Articles de revues : « Mental health care without consent »

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Fennell, Phil. « The Mental Capacity Act 2005, the Mental Health Act 1983, and the Common Law ». International Journal of Mental Health and Capacity Law 1, n^o 13 (5 septembre 2014) : 163. http://dx.doi.org/10.19164/ijmhcl.v1i13.178.

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This paper considers what has come to be known as the ‘interface’ between the Mental Capacity Act 2005 and the Mental Health Act 1983. Until the 2005 Act comes into force in 2007, practitioners will have to be aware of the interface between powers to admit to institutional care and treat without consent under common law and those which exist under the Mental Health Act 1983.In simple terms, the interface question is ‘When may the common law or, after 2007, the 2005 Act, be used to admit to institutional care and treat without consent, and when will use of the Mental Health Act be required?’ This article argues that there are two decisions of the European Court which need to be considered in determining how to bridge what has become the “Bournewood gap”: HL v United Kingdom and Storck v Germany. These will require that the State must provide effective supervisory mechanisms to ensure that mentally incapacitated people are not deprived of their liberty (Article 5) and do not have their right of bodily integrity interfered with (Article 8) without lawful authority.

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Ashley, Florence. « Reply to ‘Hormone replacement therapy : informed consent without assessment?’ ». Journal of Medical Ethics 45, n^o 12 (12 juillet 2019) : 826–27. http://dx.doi.org/10.1136/medethics-2019-105628.

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In a previous article, I argued that assessment requirements for transgender hormone replacement therapy (HRT) are unethical and dehumanising. A recent response published by the Journal of Medical Ethics criticises this proposal. In this reply, I advance that their response misunderstood core parts of my argument and fails to provide independent support for assessment requirements. Though transition-related care may have similarities with cosmetic surgeries, this does not suffice to establish a need for assessments, and nor do the high rates of depression and anxiety justify assessments, especially given the protective role HRT plays towards mental well-being.

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Maylea, Christopher. « The capacity to consent to sex in mental health inpatient units ». Australian & ; New Zealand Journal of Psychiatry 53, n^o 11 (22 mai 2019) : 1070–79. http://dx.doi.org/10.1177/0004867419850320.

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Objective: Discussions of capacity to consent in mental health care usually revolve around capacity to consent to treatment. This paper instead explores the issue of capacity to consent to sexual activity in a mental health inpatient setting as a way of exploring capacity from a different perspective. This is not a purely theoretical exercise, with both consensual sexual activity and sexual assault commonplace in mental health inpatient units, current policy and practice approaches are clearly not working and require re-examination. Methods: Four key frameworks are explored: human rights law, mental health law, the criminal law and the law of tort governing the duty of care. These frameworks are explored by highlighting relevant case law and statutes and considering their potential application in practice. This is undertaken using the state of Victoria, Australia, as a case study. Results: The four frameworks are shown to be consistent with each other but inconsistent with contemporary policy. All four legal frameworks explored require clinicians to take a case-by-case assessment to ensure that a person’s right to make their own decisions is preserved ‘ unless the contrary is demonstrably justified’ or where it is ‘ legally demanded’. While Victorian inpatient units attempt to enforce a blanket ban on consensual sexual activity in inpatient settings, this ban may be without legal basis and may be in breach of both human rights and mental health law. Conclusion: In policing the lawful bodily interactions of their patients and pushing sexual activity out of sight, clinicians may be breaching their duty of care to provide sexual health support and risk creating an environment in which the therapeutic relationship will be sacrificed to the enforcement of institutional policy. Clinicians and policymakers must understand the relevant legal frameworks to ensure that they are acting ethically and lawfully.

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Bakshi, Shinjini. « Peer Support as a Tool for Community Care : “Nothing About Us, Without Us” ». Columbia Social Work Review 19, n^o 1 (4 mai 2021) : 20–43. http://dx.doi.org/10.52214/cswr.v19i1.7602.

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In the face of socio-political marginalization, frontline communities reclaim power by harnessing peer wisdom and resilience. The year 2020 marked the confluence of a global pandemic and widespread resistance against anti-Black racism and police violence, highlighting the value of peer voices and community perspectives. To dismantle and transcend carceral approaches to community care, the field of social work is invited to join a larger anti-carceral mental health movement that honors lived experience and works alongside peers to build identity-affirming structures of mental health care. This article examines the ways in which frontline communities benefit from expanded access to anti-carceral formal and informal peer support as a mental health safety net that interrupts harm and prioritizes agency, consent, and self-determination. This paper broadens social work’s conceptualization of peer support through theoretical frameworks of anti-carceral social work, abolition, and intersectionality. Social work and its adjacent fields are called to urgently center Black liberation, collective healing, and community care by advocating for the integration of formal and informal peer support into mental health policy and practice. This paper strategically leans into a lineage of critical peer thought scholarship by utilizing footnotes and citations to model the ethical acknowledgment of peer labor within human rights movements. This intentional structure promotes radical solidarity that resists the exploitation of people with lived experience.

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Adwedaa, E. O. « Consent to Medical Treatment : What about the Adult Patient who is Incapable of Providing a Valid Consent ? » Postgraduate Medical Journal of Ghana 4, n^o 2 (12 juillet 2022) : 93–97. http://dx.doi.org/10.60014/pmjg.v4i2.153.

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Consent to medical treatment is a principle that is increasingly gaining attention in health care systems across the world. For consent to be valid, five essential elements must exist. The patient must have the mental ‘capacity’ to provide consent, he or she must receiveadequate and accurate information, understand the information disclosed, make a decision voluntarily and without coercion, and then authorize the treatment. In an article on ‘consent to medical treatment’ in a previous edition of this journal, I outlined how the Ghanaian courts may resolve consent related information disclosure disputes. That article dealt with the provision of information to the adult patient who has the mental capacity to provide lawful consent to medical treatment. A likely question that an interested reader of that article may ask is; ‘what are the legal provisions in Ghana for treating patients who lack the capacity to provide lawful consent to medical treatment as a result of factors such as a young age, disease, severe brain or mental illness or incapacity such as occurs in severe dementia, severe learning disabilities, and being unconscious? The purpose of this article is to attempt to answer sucha question. The scope of the article is limited to the management of the adult patient without the mental capacity to consent to medical treatment, which for the purpose of this article, in Ghana, refers to any individual aged 18 years or older who lacks the mentalcapacity.

