Mental Health Law Research Articles

Gender-based provisions in mental health legislation: a review of English language jurisdictions.

Legislation is a powerful tool for facilitating mental healthcare. Gender is an important social determinant of physical and mental health. Many jurisdictions are in the process of revising their mental health law, to align with human rights commitments. Consideration of gender in these revisions could enhance the mental healthcare received by women, transgender and non-binary individuals. This paper examines gender-based provisions in mental health law published in English. Countries that use English as an official language were identified. Jurisdictions in these countries with stand-alone mental health laws were included. Legislation was reviewed for gender-specific provisions. Seventy-five countries were evaluated; 71 jurisdictions were included. Thirty-eight jurisdictions had 88 gender-specific provisions. These addressed ten key areas, including: general gender-based protections, female representation on boards and review panels, protections during searching and restraint, gender separated facilities, protections in relation to parenting, fertility, sterilisation and termination. Fiji, Ghana, India, and the Australian jurisdictions had the highest number of gender-specific laws. However, gender-specific provisions are highly heterogeneous and are drafted from a cisnormative perspective and fail to adequately address the specific needs of individuals outside of that framework. Gender-specific provisions can enhance the protections afforded by mental health law. However, as legislation can be a blunt instrument, careful consideration must be given to potential unintended consequences. During revisions of mental health law consideration should be given to gender-specific provisions and legislation must be inclusive of individuals identifying as transgender, non-binary and other genders.

Compulsory treatment at home: an interview study exploring the experiences of an early group of patients, relatives and mental-health workers

BackgroundWhen introduced in 2020, the Netherlands’ Compulsory Mental Healthcare Act included provisions for compulsory community treatment (CCT) and compulsory treatment in patients’ homes (CTH). Although CCT has been incorporated into mental health care in many countries, its effectiveness is debated. We know of no other countries in which CTH has been adopted.The aim of this study is to evaluate how an early group of participants experienced CTH. They were drawn from three stakeholder groups: patients, relatives and mental-health workers.MethodsIn total, 17 open interviews were conducted with six patients, five relatives and six mental-health workers. All had experience with CTH. Thematic analysis was used to analyze the interviews.ResultsFive themes were identified: 1). Reasons for applying for a court order with options for CTH. The reasons included preventing harm, avoiding hospitalization, and providing a safety net. 2.) Participants’ experiences with CTH in practice. The four most noteworthy experiences were related to the process of applying for a court order; compulsory home visits and the compulsory use of medication; the involvement of relatives during treatment; and the influence of CTH on the relationship between patients and relatives. 3.) The advantages and disadvantages of CTH. The most important advantages were avoiding hospitalization; improving medication adherence; facilitating easy access to care; early signaling of deterioration; early intervention; and regained autonomy. The most important disadvantages were restricted autonomy; fewer options for monitoring compared to hospitalization; and problems regarding control of patient behavior. 4.) Participants’ preferences. All preferred CTH to hospitalization. 5.) Participants’ suggestions for improving CTH. These included the need not only to provide patients with better information, but also to improve the involvement of relatives during treatment.ConclusionThe interviewees found that CTH might help to avoid hospitalization by providing stakeholders with more options for arranging effective care at home. Although this suggests that initial experiences of CTH under the new Dutch mental health law were positive, it is still uncertain whether CTH as currently implemented really differs from CCT.

Mental health and capacity laws in Northern Ireland: examining the position of children and young people.

Mental health and capacity laws applicable to children and young people in Northern Ireland (NI) lack clarity and coherence, with significant gaps in service provision and safeguarding. Drawing on an examination of such laws, we argue that law reform is needed. In the short term, we suggest there is merit in publishing statutory guidance, such as a Code of Practice, to address both the issue of evolving capacity in children and to facilitate best practice in policy and practice. This modest reform in the short term should be accompanied by a firm political commitment to ensuring that NI's innovative fusion mental capacity legislation is fully brought into force in the medium term. Meanwhile, law reform should form part of a holistic approach on the part of NI's policy-makers towards improving mental healthcare provision for children and young people in line with a human rights-based approach. This would include the following: increased allocation of funding and resources to facilitate more timely access to suitable treatment and related services; enhancing participation in policy, judicial, and clinical decision-making that impacts their lives; and employing a range of executive accountability mechanisms to drive improvements in such provision over time.

