Use Of Guardianship Research Articles

Between the convention and conventional practice: Israeli social workers' recommendations regarding the legal capacity of people with disabilities.

BackgroundFollowing the convention on the rights of persons with disabilities (CRPD), various countries have recently amended their legal capacity laws with the aim of restricting the use of guardianship and increasing the use of other, less restrictive practices, mainly supported decision making. As social workers have a key role in carrying out these reforms, this study examines how Israeli social workers make legal capacity‐related decisions.MethodSemi‐structured interviews with 27 Israeli social workers.ResultsThematic analysis identified three factors driving social workers' recommendations regarding guardianship and supported decision‐making: the person's diagnosis and functioning level, and the presence of a supportive family. A fourth factor, the person's preferences, played a complex and more limited role.ConclusionsMany changes have yet to be made to fully apply the support paradigm in Israel, since social workers still tend to base their recommendations on factors not fully aligned with the CRPD.

‘Necessity is Neither Condemned nor Praised’: Social Workers’ Meanings of Guardianship for Disabled People

Abstract Throughout the years, disabled people, especially those with intellectual and mental disabilities, have frequently been appointed authorised guardians. Having been criticised for restricting individual freedom and autonomy and in line with the 2006 UN Convention on the Rights of Persons with Disabilities, a 2016 reform in Israel's Legal Capacity and Guardianship Law called for restricting the use of guardianship and preferring less restrictive alternatives, specifically supported decision making (SDM). The success of this reform rests largely on social workers. This study examined the meanings social worker attach to guardianship and SDM. In-depth semi-structured interviews were conducted with twenty-seven Israeli social workers. The findings showed that whilst they acknowledged the shortcomings of guardianship, they nevertheless perceived it to be vital. They provided three justifications for this view: guardianship as a safeguarding practice, guardianship as promoting individual well-being and guardianship in the service of third parties. These findings are discussed in terms of their meaning for guardianship as a risk-aversive practice designed to promote service users’ well-being and quality of life and in terms of the role played by third parties in bringing SDM into force. Recommended steps for moving the current reform in guardianship from paper to practice are highlighted.

Continuity for children after guardianship versus adoption with kin: Approximating the right counterfactual

Over the past two decades there has been a rapid increase in the number of children and youth living in guardianship and adoptive homes who were previously in foster care. Further, previous studies compared outcomes for children in guardianship homes to those for children in adoptive homes, despite the fact that many factors likely affect the selection of foster youth into different types of permanent placements. This study examined two counterfactuals for guardianship as a permanent placement type: adoption only and adoption or long-term-fostercare (A+LTFC). Longitudinal outcomes were tracked for children who exited foster care with relatives through guardianship (N=4,884) or adoption (N=12,163), as well as children in long-term foster care with relatives (N=4,840). Propensity scores were used to match children on key indicators. In the matched sample of guardianship versus adoption cases only, children who exited to guardianship were more likely to experience discontinuity than children who exited through adoption, 11% vs. 6% respectively. However, when guardianship was compared to the combination of adoption or long-term foster care, children in guardianship experienced the same proportion of discontinuity, 11% vs. 11% respectively. These results suggest that simply matching guardianship to adoption without taking into account LTFC may be the wrong way to estimate the “what if” counterfactual if children were not discharged to guardianship. Findings also support the use of guardianship as a potential solution for children in LTFC whose caregivers are not planning to adopt.

Ethical Concerns and Procedural Pathways for Patients Who are Incapacitated and Alone: Implications from a Qualitative Study for Advancing Ethical Practice.