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Schulz, Sarah L. « The Informed Consent Model of Transgender Care : An Alternative to the Diagnosis of Gender Dysphoria ». Journal of Humanistic Psychology 58, n^o 1 (13 décembre 2017) : 72–92. http://dx.doi.org/10.1177/0022167817745217.

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Historically, researchers and clinicians have viewed the transgender experience through a narrow diagnostic lens and have neglected to acknowledge the diverse experiences of those who identify as transgender. Currently, under the mainstream treatment paradigm, in order to be deemed eligible for gender transition services, transgender clients must meet criteria for a diagnosis of “gender dysphoria” as described in the DSM-5. An alternative to the diagnostic model for transgender health is the Informed Consent Model, which allows for clients who are transgender to access hormone treatments and surgical interventions without undergoing mental health evaluation or referral from a mental health specialist. This model shows promise for the treatment and understanding of the transgender experience outside of the lens of medical pathologization.

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Kramers-Olen, Anne. « Quantitative assessment of sexual knowledge and consent capacity in people with mild to moderate intellectual disability ». South African Journal of Psychology 47, n^o 3 (septembre 2017) : 367–78. http://dx.doi.org/10.1177/0081246317726457.

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While it is well known that people with an intellectual disability experience the same needs for intimacy as those without an intellectual disability, a number of developmental, structural, environmental, and attitudinal barriers circumvent the expression of sexuality in people with an intellectual disability – particularly in institutional and residential health care settings. People with an intellectual disability generally have lower levels of sexual knowledge than those without an intellectual disability, and sexual exploration and expression is frequently viewed with concern by mental health care practitioners and caregivers, who may regard people with an intellectual disability as being ‘nonsexual’ or ‘hypersexual’. However, the rights of people with an intellectual disability to sexual expression have been established in policy and legislation. Service providers are required at times to make determinations regarding the ability of people with an intellectual disability to consent to sexual intercourse in a number of health care settings. There is a dearth of published literature on psychometric instruments to assess sexual knowledge and consent capacity. This article briefly reviews the more commonly used sexual knowledge and consent assessments for people with mild to moderate intellectual disability and advances recommendations in this regard.

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Slade, Mike, Vanessa Pinfold, Joan Rapaport, Sophie Bellringer, Sube Banerjee, Elizabeth Kuipers et Peter Huxley. « Best practice when service users do not consent to sharing information with carers ». British Journal of Psychiatry 190, n^o 2 (février 2007) : 148–55. http://dx.doi.org/10.1192/bjp.bp.106.024935.

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BackgroundService users with psychosis may not consent to sharing information with carers. However, carers require access to relevant information to support them in their role.AimsTo inform clinical practice when service users withhold consent to share information with their carer.MethodStudy data were derived from a synthesis of policy review (n=91), national survey (n=595) and individual interviews (n=24).ResultsKey principles to guide information-sharing practices were identified. Service users highlighted confidentiality being guaranteed by consent processes. Carers suggested a ‘culture shift’ was required, with professionals trained to work with carers. Professionals emphasised mental capacity, professional judgement and the context of care. A best practice framework is proposed.ConclusionsAn important distinction is between general information, which can always be shared without consent, and personal information, which is new to the carer and where consent needs to be considered. Clinical judgement is central to balancing conflicting ethical imperatives in this area.

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Akhmetianova, Zamira Asrarovna, Geliusa Khadievna Garaeva, Olga Nikolaevna Nizamieva et Farda Ildarovna Khamidullina. « Rights of underage patients ». Linguistics and Culture Review 5, S1 (8 octobre 2021) : 1195–202. http://dx.doi.org/10.21744/lingcure.v5ns1.1505.

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The right of Russian citizens to their health protection is enshrined in the Constitution of the Russian Federation. However, there are peculiarities of the exercise of this right by a minor category of patients. The article analyzes the legal status of a minor patient, considers his social and individual rights in medical care. The peculiarities of the exercise of the child's right to information about the state of his health are revealed, the aspects of deciding on consent or refusal from medical care are considered. Given the fact that minor patients do not have full civil legal capacity, i.e. they cannot be responsible for their health and are not able to protect themselves, the article examines the relationship between the child's right to give his consent to medical intervention with the volume of civil legal capacity, as well as the conditions for the participation of a minor in contractual relations in the field of health care. The authors analyzed peculiarities of the exercise of rights by certain categories of minor patients: those who suffer from mental disorders, orphans and children left without parental care, minors, drug addicts, etc.

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Jones, Linda A., Jenny R. Nelder, Joseph M. Fryer, Philip H. Alsop, Michael R. Geary, Mark Prince et Rudolf N. Cardinal. « Public opinion on sharing data from health services for clinical and research purposes without explicit consent : an anonymous online survey in the UK ». BMJ Open 12, n^o 4 (avril 2022) : e057579. http://dx.doi.org/10.1136/bmjopen-2021-057579.

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ObjectivesUK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences.Design/setting/interventions/outcomesPre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data.ParticipantsOpen to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition.ResultsMost (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19.ConclusionsSupport for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support.Trial registration numberISRCTN37444142.

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Udo, Itoro, Zeid Mohammed et Amanda Gash. « Article Commentary : Psychiatric Issues in Palliative Care : Assessing Mental Capacity ». Palliative Care : Research and Treatment 7 (janvier 2013) : PCRT.S10889. http://dx.doi.org/10.4137/pcrt.s10889.

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Issues surrounding capacity to consent to or refuse treatment are increasingly receiving clinical and legal attention. Through the use of 3 case vignettes that involve different aspects of mental health care in palliative care settings, mental capacity issues are discussed. The vignettes tackle capacity in a patient with newly developed mental illness consequent to physical illness, capacity in a patient with mental illness but without delirium and capacity in a patient with known impairment of the mind. These discussions give credence to best practice position where physicians act in the best interests of their patients at all times. It is important to emphasize that capacity decisions have to be made on a case by case basis, within the remit of legal protection. This is a fundamental requirement of the Mental Capacity Act 2005, England & Wales (MCA). The later is used as the legal basis for these discussions. The psychiatric liaison service is a useful resource to provide consultation, advice and or joint assessment to clinicians encountering complex dilemmas involving decision-making capacity.

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Ciechorski, Jan. « Glosa do postanowienia Sądu Najwyższego z dnia 5 listopada 2015r., sygn. V CSK 456/15 ». Przegląd Prawa Medycznego 2, n^o 4 (4 octobre 2021) : 179–92. http://dx.doi.org/10.70537/a6dths71.