A scoping review of health models for the community mental health needs of the United Arab Emirates: Nurturing the social determinants of mental health through social prescribing in the Middle East

Despite the growing interest in social prescribing the diversification of health and social care strategies to support the well-being of patients has remained entrenched with a focus on the hospital setting within the Middle East. The United Arab Emirates has commenced progressing community mental health care to lead changes in how care and treatment are delivered within the United Arab Emirates. The authors adopted the use of the framework of Arksey and O’Malley (2005) to provide a systematic approach to searching the literature and creating a comprehensive foundation to guide the review. This scoping review provides a better understanding of the compatibility, content and outcomes of a selection of health models whilst also allowing further clarification before empirical studies. The scoping review findings will inform the proposed use of social prescribing as an actionable approach to create a focus on the need to include and empower the social determinants of mental health. This article proposes an evidence-based health strategy that supports and enhances recent additions to national legislation on the inclusion of the Mental Health Law within the United Arab Emirates to meditate and prevent inequities in addressing the mental health needs of citizens and residents within the nation’s diverse communities.

Examining legal challenges in involuntary hospitalisation proceedings: insights from judicial analysis in China

Since the implementation of China’s Mental Health Law, there has been a notable increase in involuntary hospitalisation cases involving individuals with mental health conditions across many provinces, leading to significant social controversy. Moreover, in the process of involuntary hospitalisation litigation, patients with mental health conditions have experienced difficulty initiating legal proceedings, presenting their cases effectively, and prevailing in court, to name a few of the many challenges they face. These obstacles, by impeding them in safeguarding their lawful rights and interests against this legal measure, substantially restrict their personal freedom. To establish a more accessible judicial relief mechanism, a number of steps need to be taken: enhancing the relevant provisions governing the acceptance of involuntary hospitalisation cases, ensuring a balanced distribution of the burden of proof between both parties, and strengthening judicial scrutiny of the legality of involuntary hospitalisation.

Implementation and Service Delivery Status of the Mental Health Law in the Province of Zamboanga del Norte

Mental health had been a growing concern while mental illness had been increasing in number worldwide. The enactment of the Mental Health Law or RA 11036 in 2018 hoped to bring about better delivery of mental health services as well as uphold the rights of patients. This led the proponent to investigate the implementation and service delivery status of the mental health law in the province of Zamboanga del Norte. Employing a descriptive-qualitative design, the study assessed the implementation of the various government agencies on the Mental Health Law as well as the delivery of mental health services in the province of Zamboanga del Norte. There were 50 mental health professionals interviewed through phone, messenger, and Google form using a structured interview guide. Data gathered through the interviews were analyzed using thematic analysis. Results revealed that most of the government agencies were able to implement the law rating from 35.72% to 100% of the implementation. Eleven themes emerged such as poor knowledge about the mental health law, no proper seminars/training about mental health law, mental health is not a priority program, lack of coordination with the various agencies involved, difficulty managing mental health crises, non-inclusive mental health program, insufficient mental health services, multitasking of mental health providers, lack of mental health professionals, stigmatized attitude towards mental illness and support from LGU. It was revealed in this study that the implementation of the mental health law in the province is not fully implemented. Furthermore, the delivery of mental health services is also insufficient. As a recommendation, the primary implementing agency must exert more effort in cascading the law to all implementing agencies and mental health professionals down to the barangay level for the law to be understood and implemented. In addition, mental health services should be improved as well as the inclusion of a mental health facility.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

A scoping review of health models for the community mental health needs of the United Arab Emirates: Nurturing the social determinants of mental health through social prescribing in the Middle East

