Review Of Health Research Articles

A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008

<p><strong>Aim.</strong> To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng.</p><p><strong>Method.</strong> A retrospective review of the register/database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included.</p><p><strong>Results.</strong> During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1% regional hospitals, 29.6% specialised psychiatric hospitals, 22.2% tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1% were from the specialised psychiatric hospitals (65.2% from Sterkfontein Hospital). Applications for outpatient care, treatment and rehabilitation (CTR) numbered 1 226 (92% assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347, respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5% inpatient, 6.5% outpatient), in the majority of cases for assisted CTR.</p><p><strong>Conclusion.</strong> The study suggests that in the 4 years since the promulgation of the MHCA in 2004 , there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments.</p>

Drafting a new curriculum for pre-registration nursing

The PasT year has been a watershed year for mental health nursing. schools of nursing are drafting the new pre-registration curriculum that will shape the identity, direction and future of the specialty. This vital task is being undertaken in the context of constrained budgets in higher education institutions (heIs) and in the Nhs, and takes account of the needs of the influential adult nursing specialty and the Nursing and Midwifery Council’s (NMC) guidance on competencies. Other mental health policy drivers include the review of mental health nursing in scotland, which culminated in Rights, Relationships and Recovery: Refreshed (Mental health Delivery and services 2010), an update of the original policy document of the same name (scottish executive 2006). The National Framework for Pre-Registration Mental health Nursing Programmes in scotland (Nhs education for scotland 2007) also guides programme and placement providers in heIs and mental health services. The document was produced jointly by practitioners, service users, carers and representatives from all heIs in scotland to apply agreed standards to all pre-registration programmes. These policies, and analogous drivers across the UK, are constantly defining and developing the roles, values and attitudes of mental health nurses, and hence the expectations of a graduate’s competencies. Mental health nurses care for one of the most marginalised and disempowered groups in our communities. Training and education prepare them to respond effectively to the needs of these people, to ensure their voices are heard. If this is not successful, there is a danger that service users’ needs will not be met, and that the specialist mental health nursing profession will be downgraded. The NMC’s UK-wide consultation (NMC 2008, 2010) appeared to favour the abolition of training in separate branches of nursing, but a switch to generic training was overwhelmingly rejected by respondents. The consultation then drafted both generic and specialised fields of competency for degree-level pre-registration training, with shared learning. The mental health nursing profession must remain alert to the need to promote specialised mental health nursing education. Mental health nursing increasingly emphasises care in the community, multi-agency community services, out-of-hours and crisis response teams and wider access to talk-based therapies. In scotland, this has been part of the shifting the Balance of Care initiative (Nhs scotland 2009). Older people’s wellbeing, involving mental health problems and dementia, is a priority in balancing care.

An evaluation of the impact of the recommendations of the Chief Nursing Officer’s (England) Review of Mental Health Nursing in Mental Health Trusts and Universities in England: findings from stage one, an e‐survey

To establish a national picture of the implementation of these recommendations in both trusts and higher education institutions. The Chief Nursing Officer for England Review of Mental Health Nursing made 17 key recommendations to improve mental health nursing. Subsequent publications aimed to help implement these recommendations. An e-survey. The survey was based on the Chief Nursing Officer review recommendations and guidance. all relevant trusts who deliver mental health services (n = 68) and higher education institutions who deliver pre-registration mental health nursing education (n = 50) in England. A total of 42 trusts (63·6%) and 40 higher education institutions (80%) completed the survey. The survey indicates that the Chief Nursing Officer review has stimulated some activity in all organisations who responded. Eleven of the recommendations were ranked similarly by trusts and higher education institutions. There were statistically significant differences between trusts and higher education institution priorities in four areas, inpatient care, evidence-based interventions, multidisciplinary team working and recruitment and retention. The findings of the survey demonstrate that all organisations have made some progress in the implementation of the Chief Nursing Officer recommendations. Trusts and higher education institutions broadly agree on the importance of each of the Chief Nursing Officer recommendations, with the exception of four items. A range of factors was identified by respondents that were perceived as facilitators and barriers to the implementation of the Chief Nursing Officer review. This article contains findings that are highly relevant for current and future clinical practice in mental health. Despite some progress, clear differences between higher education institutions and trusts are apparent. It is important that these differing perspectives are acknowledged and resolved to improve healthcare provision. Both trusts and higher education institutions reported difficulty with engaging service users and carers. A range of factors are identified that act as facilitators and barriers to the implementation of healthcare policy.