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Gloss to the decision of the Supreme Court of 5/11/2015, V CSK 456/15 The Supreme Court in the commented judgment aptly pointed out that the conditions for admission to a psychiatric hospital in the application procedure (Article 29 of the Act on Mental Health Protection) as any reception without consent must be understood strictly, and thus can not be interpreted in a wide way. This means that the medical condition in the form of mental illness can not be extended to other psychiatric disorders, and the premise concerning the behavior of this person - inability to satisfy basic life needs - should be understood as a real life threatening situation in the long term, and there is a real opportunity to improve (not deteriorate) mental health as a result of admission. At the same time, compulsory admission should be treated as a last resort if it is not possible to prevent it through outpatient care or hospitalization with the consent of the patient. When adjudicating that placement without consent, the court should consider not only health considerations, but also the interests and other good of the patient. A person applying for such a decision by a court should submit a psychiatrist's position regarding the need for treatment in a psychiatric hospital. If this is not possible, it should make the necessity of psychiatric hospitalization and the reasons for not submitting the position of a psychiatrist in the justification of the application. Then the court should order a psychiatric examination of the person concerned.

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Nagpal, R., et V. G. Jhanwar. « Surreptitious Drug Administration : Collective Decision Making Over Riding Personal Autonomy ». European Psychiatry 41, S1 (avril 2017) : S612. http://dx.doi.org/10.1016/j.eurpsy.2017.01.972.

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A quaint problem indeed. This is an issue where ethical and practical management issues lock horns. An individual with no insight on a rampage, a threat to self and others cannot be given medicines without consent except in an indoor facility and admitted under a specific provision of the current statute. Contrary to the law, the mental health policy envisages community care of the individual. For a time defined interval, surreptitious medication can be administered providing much needed relief to the caregivers and calms the recipient. Surreptitious medication can of course be an instrument of control and hence would necessitate a system of checks and balances. Surreptitious medication tests legal and ethical boundaries. It offers relief to caregivers but can be an instrument of abuse. The act of administering a drug without the individual's consent is prima facie wrong but if the context is woven in, a whole new dimension arises.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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WONG, J. G., I. C. H. CLARE, M. J. GUNN et A. J. HOLLAND. « Capacity to make health care decisions : its importance in clinical practice ». Psychological Medicine 29, n^o 2 (mars 1999) : 437–46. http://dx.doi.org/10.1017/s0033291798008113.

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Background. Assessment of capacity plays a pivotal role in determining when decisions need to be made on behalf of an individual. It therefore has major clinical management implications for health care professionals and civil liberties implications for the person concerned. In many countries, there is a presumption that adults have the capacity to make health care decisions. However, in persons with a mental disability, capacity may be temporarily or permanently impaired.Methods. A selective review is presented which considers: (i) the broad approaches taken to determining capacity; (ii) the abilities commonly assessed in determining capacity; and (iii) the principles underlying health care decision-making for adults who are without capacity.Results. Capacity is a functional concept, determined by the person's ability to understand, retain, and weigh up information relevant to the decision in order to arrive at a choice, and then to communicate that choice. We have reviewed the studies that examined decision-making abilities in people with dementia, chronic mental illness or intellectual disabilities. Approaches to decision-making in adults who lack capacity include: anticipatory decisions made through advance health care statements or decisions by proxy based on ‘best interests’ or ‘substituted judgement’.Conclusions. The understanding of clinical and legal aspects of capacity is still developing. This paper examines current concepts of capacity and decision-making on behalf of those without capacity. We propose a framework, in line with current ethical and legal guidelines, as an aid to clinicians when they are seeking consent for a health care intervention.

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Valery, K. M., A. Prouteau, S. Guionnet, L. Violeau et T. Fournier. « When mental health care is stigmatizing : experience of users and families and associated factors ». European Psychiatry 65, S1 (juin 2022) : S207. http://dx.doi.org/10.1192/j.eurpsy.2022.541.

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Introduction Mental health care is considered to be one of the main sources of mental illness stigmatization. Detailed information about these stigmatization experiences is needed to reduce stigma in mental health practices. Objectives The study aimed i) to identify the most relevant stigmatizing situations in mental health care encountered by users and families, ii) to characterize the relative importance of these situations in terms of frequency, experienced stigmatization and suffering, and iii) to identify individual and contextual factors associated with these experiences. Methods In a focus group, users were asked to select the 15 most relevant stigmatization situations among those they elicited and those that were taken from the literature. An online survey was then conducted among users and family members to characterize these situations and identify predictors. Results A total of 235 participants were included: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses and 80 family members. The results revealed 15 situations with different levels of frequency, stigmatization and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization and with a higher frequency. Moreover, factors such as recovery-oriented practices and measures without consent were the best predictors of experienced stigmatization. Conclusions These original stigmatization situations could be targeted to reduce stigmatization and associated suffering in mental health practices. Results strongly suggest that recovery-oriented practice should be fostered to fight stigma in mental health care. Disclosure No significant relationships.

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Chumakov, E. « Challenges that early career psychiatrists can face on compulsory treatment ». European Psychiatry 67, S1 (avril 2024) : S39. http://dx.doi.org/10.1192/j.eurpsy.2024.138.

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AbstractThe delivery of mental health care worldwide often involves compulsory treatment, a practice encountered by early career psychiatrists from the outset of their training. Despite its prevalence, little research has explored the challenges faced by trainees and early career psychiatrists when compelled to administer treatment without patient’s consent. This presentation will synthesize research data and offer personal reflections on the author’s experiences.Challenges that early career psychiatrists can face regarding compulsory treatment can be categorized into personal, professional, and institutional. Personal challenges encompass the emotional stress associated with applying coercive measures, coping with negative emotions, and managing service users’ attitudes toward treatment without consent. There is also concern that compulsory treatment may elevate the risk of emotional burnout. Professional challenges involve the administrative burden associated with organizing compulsory treatment, often exacerbated by the formalization of the process as a bureaucratic procedure in many European countries. Additionally, dealing with legal processes, including interactions with lawyers and courts, can pose significant difficulties, even though it is clearly done to protect the rights of the persons receiving care. Institutional challenges encompass the overall policy of providing compulsory psychiatric care in the psychiatrist’s home country and the specific practices of coercive measures in a given treatment facility. Furthermore, the lack of dedicated time for ethics of coercion during training is a common issue.In the current landscape of mental health care, early career psychiatrists must undergo training to handle coercive measures. While these measures are sometimes unavoidable, ethical principles must guide their administration. Additionally, access to supervision/mentoring is crucial for early career professionals facing challenging cases.Disclosure of InterestNone Declared

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Gurrera, R., M. Karel, A. Azar et J. Moye. « Neuropsychological performance variability is associated with reduced treatment consent capacity ». European Psychiatry 26, S2 (mars 2011) : 836. http://dx.doi.org/10.1016/s0924-9338(11)72541-x.