Despite the growing interest in social prescribing the diversification of health and social care strategies to support the well-being of patients has remained entrenched with a focus on the hospital setting within the Middle East. The United Arab Emirates has commenced progressing community mental health care to lead changes in how care and treatment are delivered within the United Arab Emirates. The authors adopted the use of the framework of Arksey and O’Malley (2005) to provide a systematic approach to searching the literature and creating a comprehensive foundation to guide the review. This scoping review provides a better understanding of the compatibility, content and outcomes of a selection of health models. The scoping review findings will inform the proposed use of social prescribing as an actionable approach to create a focus on the need to include and empower the social determinants of mental health. This article proposes an evidence-based health strategy that supports and enhances recent additions to national legislation on the inclusion of the Mental Health Law within the United Arab Emirates to meditate and prevent inequities in addressing the mental health needs of citizens and residents within the nation’s diverse communities.

A scoping review of health models for the community mental health needs of the United Arab Emirates: Nurturing the social determinants of mental health through social prescribing in the Middle East

Despite the growing interest in social prescribing the diversification of health and social care strategies to support the well-being of patients has remained entrenched with a focus on the hospital setting within the Middle East. The United Arab Emirates has commenced progressing community mental health care to lead changes in how care and treatment are delivered within the United Arab Emirates. The authors adopted the use of the framework of Arksey and O’Malley (2005) to provide a systematic approach to searching the literature and creating a comprehensive foundation to guide the review. This scoping review provides a better understanding of the compatibility, content and outcomes of a selection of health models. The scoping review findings will inform the proposed use of social prescribing as an actionable approach to create a focus on the need to include and empower the social determinants of mental health. This article proposes an evidence-based health strategy that supports and enhances recent additions to national legislation on the inclusion of the Mental Health Law within the United Arab Emirates to meditate and prevent inequities in addressing the mental health needs of citizens and residents within the nation’s diverse communities.

An incongruence between policy, practice, and cultural values: implications for mental health services in Namibia

ABSTRACT Mental health access, provisions, and utilization of social services in Namibia have seen challenges as well as opportunities for improvement. In this article, the authors 1) discuss Namibia’s antiquated mental health law and policies, 2) discuss the current landscape of social work and mental health in Namibia and similarly situated countries, 3) explore five-to-ten year projections for development, 4) discuss preventative and innovative solutions to address mental health in Namibia in the context of the grand challenge related to eradicate social isolation, and 5) explore opportunities for social work practice and research.

The reform of Irish mental health law: Aligning with human rights obligations?

This article critically examines the proposed reforms to Irish mental health law the Mental Health Act 2001 (2001 Act). The article will provide background to the 2001 Act and the lengthy law reform process, which has resulted in the publication of the Heads of Bill that propose significant amendments. The article assesses the suggested reforms, considering Ireland's 2018 ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD), which provides important context to the law reform process. The 2001 Act is the primary piece of legislation regulating mental health services and safeguarding the rights of persons subject to the legislation in Ireland. While passed in 2001, the legislation did not come into effect until 2006. The 2001 Act was seen as bringing Irish mental health law into compliance with international human rights law, in particular the European Convention on Human Rights (ECHR). However, Ireland's ratification of the CRPD has necessitated closer scrutiny of the legislation. This review has culminated in the publication of a Heads of Bill in July 2021 and pre-legislative scrutiny by the responsible parliamentary committee in 2022. The long title of the Heads of Bill explicitly states its goal of safeguarding individual autonomy and underscores its commitment to upholding and advancing the rights of people subject to the legislation. The analysis of the Heads of Bill addresses several key areas. These areas include a background to the long process of review, new guiding principles, the category of persons under the mental health legislation, mental health tribunals, consent to treatment, advance healthcare directives, provisions relating to children and young people, and independent advocacy. Based on this analysis of the Heads of Bill, recommendations are suggested which would strengthen respect for the human rights of persons subject to the legislation.