Review of Mental Health, Naturally: The Family Guide to Holistic Care for a Healthy Mind and Body

The Journal of Alternative and Complementary MedicineVol. 16, No. 8 Book ReviewReview of Mental Health, Naturally: The Family Guide to Holistic Care for a Healthy Mind and BodyWilliam BendaWilliam BendaSearch for more papers by this authorPublished Online:9 Aug 2010https://doi.org/10.1089/acm.2010.0283AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Review of Mental Health, Naturally: The Family Guide to Holistic Care for a Healthy Mind and Body." , 16(8), pp. 919–920FiguresReferencesRelatedDetails Volume 16Issue 8Aug 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:William Benda.Review of Mental Health, Naturally: The Family Guide to Holistic Care for a Healthy Mind and Body.The Journal of Alternative and Complementary Medicine.Aug 2010.919-920.http://doi.org/10.1089/acm.2010.0283Published in Volume: 16 Issue 8: August 9, 2010Online Ahead of Print:July 28, 2010PDF download

The Mental Health Act 1987: Quo Vadimus?

Persons with mental illness have the right to a range of treatment and supportive services in the community. These need to be assured to them by law. While older legislations viewed persons with mental illness either as "being dangerous" or as "objects of charity", the current UN Convention on the Rights of Persons with Disability views them as "subjects with rights". This has led to an urgent relook at the Mental Health Act 1987, which has faced criticism ever since its enactment. The recently proposed amendments enlarge the scope of regulation to include diverse mental healthcare facilities and professionals; seek the setting up of a State Mental Health Review Commission; lay down guidelines for "independent" and "supported" admissions; and propose new sections for emergency and other treatments, physical restraint and discharge. The debate regarding these amendments ranges from whether an amendment of the MHA will suffice or whether a new Act is required; whether the amendments are sufficiently broad-based or excessively focused on inpatient treatment; how mental illness is addressed in other Acts; who are key stakeholders, and, most important, whether the mechanisms for service provision have been adequately thought through. The process of initiating the amendments has been questioned by different stakeholders and highlights the need to bring about legislative change through adequate dialogue and collaboration.

Human Rights and Review of the Involuntary Status of Patients with a Mental Illness: Kracke after Momcilovic

Arguably, Australia's most significant judicial pronouncement on the human rights of those with mental illnesses was made in 2009 by Justice Bell, the then President of the Victorian Civil and Administrative Tribunal (“VCAT”). The decision is an exhaustive analysis of the application of the Charter of Human Rights and Responsibilities Act 2006 (Vic) to the involuntary status of a person subject to a community treatment order in Victoria. It occurred in the context of delays in the conduct of reviews of the status of a mentally ill person by Victoria's Mental Health Review Board (“the Board”). The outcome of the hearing was a declaration that the Board had breached the person's human rights to a fair hearing, even though the person's involuntary status on a community treatment order was not disturbed by VCAT. Whilst some important aspects of Justice Bell's decision concerning the general methodology to be applied when analysing human rights were overturned in the subsequent Court of Appeal decision of R v Momcilovic [2010] VSCA 50, the latter decision did not concern mental health and so leaves Kracke as the most detailed articulation and analysis of human rights within this difficult sphere.

Is the Mental Health Review Tribunal Inherently Unfair to Patients?

The Mental Health Act 1983 (UK), which governs the compulsory detention of psychiatric patients in England and Wales, includes a number of statutory safeguards to ensure that the patient's continued detention is not unlawful. One of these safeguards is the Mental Health Review Tribunal (MHRT). The primary role of MHRTs is to review the legality of a patient's detention in hospital and to direct discharge of those to whom the criteria for detention do not apply. Their powers, duties and procedures are contained within the Mental Health Act 1983 (UK) and the Tribunal Procedure (First-tier tribunal) Rules 2008. To hear individual cases, tribunals sit as a panel of three: a psychiatrist, a lay person and a legal chairperson. Article 5 of the European Convention of Human Rights (ECHR) enshrines the individual's right to liberty and security, but also includes a provision permitting the detention of persons of unsound mind. The ECHR also includes the right for an individual to have a periodic review of his or her detention and the lawfulness of it, a function that is fulfilled by the MHRT system. Currently approximately 40 000 patients per year are detained under the Mental Health Act, and almost 22 000 appeals are made to the MHRT, of which 12 000 are heard, in over 600 locations. The aim of this article is to examine the evidence as to whether MHRTs are inherently unfair to patients and biased towards overcautious professionals, and consider this in the light of various changes to the MHRT system proposed and adopted over recent years.

Is There a Role for Occupational Therapy within a Specialist Child and Adolescent Mental Health Eating Disorder Service?