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The capacity of older adults to make health care treatment decisions is often impaired in dementia and has been linked to performance on specific neuropsychological tasks. Within-person across-test neuropsychological performance variability has been shown to predict future dementia. This study examined the relationship of within-person across-test neuropsychological performance variability to treatment decision (consent) capacity in community-dwelling older individuals. Men (N = 79) and women (N = 80) with (N = 83) or without (N = 76) probable mild to moderate dementia completed a neuropsychological test battery and a standardized capacity assessment that evaluates each of the following treatment decisional abilities separately: Understanding, Reasoning, Appreciation, and Expression of Choice. Standard scores were used to compute mean neuropsychological performance and within-person across-test variability. Neuropsychological performance and within-person variability were independently associated with continuous and dichotomous measures of capacity. The results of this study provide support for the emerging view that multiple distinct cognitive abilities are required to support this function, and indicate that the sensitivity and accuracy of consent capacity assessments can be improved by evaluating each of these components separately.

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Loomes, Gillian. « Researching about us without us : exploring research participation and the politics of disability rights in the context of the Mental Capacity Act 2005 ». Journal of Medical Ethics 44, n^o 6 (3 mars 2018) : 424–27. http://dx.doi.org/10.1136/medethics-2016-104129.

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The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the Mental Capacity Act (MCA) 2005, which sets out in Anglo-Welsh law the circumstances and requirements for research participation by individuals lacking the capacity to provide informed consent. Drawing on my own perspective on research participation in relation to physical and psychosocial disability, I consider the implications of my potential future loss of capacity (eg, if I were to be in a vegetative or minimally conscious state following an accident) for my right to participate in disability-related research. I examine the barriers to such participation and suggest that partial solutions may be found in the advance decision-making and advance care-planning frameworks of the MCA 2005 and related policy, but that current legislative and policy frameworks nevertheless still curtail my rights with regard to research participation on loss of capacity to consent. In so doing, I seek to provoke debate concerning what this legislative provision means for the disability rights movement, and the possibilities and challenges it presents to the movement’s commitment to ‘nothing about us without us’.

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Rhoden, Nancy K. « Legal Issues in Neonatal Intensive Care ». International Journal of Technology Assessment in Health Care 7, S1 (janvier 1991) : 139–42. http://dx.doi.org/10.1017/s026646230001268x.

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The United States, unlike most European countries, has had substantial legal, regulatory, and legislative activity concerning treatment decisions for newborns. This activity began as a result of the highly publicized “Baby Doe” case, in which parents of a child born in 1982 with Down syndrome and esophageal atresia refused consent for surgery, and the Indiana state courts refused to intervene (1). Initially, the Department of Health and Human Services promulgated a series of “Baby Doe” regulations intended to prohibit nontreatment. The regulations were at all times invoking the theory that it is discriminatory to fail to provide treatment to a handicapped infant if such treatment would be provided to a child without such handicap (2). This theory worked well for the department's paradigm case, where the handicap was one such as Down syndrome, and there was an associated physical defect that could be corrected and that would be treated were the infant of normal mental capacity. But a nondiscrimination theory here is extremely rigid: it appeared that even devastating levels of handicap— indeed, even the most extreme “handicap” of unconsciousness — would be irrelevant to treatment decisions.

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Feeney, Larkin, et Paul Moran. « Information sharing and risk : a survey of psychiatrists ». Irish Journal of Psychological Medicine 24, n^o 3 (septembre 2007) : 94–98. http://dx.doi.org/10.1017/s0790966700010387.

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AbstractObjectives: Historical information is central to decision making in mental health care. Clinical information in the Irish mental health services is currently mostly paper based. Mental health care in Ireland has moved from an institutional medical model towards a community based multidisciplinary model in recent years. This change has resulted in a dispersal of information between multiple sites and professionals, rendering it less accessible, particularly in emergency settings.This study sought to find out if psychiatrists working in Ireland were experiencing information problems, their ideas about and attitudes towards electronic solutions to these problems, and their views as to what particular pieces of information are indispensable in emergency mental health assessments.Method: A questionnaire was designed to answer these questions and sent to a representative sample of 150 psychiatrists working in Ireland.Results: One hundred and nineteen questionnaires (79.3%) were returned complete. Of the 119 respondents 98(82.4%) stated that they had performed emergency mental health assessments within the past year without access to key information and 79(66.4%) said they would have made different decisions in some cases had they had all the available information. Information deficits were particularly apparent in liaison and forensic psychiatry.Of the respondents 110(92.4%) stated that they would welcome an electronic database designed to support emergency mental health assessments. Misgivings were expressed regarding forms of consent, data quality, breach of confidentiality, resources and much more. Risk factors (ie. self-harm potential), a high alert message and medication details were the data items thought to be most critical.Conclusions: A shareable set of essential pieces of information (a minimum data set) would offer a balance between patient safety, confidentiality and shareability. A wider debate about solutions to the information deficits in mental health care in Ireland needs to take place among all stakeholders so that this idea can be moved forward.

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Charles, Jocelyn, Einat Danieli, Kiara Fine, Jaipreet Kohli, Stacy Landau, Jagger Smith et Naomi Ziegler. « Neighbourhood Care Teams : Integrating Health Care and Social Services for Seniors in Toronto Community Housing ». International Journal of Integrated Care 23, S1 (28 décembre 2023) : 428. http://dx.doi.org/10.5334/ijic.icic23501.

