National Mental Health Law Research Articles

Social Care and the Social Organization of Care as Key Categories for the Analysis of Public Policies

This work is part of the development of the UBACYT Research Project: Articulations between Mental Health and Primary Health Care in Argentina 2014- 2017: Discourses, Practices and Subjectivity in the process of implementing the National Mental Health Law N° 26,657, directed by Prof. Alicia Stolkiner. Its objective is to describe and analyze the categories of “social care” and “social organization of care” as keys for the analysis of public policies aimed at elderly people with dependency. In previous works, the care of the elderly was addressed as a right to be included in the public agenda and proposals for dependency care based on the community were analyzed, such as Day Clubs and Day Centers. Analysis of conceptions of care and the social organization of care as a key category in the analysis of public policies, which makes it possible to identify the distribution of care responsibilities between the state, market, family and community. It is a type of theoretical research of documentary and bibliographical analysis.

Epidemiologic Analysis of the Inpatient Psychiatric Unit at a General Metropolitan Community Hospital of Buenos Aires city, Argentina

To explore the frequency of sociodemographic, clinical, and therapeutic variables of the Inpatient Psychiatric Unit at the Italian Hospital of Buenos. Considering that the Inpatient Psychiatric Unit functions within a General Metropolitan Community Hospital, referent both at the local and the international level, we deem it relevant to perform an updated characterization of the population admitted into our Unit. This is especially important given the changes presented since the approval of the National Mental Health Law N° 26.657. We performed an observational descriptive and analytic cross-sectional study, studying the patients admitted into the Inpatient Psychiatric Unit for a period of 12 consecutive months (from October 1st, 2018, to September 30th, 2019). During the study period a total of 254 hospitalizations were registered. Mean Age: 51,85 years (S.D.=21,23), Median hospitalization time 22 days [IQR=14.00, 34.00], 31.5% of the admissions were involuntary. The most frequent cause of hospitalization was due to depressive episodes (32.7%), psychosis (22.8%), and dementia/behavioral symptoms (13%). 10.6% of the patients were admitted into our Unit after a suicide attempt. The present study provides an updated analysis of the hospitalized population. It contributes to outlining the changes that have taken place over the last years, because of the new legislation. The description of the epidemiologic characteristics of the inpatient population in our setting is crucial to have a current situation diagnosis that allows us to develop health-policy strategies and an adequate allocation of resources.

Knowledge of mental health diagnosis among patients and their family members: an inpatient survey in China

Background Patient-oriented information disclosure has been advocated by the National Mental Health Law (NMHL) in China since 2012; however, reporting on diagnostic disclosure to patients with mental disorders after the NMHL is limited. Amis This study aims to investigate and compare the knowledge of mental health diagnosis among patients and their family members in China. Methods An inpatient survey was conducted among 205 patients with mental disorders and their family members. Group differences of the correctness of self-reported mental health diagnosis were compared, and logistic regression was performed to investigate correlates among both patients and their family members. Results Overall, 76.7% patients and 80.6% of their family members reported a correct diagnosis. Only 46.2% patients with psychotic disorders correctly knew their diagnosis, significantly lower than their family members and patients with non-psychotic disorders. Multivariate regression analysis found that the diagnosis of psychotic disorders was a risk factor of patients’ diagnostic knowledge (AOR = 0.137; 95% CI = 0.044–0.429), while family members’ diagnostic knowledge was associated with their employment (AOR = 6.125, 95% CI = 1.942–19.323) and parent-child relationship with patients (AOR = 3.719; 95% CI = 1.057–13.086). Conclusions The majority of patients with non-psychotic disorders know their diagnosis correctly and informing family members of patients’ diagnosis remains a common practice in psychiatric setting after the implementation of China’s NMHL.

Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China

BackgroundA goal of China’s 2012 National Mental Health Law is to improve access to services and decrease urban versus rural disparities in services. However, pre-reform data is needed for objective evaluation of these reforms’ effectiveness. Accordingly, this study compares the pre-reform utilization of medical services for the treatment of schizophrenia in rural and urban communities in China.MethodsIn a large community-based study in four provinces representing 12% of China’s population conducted from 2001 to 2005, we identified 326 individuals with schizophrenia (78 never treated). Comparing those living in urban (n = 86) versus rural (n = 240) contexts, we used adjusted Poisson regression models to assess the relationship of ‘never treated’ status with family-level factors (marital status, family income, and number of co-resident family members) and illness severity factors (age of onset, symptom severity and functional impairment).ResultsDespite similar impairments due to symptoms, rural patients were less likely to have received intensive mental health services (i.e., use psychiatric inpatient services), and appeared more likely to be ‘never treated’ or to only have received outpatient care. Among rural patients, only having more than four co-resident family members was independently associated with ‘never-treated’ status (RR = 0.34; 95% CI, 0.12–0.94; p = 0.039). Among urban patients, only older age of onset was independently associated with ‘never-treated’ status (RR = 1.06; 95% CI 1.02–1.10, p = 0.003).ConclusionsIdentifying differential drivers of service utilization in urban and rural communities is needed before implementing policies to improve the utilization and equity of services and to define metrics of program success.

No sin la clínica

El presente escrito muestra dos cuestiones interrelacionados. En primer lugar, interrogar la actualidad de la ley nacional de salud mental a través de la experiencia previa sostenida y compartida como practicante de la clínica, en el ámbito público de la salud mental en la Provincia de Santa Fe. En segundo lugar, y como consecuencia inherente y decantada en otro tiempo lógico respecto de la experiencia –momento de paso y reescritura– abrir la interrogación sobre la intersección del discurso analítico y lo político.

Changing patterns and influencing factors of involuntary admissions following the implementation of China\u2019s mental health law: A 4-year longitudinal investigation

Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China’s first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.

Identity as a rights advocate: contextualizing the understanding of mental health user associations in Argentina

The importance of mental health services users’ participation regarding rights advocacy has been recognized during the last decades. The analysis of the cultural context in which rights advocacy takes place seems to be useful for understanding the different levels of development of users’ advocacy around the world. With the aim to describe the relationship between the perceptions of participants of a mental health rights advocacy association regarding their involvement in advocacy, its effects, and the cultural context, a descriptive qualitative study was carried out in Argentina, based on a ‘what matters most’ framework. Results show that the recovery of the culturally valued identity of militante (advocate) was seen as an important benefit. Social rights such as work and housing were ranked as the most important to advocate for. Based on the Argentinean National Mental Health Law, the relationship between top-down and bottom-up approaches toward users’ participation are discussed

The mental health users’ movement in Argentina from the perspective of Latin American Collective Health

ABSTRACTThe mental health users’ movement is a worldwide phenomenon that seeks to resist disempowerment and marginalisation of people living with mental illness. The Latin American Collective Health movement sees the mental health users’ movement as an opportunity for power redistribution and for autonomous participation. The present paper aims to analyze the users’ movement in Argentina from a Collective Health perspective, by tracing the history of users’ movement in the Country. A heterogeneous research team used a qualitative approach to study mental health users’ associations in Argentina. The local impact of the Convention on the Rights of Persons with Disabilities and the regulations of Argentina’s National Mental Health Law are taken as fundamental milestones. A strong tradition of social activism in Argentina ensured that the mental health care reforms included users’ involvement. However, the resulting growth of users’ associations after 2006, mainly to promote their participation through institutional channels, has not been followed by a more radical power distribution. Associations dedicated to the self-advocacy include a combination of actors with different motives. Despite the need for users to form alliances with other actors to gain ground, professional power struggles and the historical disempowerment of ‘patients’ stand as obstacles for users’ autonomous participation.

Changing of Chinese psychiatrists' attitudes toward consent process to treatment and its association with the China's National Mental Health Law.

Few studies have addressed informed consent in Chinese psychiatric practice. We wished to explore psychiatrists' attitudes toward informed consent in Shanghai after promulgation of the first national law for mental health care in China: the National Mental Health Law. A total of 398 psychiatrists were recruited from seven psychiatric hospitals in Shanghai. Their anthropometric data were collected. A confidential, self-report questionnaire addressing attitudes toward the informed consent process was completed by all participants. Most respondents would like to inform patients/guardians of the diagnosis (95.2%), treatment plan (93.5%), treatment goals and potential adverse effects of prescribed medications (94.7%), and alternative treatment plans (71.9%). In addition, 58.4% of psychiatrists thought that the informed consent process for physical restraint was difficult to follow. According to logistic regression, psychiatrists not trained to use the National Mental Health Law were more likely to have a negative attitude toward the informed consent process compared with those trained (adjusted odds ratio = 0.21; 95% confidence interval: 0.07-0.59; p = 0.003). Psychiatrists trained to use the National Mental Health Law had more positive attitudes toward the informed consent process. Lack of such training could affect the attitudes of psychiatrists toward the informed consent process in China.