In Northern Ireland, only two occupational therapists work within the specialist field of child and adolescent mental health (CAMH). This is despite recommendations made by the Bamford Review of Mental Health and Learning Disability (Northern Ireland) that occupational therapy should be a core element of CAMH provision. The College of Occupational Therapists has urged practitioners to challenge inequalities in health and social care provision and to use occupational language to reinforce the relationship between occupation, recovery and wellbeing. This opinion piece highlights occupational therapy core skills and occupational therapy frames of reference or modalities, underlining the application of both to eating disorders. The treatment models discussed are the Model of Human Occupation, the Canadian Model of Occupational Performance and sensory integration. Evidence reinforces that the models discussed are applicable, appropriate and valuable when treating children and adolescents with an eating disorder. It is argued that the valuable and unique role of occupational therapy must be recognised by health and social care commissioners and CAMH providers and be vocalised by occupational therapists. CAMH teams are advised to embrace the unique skills that occupational therapists have to offer children and adolescents with eating disorders in order to ensure that clients receive truly multidisciplinary and client-centred evidence-based services.

Review of Health for Sale,1 By Mannut Film

Review of Health for Sale,1 By Mannut Film

Shared Decision Making Is an Ethical Imperative

Shared Decision Making Is an Ethical Imperative

Trends in the Mental Health Act Review Tribunals: A Welsh experience 2004–2008

Aims and methodThis study aims at identifying any local trend in the appeal process and to determine if we are complying with the MHA 1983 and the Code of Practice by reviewing all the appeals to Mental Health Review Tribunals in a psychiatric hospital in South Wales for the period from 2004 to 2008. ResultsThe total numbers of sections and appeals remain steady over the years. Men are slightly more detained than women mainly under Sections 2 and 3 of the MH Act 1983. The main diagnoses for detention were: bipolar affective disorder, schizophrenia and psychosis. 95% of cases had appeals and 5% referrals. A hearing was held in 52% of cases (n=60), the RMO discharged 38% of patients and the patient withdrew appeal in 10% of cases. 95% of cases were British White ethnicity. Single men tended to appeal more than women 68% vs. 32%. There was no observed trend in the result of the appeals and the proportions of appeal discharged by the hearing remained unchanged. The results of the appeals were not associated with gender, ethnicity, marital status, age or the type of section involved. The patients who were previously detained tend to appeal more, i.e. the more number of detentions, the more number of appeals. In only 12% of cases who had the hearings, the appeal was successful and the patients were discharged from their sections. Clinical implicationsThe study shows steady volume of sections and appeals and the appeals are no more likely to result in discharge. The amendments of the Act 2007 also attract an increase in the appeal process especially in relation to the Community Treatment Orders and the Deprivation of Liberty. The use of both the Act and the Mental Capacity Act 2005 will increase workload for all involved practitioners.

Erratum

This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/13619322200800019. When citing the article, please cite: M Ferriter, E Kaltenthaler, G Parry, C Beverley, (2008), “Computerised Cognitive Behaviour Therapy for Phobias and Panic Disorder: A Systematic Review”, Mental Health Review Journal, Vol. 13 Iss: 3, pp. 24 - 31.

Medical treatment under Part IV of the Mental Health Act 1983 and the Human Rights Act 1998: review of Article 3 and 8 case law

Since the introduction of the Human Rights Act 1998, all courts and tribunals are obliged to interpret all laws and statute consistently and compatibly with the Human Rights Act. This includes the Mental Health Act 1983 (and the 2007 amendments) and mental health review tribunals. Mental health case law has evolved with regard to medical treatment under Part IV (Consent to Treatment) of the Mental Health Act being compliant with the Human Rights Act. Review and analysis of such case law can aide everyday clinical decision-making as well as improving knowledge of the Human Rights Act.

Learning From the Past, Looking to the Future: Is Victorian Mental Health Law Ripe for Reform?1

It is almost 30 years since the policy which underpins the current Victorian Mental Health Act was developed. The delivery of mental health services has changed dramatically over those years. As a result, the Act has been amended on numerous occasions, rendering it inaccessible for most people other than mental health law specialists. This article suggests that it may be time to legislate again, despite acknowledging that legislation tends to follow rather than precede change in mental health service delivery. The article traces the history of Victorian mental health legislation, from the opening of the first asylum in 1848, to the agitation for reform in the late 1970s which led to the passage of the current Act. Law reform is enhanced by clear identification of the values that underpin our laws. The new Victorian Charter of Human Rights and Responsibilities Act and the UN Convention on the Rights of Persons with Disabilities may assist in identifying important contemporary values which should inform new mental health laws. The following areas merit consideration when new mental health laws are considered: advance directives, the interaction between mental health and guardianship laws, information for family and friends of patients, the extended use of community treatment orders, the grounds for civil commitment, the jurisdiction of the Mental Health Review Board of Victoria, and the establishment of a commission to coordinate research and planning for the delivery of mental health services.

