gender; and negative affective reactions to hospitalisation on admission were significantly associated with birth in Ireland and being employed. Total score across these four subscales was significantly associated with involuntary status and positive symptoms, and had borderline significant associations with birth in Ireland, being employed and female gender. Overall, perceived coercion on admission, assessed in retrospect by the patient, is more closely associated with involuntary status and symptoms than it is with subsequent formal coercive practices, such as seclusion and restraint. The role of gender merits particular attention in future research, especially in relation to procedural injustice on admission and perceived coercion on admission.

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.

Systematic violations of patients' rights and safety: Forced medication of a cohort of 30 patients.

We assessed the records for 30 consecutive patients who had appealed decisions about forced medication with antipsychotics to the Psychiatric Appeals Board in Denmark. In all 21 cases where there was information about the effects of previous drugs, the psychiatrists stated that antipsychotics had had a good effect whereas none of the patients shared this view. The harm caused by earlier or currently used antipsychotics did not seem to have played any role in the psychiatrists' decision-making. The legal requirements for using force to protect the patients' health were never met and less intrusive treatments than antipsychotics, eg, benzodiazepines or psychotherapy, were never mentioned as options. The power imbalance was extreme, the patients felt misunderstood and ignored, their legal protection was a sham, and the harm done was immense. The violation of patient rights is a global problem. We suggest that forced medication be abandoned.

Engaging young people in early psychosis services – a challenge for social work

ABSTRACT Gaining an understanding as to why youth engage or disengage with Early Psychosis Services (EPS) is important for social workers providing interventions to young people. The aim of the focus group study reported here was to explore the lived experience of six young people engaging with an EPS. Five key themes were identified as influencing engagement: hospital experiences and transition to the community EPS, experiences with EPS provision, stigma and involuntary treatment status, substance use, and the influence of family and social support. Identifying these factors can assist social work practitioners to develop interventions that encourage engagement with services.

Actitudes de los profesionales de la salud mental ante la capacidad y el internamiento no voluntario en anorexia nerviosa: construcción, validación y resultados del cuestionario ACINOVAN

IntroductionAnorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. ObjectiveTo create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. MethodsThe sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. ResultsFavourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. ConclusionsThe resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Antipsychotic Polypharmacy in the Treatment of Patients with Schizophrenia in Nine Psychiatric Hospitals of the Landschaftsverband Rheinland, Germany

Antipsychotics are the cornerstone in the treatment of schizophrenia and are primarily recommended as monotherapy by evidence-based guidelines. Nevertheless, antipsychotic polypharmacy (APP) is prevalent in routine practice and APP is also used as a quality indicator since 2016 in quality management programs. Based on routine data of nine psychiatric hospitals of the Landschaftsverband Rheinland (LVR)/Germany the prevalence of APP was determined and correlated with factors of routine healthcare in order to monitor the adoption of APP and to discuss its feasibility as a quality indicator. All cases with schizophrenia (ICD-10 F20.x; ≥ 18 years) discharged between June 1st, 2016, and June 1st, 2017, (in-patient and day clinic) were extracted from an established research database shared by all nine hospitals and analyzed regarding APP prevalence at the time of discharge. Based on 6,788 cases, the prevalence of APP was 55.5 % with an average of 2.4 antipsychotics (SD = 0.6) administered simultaneously. In multivariate analyses, significant predictors for APP were: gender (male > female), the number of days in hospital (long > short), involuntary treatment (no > yes) and the location of the hospital. We found a high proportion of polypharmacy in inpatient schizophrenia patients and significant differences between hospitals. The use of the results as a quality indicator (criteria ≥ 2 antipsychotics) remains dependent on the background of the individual treatment courses, which cannot be adequately represented by the existing routine data. The LVR has been using the quality indicator of ≥ 3 antipsychotics since 2018, which is discussed as a more appropriate approach for future evaluations.

A prospective randomized controlled clinical study on the optimal treatment interval of pulsed dye laser in treating hypertrophic scar after burn