Paradigm Shift or Paradigm Paralysis? National Mental Health and Capacity Law and Implementing the CRPD in Scotland

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) highlights the need to actively remove obstacles to, and promote, the full and equal enjoyment of human rights by persons with disabilities. This is challenging us to revisit existing conceptions about what is genuine equal and non-discriminatory enjoyment of human rights by persons with cognitive, intellectual and psychosocial disabilities and to accept that a real and fundamental culture change is required in order to achieve this. Whilst many states are seeking to address CRPD requirements in law and policy, including those identified in its Article 12, it is arguable that these do not go far enough in order to secure this culture change. This article considers three issues that need to be resolved as part of the process of achieving this paradigm shift, namely capacity assessments as thresholds for involuntary interventions, authorising involuntary interventions and support for the exercise of legal capacity, both generally and in the particular context of Scotland’s mental health and capacity laws. In doing so, it argues that it is debatable whether the CRPD paradigm shift can be realistically achieved by simply adapted or supplementing current legal and policy models.

Opinions of professionals and family members about the National mental health law regulating involuntary commitment of psychiatric patients: An international comparative study in 10 countries

IntroductionPrevious research illustrated that the laws regulating involuntary placement and treatment of persons with mental health problems are very diverse across countries: procedures for involuntary commitment and stakeholders involved in the initiation and decision making vary across countries; most laws include criteria of danger/risk, which take various forms in EU Member States’ legal frameworks, while the need for treatment in the best interests of the patient is sufficient to detain individuals in other countries, etc.ObjectivesThis study will compare the opinions of professionals and family members about the operation of the National mental health law regulating forcibly admission and treatment of psychiatric patients in ten countries: Ireland, Iceland, UK, Romania, Slovenia, Denmark, Sweden, Germany, Norway and India.AimsTo gain insights into stakeholders’ satisfaction with the operation of their national legislation and to compare the effectiveness and acceptability of different legislative processes across countries. Such scientific findings are needed in order to improve and harmonize legal practices, and to enhance fundamental rights protection of persons with mental health problems, which eventually could result in a lower rate of compulsory admissions.MethodsA short anonymous questionnaire consisting of 9 items was developed, using the online software Survey Monkey. It was distributed to representative samples via e-mail to psychiatrists, general practitioners, acute and community mental health nurses, tribunal members, guards and family members in each collaborating country. The levels of agreement/disagreement were measured on a Likert- scale.Results/ConclusionsThe study's results and conclusions will be presented at the conference.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Privacy, confidentiality and carers: India's harmonisation of national guidelines and international mental health law