Effectiveness of Mental Health Promotion Policies and Programs of State Universities

The Mental Health Law, also known as RA 11036, is the approved legal basis for promoting awareness about mental health. It mandates every local government unit and academic institution to create its programs following the general guidelines set by the Philippine Council for Mental Health created under this law. Moreover, because there is a growing number of adolescents suffering from mental health problems, there is an excellent need for universities to take care of students’ mental health. This study primarily seeks to assess the effectiveness of mental health promotion policies and programs in the state universities of Region 2 in the Philippines and to know if there are significant differences between the respondents’ assessed effectiveness when grouped according to their profile variables: students (age, sex, years of stay, course) and implementers (educational attainment, years of experience, number of seminar/training & employment status). The study utilized a quantitative method, specifically using a survey questionnaire. Sampling was done through stratified and convenience sampling. The study’s results show that both students and implementers rated the efforts of the state universities in implementing mental health promotion policies and programs as “effective.” Implementers consistently gave higher ratings than students. Moreover, significant differences were present among the respondents’ assessed effectiveness of the academic institutions when grouped according to university, sex, and course/program. Regarding years of stay, only the indicator “facility access and referral mechanisms for psychosocial support” received a significant difference rating.

Breaking the stigma- mental health and legislative evolution in the Covid-19 era

Mental health legislation is vital for safeguarding the rights of individuals with mental disorders, a vulnerable segment of the population. This article explores the evolution and impact of Romania's mental health laws, which have developed to align with European standards while addressing the unique challenges of the Romanian mental health system. By examining recent legislative advancements and new policies, such as the National Mental Health Strategy 2020-2030 and the Mental Health and Wellbeing Act of 2021, the article highlights efforts to improve mental health care and reduce stigma. Comparisons with mental health legislation in other European Union countries, including Germany, France, Spain and others, provide a broader context for understanding Romania's progress and ongoing needs. The role of media in perpetuating stigma and the importance of public education and legislative reform are discussed as crucial components for fostering a supportive environment for individuals with mental disorders. Furthermore, the article addresses the biopsychosocial implications of stigmatization and the necessity of a societal commitment to enhance mental health understanding and support. The conclusion emphasizes that continuous legislative updates, public awareness campaigns, and integrated community-based services are essential for creating an inclusive and respectful society for those affected by mental disorders.

Workplace Mental Health Law – Comparative Perspectives

Workplace Mental Health Law – Comparative Perspectives

Authors' Reply: In the liminal spaces of mental health law - what to do when section 136 expires?

Authors' Reply: In the liminal spaces of mental health law - what to do when section 136 expires?

RE: In the liminal spaces of mental health law - what to do when section 136 expires?

RE: In the liminal spaces of mental health law - what to do when section 136 expires?

An international interdisciplinary approach to developing video educational materials promoting mental health literacy among adolescents in the Philippines.

Adolescent mental ill-health is a common international challenge affecting both high- and lower-middle-income countries. The Republic of the Philippines enacted its first mental health law in 2019, underlining the importance of the promotion of adolescent mental health education in schools. In Japan, course instructions about mental ill-health were formulated in a Course of Study that reflects governmental curriculum guidelines. Embedded since 2022, the Course of Study aimed to promote an understanding of current issues of adolescent health. The National Center for Global Health and Medicine in Japan has been sharing experience of promoting public health practices and advancing medical technology in low- and middle-income countries, especially in the Western Pacific region. This paper describes the development process and content of these resources by an interdisciplinary team from Japan and the Philippines. The interdisciplinary team created an embedded mental health education programme using animated videos for the Philippine school curriculum to improve mental health literacy in adolescents. Two six-minute animated videos of age-relevant stories were created. The animation scenarios illustrate: 1) mental health problems and recovery; and 2) major symptoms of mental illnesses, including depression, anxiety, and schizophrenia. Each animated video presents several items for discussion among students and/or teachers, both in class and online for students unable to attend school. Our efforts may provide good opportunities for enhancing adolescents' mental health activities in the Philippines. In the following steps, we should investigate the effectiveness of school-based MHL using these animated videos with rigorous evaluation methods.

Mental health patients' preferences regarding restrictive interventions: An integrative review.