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Toronto Seniors Housing Corporation (TSHC), owned by the City of Toronto, provides housing for 15,000 low-income seniors in 83 seniors-designated buildings across Toronto. The North Toronto Ontario Health Team (including primary care, hospital, community and home-care) partnered with one of the TSHC buildings in North Toronto to develop and implement a Neighbourhood Care Team (NCT) model to support TSHC’s Integrated Service Model to address tenants' health and social needs, co-designed with the tenants. The goal of the NCT is to provide an integrated model of care that is accountable to meeting the needs of people living within a specific neighbourhood so that people experience one system that provides simple access to service, and care that is coordinated with streamlined communication of health care providers. The NCT objectives include: Increasing primary care provider connections Increasing mental health & addictions care access and support options Increase Digital Health access and literacy to support primary care and specialist access, reduce social isolation and increase wellness Reduce avoidable ED and hospital use. The service design is guided by a co-design process with the tenants as follows: Door to door survey to engage tenants in identifying their barriers and the services and supports most meaningful to them Eliciting and voting on key education and support initiatives at an influenza vaccination clinic Communication back to tenants regarding the results of the survey and how the strategies/activities planned for the building have been prioritized based on their feedback. Multi-organization Education Fair focusing on the top issues addressed during the vaccination clinic survey which was well attended Regular educational sessions in response to tenant interest, combined with a self-screening component to help link the information to a concrete service/intervention to promote better health. Providing translation support to enable access and engagement by tenants from a variety of cultural backgrounds. Ongoing commitment to continue and co-design services and elicit tenants’ feedback. The team has worked to design structures to strengthen coordination and collaboration among the various delivery partners: Multi-organizational bi-weekly huddles to discuss residents identified with unmet needs (with consent or anonymized without consent) and identify options for improving their access to health care/social services and respond to their needs in a timely manner Designed pathways for ensuring attachment to primary care, access to primary care and specialist support, access to home care services and assistance with social determinants of health Established mechanisms to obtain informed consent and enable information sharing between delivery partners. Multi-modality tenant engagement to tailor services and supports to a TSHC building has led to increased involvement by tenants and a growing interest by tenants in strategies to improve their health and social inclusion. Cross-sector collaboration is an efficient and effective way to establish needs-based integration of health and social care services in this setting. Strong leadership as well as co-developed processes, frequent building meetings and cross-sector huddles were effective ways of sharing innovative ways of meeting needs with limited resources.

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Harris, Suzanne C., Derek Yates, Michael Patel et Khushboo Patel. « Student engagement and perceptions of stigmatizing views in a mental health–focused collegiate organization ». Mental Health Clinician 7, n^o 5 (1 septembre 2017) : 187–93. http://dx.doi.org/10.9740/mhc.2017.09.187.

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Abstract Introduction: While often unintentional, stigma associated with mental health remains prevalent among health care professionals and is implicated in treatment disparities between patients with and without mental disorders. Pharmacists and pharmacy students have also been previously described as prone to discomfort interacting with this population. The purpose of this study was to evaluate stigma, student involvement in mental health activities, and student interest in psychiatric pharmacy. Methods: An anonymous, voluntary online survey was open to all student chapters in a mental health–focused professional organization. Sixty-five students from 19 chapters participated in the survey after consent was obtained. Stigma and social distance survey items were adapted from previously validated instruments. Descriptive statistics were used and correlations were investigated using Spearman rank correlation. Results: Results indicated that students had overall low stigma but more negative views related to disclosure of one's own illness or to more personal interactions. Level of involvement was unrelated to level of stigma, and perceived impact by nonleadership activities was associated with lower stigma (P = .016). Shadowing pharmacists and community service were frequently reported as most influential on student perceptions of mental health (23% and 26%, respectively). Discussion: Students involved in a mental health–focused organization had overall positive perceptions toward mental illness. Student engagement in specific opportunities at any level may be more influential than total number of activities participated in. Students have a strong interest in pursuing extracurricular activities in mental health and perceive interactions with patient contact as the most influential on their attitudes.

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Smith, Chris, Jenny Hewison, Robert M. West, Elspeth Guthrie, Peter Trigwell, Mike J. Crawford, Carolyn J. Czoski Murray et al. « Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO) : a protocol ». BMJ Open 9, n^o 11 (novembre 2019) : e032179. http://dx.doi.org/10.1136/bmjopen-2019-032179.

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IntroductionWe describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in acute hospitals in England.Methods and analysisThe project will use three data sources: (1) Hospital Episode Statistics (HES), a database controlled by NHS Digital that contains patient data relating to emergency department (ED), inpatient and outpatient episodes at hospitals in England; (2) ResearchOne, a research database controlled by The Phoenix Partnership (TPP) that contains patient data relating to primary care provided by organisations using the SystmOne clinical information system and (3) clinical databases controlled by mental health trusts that contain patient data relating to care provided by liaison psychiatry services. We will link patient data from these sources to construct care pathways for patients who have been admitted to a particular hospital and determine those patients who have been seen by a liaison psychiatry service during their admission.Patient care pathways will form the basis of a matched cohort design to test the effectiveness of liaison intervention. We will combine healthcare utilisation within care pathways using cost figures from national databases. We will compare the cost of each care pathway and the impact of a broad set of health-related outcomes to obtain preliminary estimates of cost-effectiveness for liaison psychiatry services. We will carry out an exploratory incremental cost-effectiveness analysis from a whole system perspective.Ethics and disseminationIndividual patient consent will not be feasible for this study. Favourable ethical opinion has been obtained from the NHS Research Ethics Committee (North of Scotland) (REF: 16/NS/0025) for Work Stream 2 (phase 1) of the Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes study. The Confidentiality Advisory Group at the Health Research Authority determined that Section 251 approval under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 was not required for the study ‘on the basis that there is no disclosure of patient identifiable data without consent’ (REF: 16/CAG/0037).Results of the study will be published in academic journals in health services research and mental health. Details of the study methodology will also be published in an academic journal. Discussion papers will be authored for health service commissioners.

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Godet, Tony, et Gérard Niveau. « Psychiatric care without consent in France : Does the type of administrative measure chosen differ according to patients' clinical profile ? » International Journal of Law and Psychiatry 61 (novembre 2018) : 76–80. http://dx.doi.org/10.1016/j.ijlp.2018.08.005.

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Chougule, Umesh, Kavita Sharma, Shreesh S. Kolekar, Hemchandra V. Nerlekar et Shailly Gupta. « Informed Consent in Surgery : Legal and Ethical Considerations ». Journal of Neonatal Surgery 14, n^o 2S (10 février 2025) : 21–30. https://doi.org/10.52783/jns.v14.1650.

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In surgery, patients must give free permission to medical procedures after being fully told of the risks, rewards, and other options. This is called "informed consent," and it is both an ethical and legal requirement. Patients' right to make their own decisions and be independent is protected by this idea. This means that medicines can't be given to them without their clear permission. Surgeons are required by law to give people enough information about the surgery they are suggesting so that they can make an informed decision about their care. Ignoring educated consent could lead to legal action, such as malpractice cases. In terms of ethics, the method goes beyond simple openness because it includes respecting the patient's right to make their own decisions and building trust between patients and healthcare workers. Surgeons have to give patients correct and understandable information while considering how well they can handle complicated medical information, which can change depending on their age, culture, and mental health. Making sure that patients are not pushed or misled and fixing language problems or gaps in health knowledge are problems that can come up with informed consent. Ethical problems can also happen when patients don't give permission, like in an emergency or when the patient isn't able to speak for themselves. This makes proxy decision-making problematic. As medical processes change with new technology, it is still necessary to have updated rules and ways of making sure that patients give their informed consent. This is to protect patients' rights and keep surgery ethical. This paper talks about how medical procedures and technology are changing by looking into the tricky area where legal requirements and moral issues meet when getting informed consent.