Trends in mental health review tribunal and hospital managers' hearings in north-east London 1997–2007

Aims and MethodTo examine trends in appeals to mental health review tribunals and hospital managers' panels in a hospital covering two outer London boroughs from 1997 to 2007. Data were also used to explore associations between demographic variables, including ethnicity, and the results of appeal hearings.ResultsThe number of detentions under Mental Health Act Sections 2, 3 and 37 rose from 203 in 1996 to 279 in 2006. the percentage of these that went to appeal increased from 34% to 81% during the same period. However, there was no observed trend in the result of the appeals. the results were not associated with gender, ethnicity, marital status, age or the section involved; 12% of appeals were successful.Clinical ImplicationsThe study shows rising use of the Mental Health Act over the past 10 years and an increasing volume of appeals against its use. Since appeals are no more likely to result in discharge, the increased use of the Mental Health Act is not balanced by increased rates of discharge by review hearings. the study also demonstrates the rising workload for all involved in appeal hearings.

S30-01 New world of Mental Health Legislation England and Wales David Jolley and Reinhard Heun

After eight years of tortured negotiations between government, professional psychiatrists and lay pressure groups, England and Wales will begin to use new Mental Health Legislation November 2008. This will not be a new Mental Health Act, but a substantial modification of the 1983 act. There are nine key changes:1.A single definition of mental disorder: ‘any disorder of mind or brain’.2.Criteria for compulsion: ‘appropriate medical treatment’ test.3.Age-appropriate services: special arrangements for under 18 years.4.Professional roles: approved clinicians and responsible clinicians (non-medical).5.Nearest relative: recognises Civil Partnerships, allows displacement.6.Supervised Community Treatment Orders.7.Mental health Review Tribunal: unified.8.Advocacy: Independent Mental Health Advocates.9.ECT: new safeguards.The Code of Practice identifies five key principles:1.Purpose - to minimise adverse effects of Mental Disorder.2.Least Restriction.3.Respect - diverse needs, values and circumstances.4.Participation - involving patient in planning, developing and reviewing treatment and care.5.Effectiveness, efficiency and equity - optimal use of resources.Earlier drafts had been described as: ‘little more than a Public Oder Bill dressed up as Mental Health legislation’; ‘ethically unworkable and practically unworkable’. Much of the dissent related to suggestions that people with Personality Disorder behaving in a dangerous or antisocial way should be subject to compulsory detention. Fears included breach of liberties and Human Rights and transformation of Mental Health Services disadvantaging people with major mental illnesses.

Widening the Circle: Making Mental Health Review Tribunal Hearings Accessible in Indigenous, Rural and Remote Settings

The aim of this paper is to overview the history, structure and activities of the Queensland Mental Health Review Tribunal in relation to Indigenous patients. The Mental Health Review Tribunal is an independent statutory body established under the Mental Health Act 2000 (MHA2000) to safeguard the rights of patients receiving involuntary treatment under the Queensland MHA2000. In the period from when the Tribunal commenced in 2002 to end of June 2008, people of Aboriginal and Torres Strait Islander background represent 2.3% of all patient registrations with the Tribunal. The Tribunal has established a range of strategies to encourage Aboriginal and Torres Strait Islander patients to attend and participate in their hearing. This includes widening the Tribunal's body of knowledge, strategies to inform patients about the Tribunal, culturally sensitive hearing practices, and widening the circle of participation in the hearing. The future direction for the Tribunal in this strategy will be influenced by more formal evaluation of the outcomes and by further development of a model for the provision of cultural advice.

MH6 v Mental Health Review Board and Another

MH6 v Mental Health Review Board and Another

Article 8 of the Human Rights Act 1998: implications for clinical practice

SummaryThe Human Rights Act was introduced into UK law in 2000 and must be considered in all cases, including mental health review tribunals. Article 8 (the right to respect for private and family life) comprises two parts and has embedded in it ‘tests’ that must be applied when assessing any interference with this protected right. A review of Article 8 case law reveals how it is used and how it can be applied in a myriad of clinical situations. Because it involves the right to respect for private life, and is in a sense individualised, it will potentially affect people (both patients and staff) in the mental health services in a variety of ways. Article 8 has implications not only for patients but also for clinicians and healthcare organisations.

Responsible medical officers and mental health review tribunals

Doctors have been found wanting when it comes to understanding legislation relating to mental health review tribunals ([Nimmagadda & Jones, 2008][1]). However, it is clear that Nimmagadda & Jones ([2008][1]) also are lacking in legal knowledge with regard to the status of doctors as responsible