Summary Context Clear guidelines on confidentiality and privacy are essential for those receiving treatment from mental health services and their families. Good mental health care also requires suitable supporting legislation. The United Nations Convention on the Rights of Persons with Disability (UN-CRPD) seeks to protect the rights and freedoms of individuals with disabilities. Its remit includes those with long-term mental or intellectual impairments. Consequently, many of the 159 signatories to the convention are attempting to revise their mental health legislation to bring it in line with the UN-CRPD. The World Health Organisation Resource Book on Mental Health, Human Rights and Legislation (WHO-RB) provides guidelines for drafting and revising mental health legislation. This document includes a checklist detailing topics, which should be addressed, but some elements of the WHO-RB appear to be in conflict with the UN-CRPD. This paper explores the UN-CRPD and the WHO-RB with specific focus on their positions on confidentiality, privacy and the rights of care-givers. We consider how the Indian Mental Healthcare Bill 2016 (IMHB) attempts to harmonise these two perspectives. Methods References to privacy, confidentiality and carers were identified and compared in the UN-CRPD, WHO-RB and IMHB. In addition to this, eleven items were identified in the WHO-RB Checklist relating to privacy, confidentiality and carers. The IMHB was analysed to see if it was concordant with these items. Results All three documents (UN-CRPD, WHO-RB and IMHB) refer to privacy, confidentiality and care-givers. The consideration of privacy in the WHO-RB was comprehensive; the UN-CRPD and the IMHB by contrast, affirm privacy as a right but fail to explore it in detail. The consideration of family and care-givers is starkly contrasted in the three documents. The UN-CRPD gives consideration to a person's right to have a family but makes little direct reference to the role of family in delivering care or supporting capacity. Regarding care-givers and family's quality of life, it briefly considers the material consequences of caring for an individual with disability, but fails to consider the psychological impact of such care-giving or how further exploration of confidentiality and privacy could ameliorate some of these stressors. The IMHB is adherent with five out of the eleven items (45.4%) drawn from the WHO-RB's checklist relating to privacy, confidentiality and carers. The IMHB attempted to address the others using its construct of nominated representatives and we identify some of the limitations of this concept in our discussion. Conclusion The UN-CRPD affirms the key fundamental principles of privacy and confidentiality, but its consideration of these principles lacks the depth required to address the complex and varied issues that can arise in the realm of mental health. The UN-CRPD fails to consider the role of the family and carers in sufficient detail. Confidentiality, privacy and the complex role of family are, however, discussed in the WHO-RB and this document can greatly supplement the UN-CRPD. This is especially true in instances when temporary limitation of specific rights is required. The IMHB has incorporated the UN-CRPD principles and applied them to mental health, and, in doing so has addressed many of the issues raised by the WHO-RB.

Physical restraint for psychiatric patients and its associations with clinical characteristics and the National Mental Health Law in China

Physical restraint (PR) for patients is an ongoing controversial topic in psychiatry. This study examined the percentage of PR and its associations with clinical characteristics and the implementation of the National Mental Health Law (NMHL) in China. The study consecutively assessed a sample of 1364 psychiatric inpatients. Socio-demographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Psychopathology and insight were measured using standardized instruments. The percentage of PR was 27.2% in the whole sample with 30.7% and 22.4% occurring respectively before and after the NMHL implementation (p=0.001). In multiple logistic regression analysis PR was positively associated with unemployment, lower income, aggression in the past month, being admitted before the NMHL implementation and poorer insight. The percentage of PR in Chinese psychiatric patients is associated with various clinical factors and appeared to decrease after the implementation of the NMHL. Focused and individualized care for patients who are unemployed, have low income, recent aggression and poor insight would be necessary at early stages of admission.

Review of Alaska Mental Health Statutes

This report identifies key statutory provisions that we recommend be amended, a description of our findings based on interviews with stakeholders, legislative history of the Alaska statutes, reviews of national best practices and, where applicable, information about emerging areas in national mental health law for Alaska to consider in creating new law. Our recommendations are based in large part on significant advances in law and medicine in the understanding and treatment of mental illness that have occurred in the years since Alaska last made significant and substantive reforms to its criminal and civil mental health statutes. It is important to note that proper implementation of many of the suggested reforms will require significant allocation of resources and development of infrastructure throughout the state and within local communities.

Mental illness stigma research in Argentina

Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.

Reporting on China's mental health surveillance.

Countries like the United States have already developed mental health surveillance, extensively covering diagnosis of mental disorders, symptoms, risk factors, and mental health services (1). These data guide Medicare and Medicaid coveragedecisionsanddirectattentiontonewareas,suchas adolescent suicide. In 2012, China’s first National Mental Health Law explicitly stipulated that a mental health surveillancenetworkshouldbeestablished(article24)andthat mental health work plans should be based on surveillance results (article 60). The National System of Basic Information Collection and Analysis for Psychoses, launched in 2011, is the only mentalhealth-themed surveillance system in China. Six severe mental illnesses—schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, psychotic disorder due to epilepsy, and mental retardation—are reported. Information ondiagnosis,medication,riskofviolence,andhistoryofcrime and violent or disruptive behavior is also collected. However, the surveillance system has at least three major problems. First, the system is a part of the National Continuing Management and Intervention Program for Psychoses (also named 686 Program), which was originally a response to the government’s concern about social harmony and stability (2). This explains why the surveillance focuses only on patients with severe mental illnesses and their violent or socially disruptive behaviors. This surveillance information is shared with public security departments. Second, although data dissemination is a core principle of surveillance, accessing data from the system is extremely difficultinChina.Unlikemonthlyreportingofcommunicable