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Fields, Lauren, Catherine A. Callaway, Elyse R. Park, Andrew A. Nierenberg, Joseph Greer, Jennifer S. Temel et Kelly Irwin. « Randomized trial protocol of bridge intervention for patients with serious mental illness and cancer. » Journal of Clinical Oncology 36, n^o 34_suppl (1 décembre 2018) : 153. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.153.

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153 Background: Individuals with serious mental illness (SMI) diagnosed with cancer often have disruptions in treatment, leading to premature mortality compared to patients without SMI. To address such gaps in care, we developed and piloted a collaborative care intervention for patients with SMI and cancer (Bridge). We now propose a randomized controlled trial (RCT) to investigate the impact of the Bridge intervention on disruptions in cancer care for patients with SMI. Methods: We will conduct a two-arm RCT (n = 120) comparing Bridge to enhanced usual care (EUC) for patients with SMI (schizophrenia, bipolar disorder, major depressive disorder) and newly diagnosed breast, lung, gastrointestinal, or head/neck cancer. The 12-week Bridge intervention includes: 1) assessment by a psychiatrist with expertise in oncology at cancer diagnosis, 2) involvement of a case manager to promote self-management and care coordination, 3) collaboration between psychiatry and oncology (e.g., joint visits, developing an integrated treatment plan) to address barriers to care, and 4) availability of study clinicians via phone, text, or in-person for consultation and follow-up with patients, caregivers, and oncology and community mental health clinicians. In the EUC arm, study staff will inform the treating oncologist of the psychiatric diagnosis and notify the patient and oncologist of available psychosocial services at enrollment. Patients will be randomized 1:1 to Bridge or EUC, stratified by presence of a caregiver. Identified caregivers will be co-enrolled, and patients without a caregiver will be eligible. We will utilize verbal consent, link study visits to oncology appointments, and personalize frequency and location (e.g., community, clinic, hospital) of contact with patients and caregivers to decrease burden and promote engagement. The primary outcome is the proportion of patients with disruptions in cancer care within 6 months of enrollment, confirmed by oncologists blinded to study arm. Secondary outcomes include clinician assessment of psychiatric illness severity as well as patient and caregiver reported measures (e.g., depression, engagement in care, treatment satisfaction). Results: N/A. Conclusions: N/A. Clinical trial information: NCT03360695.

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Azizi, L., O. Seyar, N. Baabouchi, F. Laboudi et A. Ouanass. « Post-traumatic stress disorder and restraint in patients followed at Arrazi Hospital ». European Psychiatry 66, S1 (mars 2023) : S979. http://dx.doi.org/10.1192/j.eurpsy.2023.2082.

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IntroductionPost-traumatic stress disorder (PTSD) is characterized by intense, unpleasant, and dysfunctional reactions that appear after an overwhelming traumatic event. A life-threatening or serious injury event can cause lasting and intense suffering.Hospitalization without consent, the use of isolation techniques, restraint or the obligation to take treatment are situations that can be perceived as traumatic.ObjectivesOur goal is: The search for the existence of psycho-pathological links and vulnerabilities between the state of post-traumatic stress and physical restraint. Consideration of the traumatic event in the development of appropriate care strategies.Our goal is:The search for the existence of psycho-pathological links and vulnerabilities between the state of post-traumatic stress and physical restraint.Consideration of the traumatic event in the development of appropriate care strategies.MethodsTo meet this objective, we carried out a descriptive study which identified 200 cases collected in the psychiatric emergency department of the Arrazi Hospital in Salé from 2017 to 2021. An exploitation sheet was drawn up and the study was carried out using Meta-chart and Visuel-chart software.ResultsAt the end of this work we found: The average age is 35 years +/- the sex ratio is equal to 1.42. 80% are single while 10% are divorced. Regarding professional activity, 70% are unemployed. 10% of patients have a level of education above the baccalaureate.As for the history, 60% of the cases studied have a personal psycho-addictive history. 34.6% of the cases studied have a medical-surgical history.The psychiatric pathologies that were found are: 10% suffer from depressive disorder, 80% have psychosis, 10% have attempted suicide.ConclusionsDuring an acute episode, patients may be exposed to coercive treatments. Hospitalization without consent, the use of isolation techniques, restraint or the obligation to take treatment are all factors that can be perceived as traumatic. For example, patients recently exposed to a first psychotic episode confirmed the traumatic character of the psychotic episode itself, of the treatment or of both.Disclosure of InterestNone Declared

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Papadopoulou, Vasiliki, Aikaterini Arvaniti, Eleni Kalamara, Eugenie Georgaca, Stelios Stylianidis, Lily E. Peppou et Maria Samakouri. « Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece ». Healthcare 11, n^o 22 (17 novembre 2023) : 2977. http://dx.doi.org/10.3390/healthcare11222977.

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Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with “F20–29 schizophrenia, schizotypal and delusional disorders” were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor’s Office of regions that are located far from the psychiatric department of UGHA (Fisher’s exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an “F20–29 schizophrenia, schizotypal and delusional disorders” diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.

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Rifqi, Muhammad Jazil. « Perlindungan Hukum terhadap Anak dalam Nikah Siri ». Al-Qanun : Jurnal Pemikiran dan Pembaharuan Hukum Islam 23, n^o 2 (19 décembre 2020) : 382–99. http://dx.doi.org/10.15642/alqanun.2020.23.2.382-399.

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Married couples must meet religious and state law. In Islamic law, marriages must be fulfilled, the harmony of the marriage, the bride and groom, prospective guardians, marriage, two people, consent and Kabul, while state law, needs to be added validity, marriage, must be in accordance with applicable law. However, not a few marriages in areas that carry out their marriages are only based on religious law and customary law, without involving Marriage Registrar to improve this marriage by considering siri marriages that increase returns to desired husbands and children. Civil rights are not guaranteed at the time of marriage to a siri marriage because the child will not obtain citizenship status, and the child only has a civil relationship with the mother and related family, which basically requires the cost of child care.