INTRODUCTION: The use of restrictive interventions is a violation of patients' rights that causes physical and psychological harm and which is a well-known challenge globally. Mental health law and legislative principles and experts agree that when restrictive interventions are applied, the least restrictive alternative should be used. However, there is no consensus on what is the least restrictive alternative, especially from the patient perspective. To investigate the literature on mental health patients' preferences regarding restrictive interventions applied during admission to a psychiatric hospital. An integrative review informed by the PRISMA statement and thematic analysis were undertaken. There were tendencies towards patients preferring observation and, for the majority, mechanical restraint was the least preferred restrictive intervention. Factors such as environment, communication and duration were found to influence patients' preferences. There is a lack of agreement on how best to measure patients' preferences and this complicates the choice of the least restrictive alternative. Nonetheless, our findings show that staff should consider environment, communication and duration when applying restrictive interventions. More research on restrictive interventions and the least restrictive alternative is warranted, but agreement is needed on standard measures, and a standard global definition of restrictive interventions.

The CRPD and mental health law reform in Scotland

Scotland's mental health and capacity legislation and its implementation is underpinned by European Convention on Human Rights (ECHR) informed principles, and such legislation and its implementation has remained largely ECHR compliant. It is designed to protect individuals' autonomy from inappropriate and disproportionate nonconsensual intrusions but its scope is largely limited to this. However, since the legislation was enacted at the start of the twenty first century the UK subsequently ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) which requires the law and related practice to focus on giving effect to all the rights of persons with mental disabilities (people living with psychosocial, cognitive and intellectual disabilities) on an equal basis with others and to actively support such equality in rights enjoyment.The Terms of Reference of the independent Scottish Mental Health Law Review (2019–2022) included considering and making recommendations to align Scotland's mental health and capacity legislation with the CRPD. After engaging widely with stakeholders its recommendations sought to strengthen the voice of persons who use services and of those who care for them, reduce the need for non-consensual measures and secure rights to the help and support necessary to live a good life. In order to achieve this, it recommended, amongst other things, a refocusing on mental health and capacity law together with a Human Rights Enablement, Supported Decision Making and Autonomous Decision Making framework.

Stigma Associated with Mental Illness: Perspectives of Judges and Lawyers in Lebanon

IntroductionLegal professionals frequently encounter forensic mental health issues in the criminal justice system. These issues can significantly impact the outcome of cases, making it essential to understand the attitudes and perceptions of these experts towards mental illness. Despite a high number of individuals with mental illness in prisons, the availability of forensic mental health services is limited. While prior research has shown widespread stigma towards mental illness, there hasn’t been a study assessing the attitudes of judges and lawyers.ObjectivesThis study aims to investigate the stigma related to mental health among Lebanese legal professionals.MethodsAn online questionnaire was sent to judges and lawyers practicing in Lebanon. The survey included a section on demographics and personal data with the following scales: Reported and intended behavior scale (RIBS) which measures mental health stigma–related behavior and Perceived devaluation and discrimination scale (PDD) measuring the extent to which a person believes that most people will devalue or discriminate against someone with a mental illness.Results A total of 215 participants, with a mean age of 38.69 and a mean 13.16 years of experience, completed the questionnaire. Most were female (62.8%) and worked as civil attorneys (47.4%). Only a minority received instruction on mental health or mental health law during training (10.7% and 8.8%). About a quarter believed their education on mental health issues was sufficient (27%). Participants with positive attitudes (RIBS) were more likely to have a family member with a mental illness (p value = .001), feel comfortable handling cases involving mental health (p value = .001), and have lived with someone with a mental illness (p value = .007). Feeling adequately educated about mental health issues was associated with lower perceived stigma (PDDS, p value = .021). No significant associations with stigma scores were found for factors like age, gender, occupation, years of experience, contact with a mental health professional, taking psychotropic medications, disclosing personal mental health issues to friends or co-workers, receiving education on mental illness or mental health law, or working with individuals with mental health issues.ConclusionsThe findings imply that enhancing mental health education and awareness within the legal profession could be a key strategy to reduce stigma and improve the overall treatment of individuals with mental health issues within the criminal justice system in Lebanon.Disclosure of InterestNone Declared