Adults who are incapacitated and alone, having no surrogates, may be known as "unbefriended." Decision-making for these particularly vulnerable patients is a common and vexing concern for healthcare providers and hospital ethics committees. When all other avenues for resolving the need for surrogate decision-making fail, patients who are incapacitated and alone may be referred for "public guardianship" or guardianship of last resort. While an appropriate mechanism in theory, these programs are often under-staffed and under-funded, laying the consequences of inadequacies on the healthcare system and the patient him or herself. We describe a qualitative study of professionals spanning clinical, court, and agency settings about the mechanisms for resolving surrogate consent for these patients and problems therein within the state of Massachusetts. Interviews found that all participants encountered adults who are incapacitated and without surrogates. Four approaches for addressing surrogate needs were: (1) work to restore capacity; (2) find previously unknown surrogates; (3) work with agencies to obtain surrogates; and (4) access the guardianship system. The use of guardianship was associated with procedural challenges and ethical concerns including delays in care, short term gains for long term costs, inabilities to meet a patient's values and preferences, conflicts of interest, and ethical discomfort among interviewees. Findings are discussed in the context of resources to restore capacity, identify previously unknown surrogates, and establish improved surrogate mechanisms for this vulnerable population.

Detentions of older adults under the Mental Health (Care and Treatment) (Scotland) Act 2003

This study prospectively examined all initial emergency and short-term detention orders of older adults under the Mental Health (Care and Treatment) (Scotland) Act 2003 in a Scottish health region in 2008 to determine differences in characteristics and outcomes by patients' age, gender and those detained by consultant compared with non-consultant clinicians. Detention order papers were scrutinized, the detaining practitioners were interviewed and case records were examined. Appropriate statistical analyses were performed. For the 87 detentions, subjects were Caucasian, male (54%) and 45% were aged 80 years or older. Ninety-four percent of detentions occurred on a weekday, during working hours (87%), in hospital (67%) with consultants initiating 74% of orders. Detention rates ranged from 66 to 171 per 100,000 over-65s. Seventy-five percent of patients had an organic disorder, 46% exhibiting psychotic symptoms. The older group had higher rates of confusion, organic diagnoses, but lower levels of previous psychiatric admissions. Consultants were more likely to detain patients with a wider variety of disorders, with more admissions to and detentions in psychiatric hospital care. Final detention outcomes were significantly different between the consultant and non-consultant groups. The results indicated few differences between the genders, but differences were more significant between the age cohorts and were further influenced by the grade of the detaining clinician. Further research is required to examine the influence that community mental health teams, advance statements and the use of guardianship and incapacity legislation have on the increasing rates of mental health detentions in the aging population.

Extra information about treatment is too much for the patient with psychosis

Background Case law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment. Aims To determine whether giving extra information impairs the mental capacity to make decisions about treatment. Method The MacCAT-T, MacCAT-FP, PANSS and GAF were administered to 88 detained forensic patients with psychosis. Two positive and two negative facts were given about each of two anti-psychotic drugs, and no treatment (twelve items). A choice was elicited. The criterion for incompetence was inability to express a choice. Two extra positive and two extra negative facts about each of the three options were given (twelve extra items) and a choice was again elicited, while repeating the MacCAT-T. Results Giving extra information led to a decline in the total score on the MacCAT-T. Twenty one were initially unable to make a choice (24%). After additional information, 33 were incapable (37.5%, Chi-squared p < 0.001). Those initially incapable had the lowest scores on all measures of functional capacity and GAF, with highest scores for symptoms. Those able to choose a treatment option had the highest levels of function and least symptoms. Those who became incapable had intermediate scores. Conclusions Giving extra information made an extra 15% unable to choose. Clinical judgement must be exercised concerning the amount of information disclosed. Deciding what is material to the individual is arbitrary when so few items of information can be processed. Greater use of guardianship and independent second opinions is recommended.

Alcohol-related brain damage--the concerns of the Mental Welfare Commission.