Mental health law in Germany

There is no national mental health law in Germany: the 16 German states are responsible for legislation concerning forced admissions, while the German Civil Code covers non-acute care, in particular for those not able to care for themselves. In forensic psychiatry, both federal and state laws apply. This article describes this situation and provides figures about detentions and other aspects of mental health law in Germany.

The New Chinese Mental Health Law

A new national mental health law for China came into force in 2013, extending the cover of mental health legislation to a further 20% of the world's people. This article focuses on the new law's civil commitment regime. It analyses the provisions governing compulsory hospitalisation, review of compulsory status, and the powers of patients' guardians. We ask whether the rights-oriented form of the new law is likely to be reflected fully in practice, in light of the dominant role accorded family members in decision-making about compulsory hospitalisation, and in light of the limits imposed on the protection of individual rights by the prevailing judicial and medical cultures in China.

Operationalizing the involuntary treatment regulations of China's new mental health law.

Mental health legislation aims to find the right balance between the interests of mentally ill patients and the interests of the public. Sociocultural differences between nations result in different approaches to defining this balance in mental health laws and changes within nations over time lead to changes in the regulations used to operationalize these laws. There is general agreement in mental health laws from different jurisdictions about the importance of maintaining patients’ autonomy and their right to receive appropriate treatment. But there are substantial differences across jurisdictions in the mechanisms developed to operationalize these principles. This issue has recently been highlighted in China because regional administrations are now developing or revising local mental health regulations to conform with the principles outlined in the new national mental health law – the Mental Health Law of the People’s Republic of China [1] (hereafter, ‘Mental Health Law’) – which came into effect on May 1st, 2013. Our work on revising the 2002 version of the ‘Shanghai Mental Health Regulations’ has highlighted several problems related to the implementation of the national Mental Health Law’s treatment of the voluntary versus involuntary inpatient admission of mentally ill individuals.

Mental health literacy among residents in Shanghai.

BackgroundThe recent adoption of China's new national mental health law provides a good opportunity to obtain baseline information about community mental health literacy in the country.AimAssess knowledge and attitudes about mental disorders among residents in Shanghai.MethodsA total of 1953 residents aged 15 or above selected from all 19 districts in Shanghai completed two self-report questionnaires – the Mental Health Knowledge Questionnaire (MHKQ) and the Case Assessment Questionnaire (CAQ). MHKQ total scores range from 0 to 20 (higher scores indicate better mental health literacy). The CAQ presents respondents with five case vignettes and possesses nine questions after each vignette measuring respondents' knowledge and attitudes towards these mental illnesses.ResultsCorrect response rates for the 20 MHKQ items ranged from 26 to 98%, with a mean rate of 72%. The internal consistency (alpha) of the 20 items on the MHKQ was 0.69, but this decreased to 0.59 after removing four items about mental health promotion. A 5-factor model for the 20 items in the MHKQ was identified using exploratory factor analysis on one-half of the surveys, but the model was only partially validated in the confirmatory factor analysis using the second half of the surveys. On the CAQ, rates of correct recognition of mania, depression, schizophrenia with positive symptoms, schizophrenia with negative symptoms and anxiety were 42%, 35%, 30%, 19% and 21%, respectively. Work stress (37.3%), problems with thinking (30.0%) and negative life events (24.4%) were reported to be the three main causes of mental disorders. Seeing a counselor (34.2%) or a psychiatrist (33.3%) were the two most common suggestions for help-seeking. Higher education and younger age were related with better mental health literacy and higher rates of recognition of common mental disorders.ConclusionsMental health literacy in Shanghai appears to be increasing, but the reliability and validity of the instruments used to assess mental health literacy (MHKQ and CAQ) have not been adequately assessed so this result must be considered preliminary. Further work, preferably including both qualitative and quantitative components, is needed to revise these instruments before they can be used to assess the effectiveness of mental health promotion campaigns.