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Alavi, Nazanin, Megan Yang, Callum Stephenson, Niloofar Nikjoo, Niloufar Malakouti, Gina Layzell, Jasleen Jagayat et al. « Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic : Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program ». JMIR Research Protocols 9, n^o 12 (18 décembre 2020) : e24913. http://dx.doi.org/10.2196/24913.

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Background The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. Objective This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. Methods This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. Conclusions If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. Trial Registration ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 International Registered Report Identifier (IRRID) DERR1-10.2196/24913

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Kotzé, C., et JL Roos. « 458 - End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer ». International Psychogeriatrics 32, S1 (octobre 2020) : 179. http://dx.doi.org/10.1017/s1041610220003105.

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Medical practitioners are confronted on a daily basis with decisions about patients’ capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end -of-life decision-making capacity in a 72-year old lady with treatment resistant schizophrenia and terminal cancer will be discussed.In the case discussed there were differences in opinion about the patients decision-making capacity. In light of this, the role of the treating clinician and importance of health-related values in capacity assessment are highlighted. It is recommended that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient’s wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient’s capacity will change the treatment approach.Compared to the general population, people with serious mental illness have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services and are rarely engaged in end-of-life care discussions. Older people with serious mental illness can engage in advance care planning. Conversations about end -of-life care can occur without fear that a person’s psychiatric symptoms or related vulnerabilities will undermine the process. Clinicians are also advised to attend to any possible underlying issues, instead of focusing strictly on capacity. Routine documentation of end-of-life care preferences can support future decision making for family and clinicians at a time when patients are unable to express their decisions.More research about palliative care and advance care planning for people with serious mental illness is needed. This is even more urgent in light of the COVID-2019 pandemic, as there are potential needs for rationing of health care in the context of scarce resources. Health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with serious mental illness.

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Swanepoel, M., et S. Mahomed. « Involuntary admission and treatment of mentally ill patients – the role and accountability of mental health review boards ». South African Journal of Bioethics and Law 14, n^o 3 (31 décembre 2021) : 84–88. http://dx.doi.org/10.7196/sajbl.2021.v14i3.717.

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The involuntary admission or treatment of a mentally ill individual is highly controversial, as it may be argued that such intervention infringes on individual autonomy and the right to choose a particular treatment. However, this argument must be balanced with the need to provide immediate healthcare services to a vulnerable person who cannot or will not make a choice in his or her own best interests at a particular time. A study carried out in Gauteng Province, South Africa (SA), highlighted the fact that the annual rate of involuntary admissions increased by almost double from 2007 to 2008. This could indicate that healthcare providers are not treating patients without their consent only when this is absolutely necessary. Alternatively, it could indicate that healthcare professionals are more aware of the provisions of the Mental Health Care Act and relevant national policy guidelines. Or it could suggest that more patients are presenting with mental illnesses or disorders that require their involuntary admission. It remains for strategies to be developed that change negative perceptions and inequities for individuals with mental illness. Above all, the strategies should be underpinned by inalienable respect for mentally ill individuals – a concept that was blatantly disregarded in the Life Esidimeni case. In this article, we highlight the functions of mental health review boards and their accountability where involuntary admissions are concerned, while emphasising the protections for mentally ill persons as a vulnerable population group, as set out in the SA Constitution.

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Robinson, Robert, et Lucy Scott-Moncrieff. « Making Sense of Bournewood ». International Journal of Mental Health and Capacity Law 1, n^o 12 (5 septembre 2014) : 17. http://dx.doi.org/10.19164/ijmhcl.v1i12.163.

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The judgment of the European Court of Human Rights in HL v UK has been understood by some commentators as making it unlawful, without the use of formal legal powers, to give treatment in a psychiatric hospital to a person who lacks capacity to consent and over whom the mental health professionals directly involved are exercising complete and effective control. This understanding follows from a reading of the judgment which equates complete and effective control with deprivation of liberty for the purposes of Article 5 of European Convention on Human Rights. If this interpretation is correct, the same principle would apply to people living in nursing homes who require a high level of care and supervision and who lack capacity. While the former could be formally detained in hospital (or a ‘registered establishment’) under the Mental Health Act 1983, the Act’s detention powers do not extend to other care settings.This article suggests that to understand the European Court of Human Rights' judgment in HL v UK it is necessary to take account of the unusual facts of the case. It is suggested that it does not follow from the judgment that the admission of a compliant incapacitated patient will necessarily deprive that person of liberty for the purpose of Article 5. The Government’s initial responses to the judgment fails to distinguish admissions which do engage Article 5 from those which do not. It is suggested that the Government should provide guidance to assist mental health professionals and others to make this distinction in individual cases.

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Wang, Hung-Yu, Joh-Jong Huang, Shu-Fang Su, Sheng-Hao Hsu, Li-Shiu Chou et Frank Huang-Chih Chou. « From folk therapy to evidence-based psychiatry practice : The benefit of evidence-based psychiatry in treatment-naive psychotic patients ». International Journal of Social Psychiatry 66, n^o 6 (28 mai 2020) : 593–99. http://dx.doi.org/10.1177/0020764020924698.

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Background: As Taiwan’s Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. Aims: To evaluate the outcomes of these patients from folk therapy to conventional treatment. Method: The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. Results: The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. Conclusion: The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.

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Dekel, Dana, Amanda Marchant, Todd Smith, Harley Morgan, Sarah Tombs, Ashrafunnesa Khanom, Karen Ingham et Ann John. « #BeSeen : understanding young people’s views of the motivation and impacts of sharing self-harm imagery online and use of their social media data for research—a UK participatory arts-led qualitative study ». BMJ Open 14, n^o 7 (juillet 2024) : e076981. http://dx.doi.org/10.1136/bmjopen-2023-076981.

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ObjectivesThis study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research.DesignThematic analysis of 27 semi-structured one-to-one interviews.SettingTwo workshops were conducted in 2021.ParticipantsWe recruited 27 study participants aged 16–24 (60% male). Sixteen (59%) participants were refugee and asylum seekers (RAS).ResultsTwo main themes were generated: (1)Online imagery of self-harmcaptured perceived motivations for sharing such images, the potential impacts on others and possible need of censorship. This theme was characterised by mixed attitudes towards motivations for sharing, with some perceiving this as attention seeking, while others thought of it as help seeking or sharing of pain. Overall, participants agreed that images of self-harm can be triggering and should include trigger warnings. (2)Data sharing for mental health and self-harm researchcaptured views on the use of social media posts and images for research purposes, and levels of trust in public and private organisations. It outlined positive views on their data being shared for research for public benefit, but highlighted issues of consent. The two most trusted organisations to hold and conduct research were the National Health Service and Universities. Participants from the RAS group were more inclined to agree to their data being used and had higher levels of trust in government.ConclusionYoung people care about their privacy and use of their data even when it is publicly available. Coproduction with young people of resources to support understanding and develop innovative solutions to gaining informed consent for data sharing and research for public benefit is required. Young people from excluded communities, post-immigration RAS and males should be purposively involved in future social media research.