Objective: To observe the influence of different treatment intervals of pulsed dye laser (PDL) in treating hypertrophic scar after burn, and to explore the optimal treatment interval. Methods: From May 2018 to March 2019, 20 burn patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University were included in this prospective randomized controlled study. Patients were divided into 1 week group (4 patients, 2 males and 2 females, aged 27 (4, 67) years, 19 scars), 2 weeks group (5 patients, 2 males and 3 females, aged 9 (3, 55) years, 15 scars), 3 weeks group (5 patients, 4 males and 1 female, aged 26 (19, 45) years, 15 scars), and 4 weeks group (6 patients, 4 males and 2 females, aged 31 (14, 48) years, 13 scars), according to the random number table, and treated with PDL with the treatment intervals of 1 week, 2 weeks, 3 weeks, and 4 weeks, respectively, with total treatment cycle of 3 months. Before the first treatment and three months after the first treatment, the Vancouver Scar Scale (VSS) was conducted and the decreased value of VSS score was calculated; the laser Doppler blood flow meter was used to measure scar blood perfusion and the proportion of change in blood perfusion volume was calculated. Data were statistically analyzed with Kruskal-Wallis test, Wilcoxon rank sum test, Wilcoxon symbolic rank sum test, Bonferroni correction, and Fisher's exact probability test. Results: The VSS scores of patients in 1 week group, 2 weeks group, 3 weeks group, and 4 weeks group in three months after the first treatment were significantly lower than those before the first treatment (Z=-3.74, -3.47, -2.69, -3.25, P<0.01). There were no statistically significant differences in the decreased values of VSS scores in three months after the first treatment among the patients in 4 groups (H=2.35, P>0.05). Three months after the first treatment, the blood perfusion volumes of patients in 2 weeks group and 3 weeks group were significantly lower than those before the first treatment (Z=-2.95, -2.50, P<0.05 or P<0.01). The proportions of changes in blood perfusion volume of patients in 1 week group, 2 weeks group, 3 weeks group, and 4 weeks group were respectively -0.02 (-1.05, 0.69), -0.29 (-0.75, 0.18), -0.11 (-0.55, 0.23), 0.05 (-0.61, 0.75). There were statistically significant differences among the 4 groups (H=9.39, P<0.05). The proportions of changes in blood perfusion volume of patients in 2 weeks group was statistically higher than that of 1 week group (Z=2.76, P<0.01). Conclusions: PDL treatment can reduce the VSS score and blood perfusion volume of scar. One treatment every two weeks or three weeks improve the scar blood perfusion volume more significantly, and can be recommended as the appropriate treatment interval of PDL for hypertrophic scar after burn.

A Systematic Review of the Legal Considerations Surrounding Medicines Management.

Background and Objectives: There is a paucity of integrated knowledge regarding legal considerations required to ensure patient safety through safe medicines management. This study explores the legal considerations surrounding medicines management, providing a synthesis of existing knowledge. An integrative systematic review of the current international knowledge was performed. Materials and Methods: The search encompassed the online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science using MeSH terms and relevant keywords relating to the legal considerations of medicines management in healthcare settings. Results: The search process led to the identification of 6051 studies published between 2010 and 2020, of which six articles were found to be appropriate for data analysis and synthesis based on inclusion criteria. Research methods were varied and included qualitative interviews, mixed-methods designs, retrospective case reports and cross-sectional interrupted time-series analysis. Their foci were on the delegation of medicines management, pharmacovigilance and reporting of adverse drug reactions (ADRs) before and after legislation by nurses, physicians and pharmacists, medico-legal litigation, use of forced medication and the prescription monitoring program. Given the heterogenicity of the studies in terms of aims and research methods, a meta-analysis could not be performed and, therefore, our review findings are presented narratively under the categories of ‘healthcare providers’ education and monitoring tasks’, ‘individual and shared responsibility’, and ‘patients’ rights’. Conclusion: This review identifies legal aspects surrounding medicines management, including supervision and monitoring of the effects of medicines; healthcare providers’ knowledge and attitudes; support and standardised tools for monitoring and reporting medicines’ adverse side effects/ADRs; electronic health record systems; individual and shared perceptions of responsibility; recognition of nurses’ roles; detection of sentinel medication errors; covert or non-voluntary administration of medication, and patient participation.

Outcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison.

In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

Compulsory Treatment as Task of Public Governance or What Thyphoid Mary and Mad King Ludwig Had in Common (Abstract)

The article concerns involuntary treatment of infectious and mental diseases. Development of the legal regulation since the 19th century has been described here. Quality of the existing legal regulation has also been evaluated. Issues of involuntary psychiatric treatment have been analysed and demonstrated by the international case-law and state court practice. Significant differences between legislation in mental and infectious diseases has been detected, as well as differences have been traced between legal standards in the area of involuntary placement and involuntary treatment of mental disorders in Latvia and other countries. It has been concluded that involuntary psychiatric treatment, in line with epidemiological safety, is a task of public governance in the area of domestic security and safeguarding of human rights and it has to be reinforced by governmental authority. Thus, proposal of elaboration of the corresponding law has been made.

Anorexia Nervosa, Lack of "Coherence" with Deeply Held Beliefs and Values, and Involuntary Treatment

Anorexia Nervosa, Lack of "Coherence" with Deeply Held Beliefs and Values, and Involuntary Treatment