Scottish mental health legislation permits 'guardianship' for certain mentally impaired individuals, which imposes a requirement on place of residence, access and attendance at specified services for treatment and rehabilitation. The use of guardianship for alcohol-related brain damage increased steeply in the years 1993-1998. Possible explanations include: (1) increased prevalence or diagnosis of these conditions; (2) reduction of hospital beds; (3) a trend towards diminishing family and social support; (4) increased social work involvement in caring for such individuals; (5) increased consideration of the use of guardianship; (6) new private residential services; (7) lack of interest in the condition by existing services. There have been legal and clinical concerns about such individuals under guardianship relating to quality of ongoing clinical assessment, need for specific treatment and for the management of associated psychiatric illness, issues over control of drinking and control of personal finances, uncertainty over the use of restraint, and need for programmes helping the individual's progress towards independent living.

Guardianship under the Mental Health Act 1983

Aims and MethodTo describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.ResultsThere were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.Clinical ImplicationsThere is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

Working for the Mental Welfare Commission for Scotland

In this article we describe a six-month attachment to the Mental Welfare Commission for Scotland undertaken as part of higher professional training. We discuss the training benefits of such an attachment, emphasising the valuable overview it provided of mental health policy and the use of guardianship and leave of absence.

The use of guardianship in mental handicap services

There has been little published on the use of Guardianship Orders in mental handicap (the term ‘mental handicap’ is used rather than ‘people with learning disability’ to avoid ambiguity). Its use in the mental handicap services in four health districts in the Mersey region was surveyed. The study was retrospective, covering a five year period ending August 1994. Guardianship was used on ten occasions. Health professionals have been divided over the interpretation of the definition of “mental impairment” in the Mental Health Act (MHA) 1983. They have tended to exclude many mentally handicapped adults who do not, in their opinion, exhibit “abnormally aggressive or seriously irresponsible conduct”. It is clearly shown by our study that some health professionals are willing to classify self-neglect and vulnerability as “seriously irresponsible conduct”, thererefore allowing wider usage of the order.

Use of Guardianship under the 1983 Mental Health Act

The powers of guardianship under the 1983 Mental Health Act confer on the guardian powers to require the patient to reside in a specified place, to require attendance for treatment and to require access to the patient for appropriate health and social services personnel. This paper presents a descriptive study and analysis of the use of guardianship over a 5-year period in four geographical areas. Cases were collected retrospectively from a variety of sources and scrutinized systematically. Three cases of guardianship for mental impairment were excluded from the analysis leaving 23 patients with mental illness. All but two of the patients were female. Older patients, mostly with dementia, accounted for three-quarters of the sample and the majority of orders in this group were to require residence in an old people's home (usually with an apparently good outcome), though three were intended to facilitate home care. In most of the younger patients a functional psychiatric illness was diagnosed and powers were used to maintain the patient at home. The absence of a specific 'power to convey' needs to be resolved for elderly patients needing residential care. The use of guardianship orders to maintain older patients in the community needs further exploration.

Guardianship under the 1983 mental health act: A study on its use in cheshire

Abstract There has been much discussion about 'guardianship’ under the 1983 Mental Health Act recently and the following article reviews the use of guardianship in one particular local authority, Cheshire. Based on a retrospective analysis of 14 cases, the article is intended to demonstrate the practice issues involved, examining the reasons why guardianship was pursued and how successful or otherwise it proved to be. The resource and legal implications of guardianship as a viable alternative to hospital admission are also explored. Whilst scarce resources do present real limitations to the usefulness of guardianship, the article concludes that the legal limits to the powers in guardianship are probably about right and that guardianship, as it is presently defined, can provide a useful and realistic framework for supporting people suffering from mental disorder in the community.

Legal guardianship in traumatic brain injury rehabilitation: Ethical implications

This article examines legal and ethical issues in the rehabilitation of the head-injured client, particularly the use of guardianship. Several models of rehabilitation goal setting are discussed, with a particular emphasis upon an educational model for the relationship between provider and client. Consistent with the educational model, questions are raised about the institution of legal guardianship given the dynamic changes that often occur in a head-injured client's competency during his or her rehabilitation course. The authors suggest changes in certain guardianship procedures that would interfere as little as possible with client growth and autonomy.