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Bertini, Lavinia, Nicola Schmidt-Renfree, James Blackstone, Oliver Stirrup, Natalie Adams, Iona Cullen-Stephenson, Maria Krutikov et al. « VIVALDI ASCOT and Ethnography Study : protocol for a mixed-methods longitudinal study to evaluate the impact of COVID-19 and other respiratory infection outbreaks on care home residents’ quality of life and psychosocial well-being ». BMJ Open 14, n^o 8 (août 2024) : e088685. http://dx.doi.org/10.1136/bmjopen-2024-088685.

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IntroductionOlder adults in care homes experienced some of the highest rates of mortality from SARS-CoV-2 globally and were subjected to strict and lengthy non-pharmaceutical interventions, which severely impacted their daily lives. The VIVALDI ASCOT and Ethnography Study aims to assess the impact of respiratory outbreaks on care home residents’ quality of life, psychological well-being, loneliness, functional ability and use of space. This study is linked to the VIVALDI-CT, a randomised controlled trial of staff’s asymptomatic testing and sickness payment support in care homes (ISRCTN13296529).Methods and analysisThis is a mixed-methods, longitudinal study of care home residents (65+) in Southeast England. Group 1—exposed includes residents from care homes with a recent COVID-19 or other respiratory infection outbreak. Group 2—non-exposed includes residents from care homes without a recent outbreak. The study has two components: (a) a mixed-methods longitudinal face-to-face interviews with 100 residents (n=50 from group 1 and n=50 from group 2) to assess the impact of outbreaks on residents’ quality of life, psychological well-being, loneliness, functional ability and use of space at time 1 (study baseline) and time 2 (at 3–4 weeks after the first visit); (b) ethnographic observations in communal spaces of up to 10 care homes to understand how outbreaks and related restrictions to the use of space and social activities impact residents’ well-being. The study will interview only care home residents who have the mental capacity to consent. Data will be compared and integrated to gain a more comprehensive understanding of the impact of outbreaks on residents’ quality of life and well-being.Ethics and disseminationThe VIVALDI ASCOT and Ethnography Study obtained ethical approval from the Health Research Authority (HRA) Social Care REC (24/IEC08/0001). Only residents with the capacity to consent will be included in the study. Findings will be published in scientific journals.

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Chaara, A., F. Laboudi et A. Ouanass. « Hospitalization in Psychiatry : Patients’ experiences at Arrazi Psychiatric Hospital in Morocco ». European Psychiatry 65, S1 (juin 2022) : S599. http://dx.doi.org/10.1192/j.eurpsy.2022.1533.

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Introduction Hospitalization in psychiatry is marked by the use of care without consent. We therefore proposed to study from this perspective the feelings and opinions of patients on such an experience. Objectives The objective of this work is to explore the experiences of patients and their perception of the effects of this hospitalization, through 3 fundamental ethical principles: Autonomy, beneficence and non-maleficence. Methods This study will be conducted at Arrazi Psychitaric Hospital, in patients at the end of their stay, via a questionnaire. Results A total of 122 patients attended the study. A very large proportion of patients were satisfied with the premises, space planning, and had knowledge of a structured planning of the organization of care. A senior doctor was identified by 95% of them. Eighty five per cent were free to move around in the hospital. The information on the care offered was perceived by 83.7%. The rates are lower with respect to clear explanations received on the disease, the effects of drugs and the type of hospitalization. Regarding the feelings experienced during the stay, 83% of people who spoke mentioned a painful experience. The feelings that prevailed were a feeling of helplessness, fear, worthlessness. On the other hand, a majority of patients expressed that the hospitalization had protective effects towards themselves and towards others, but that it wasn’t justified. Conclusions These results suggest that autonomy and beneficence are respected. Therefore, an attention should be paid to various information given during the stay. Disclosure No significant relationships.

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Kendall, Cameron, Emma Livesey et Sally Arnold. « Improving Patient ECG Experience Within Perinatal Mental Health and Enabling Better Antipsychotic Physical Health Monitoring ». BJPsych Open 9, S1 (juillet 2023) : S98. http://dx.doi.org/10.1192/bjo.2023.292.

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AimsAn ECG should be undertaken as part of physical health monitoring for newly admitted patients and as part of antipsychotic initiation and monitoring. This project compared patient experience between a traditional 12 lead ECG and a 6 lead hand held ECG device (KardiaMobile 6L device). The intention was to make ECGs within perinatal mental health better tolerated, subsequently improving physical health monitoring. On our mother and baby unit, patients were reluctant to expose the chest area to have a 12 lead ECG performed due to factors including breastfeeding and feeling self-conscious about postnatal body changes. Inability to perform 12 lead ECGs, due to lack of patient consent, increased the chance of antipsychotic prescribing without baseline monitoring. We sought to find an alternative, more acceptable way to monitor physical health in this cohort, so we could improve the safety of prescribing medications and patient care as a whole.MethodsData were gathered prospectively over a three-month period, on our eight-bed perinatal inpatient unit. Each patient had a 12 lead ECG performed on admission and then a hand held 6 lead ECG performed for monitoring purposes. Patients with pre-existing cardiac comorbidities were excluded. All ECGs were interpreted by a trained clinician, and patients provided formal feedback on their experience of having a traditional 12 lead ECG and a handheld ECG undertaken.Results14 patients were included. All preferred the hand held ECG compared to the traditional 12 lead. Patients felt the 12 lead ECG was intrusive, describing feelings of anxiety and being uncomfortable, particularly with the amount of wires and stickers required. With the hand held device patients felt more relaxed, found the procedure easier to have done, and that it was quicker to be undertaken. All agreed they would be more likely to have regular ECGs performed if it was with the hand held device.ConclusionAlthough a 12 lead ECG is gold standard, in patients who decline a traditional ECG, this handheld ECG would be a safer alternative rather than no ECG being undertaken.Patient feedback is overwhelmingly positive towards the use of the handheld ECG device, particularly as less body exposure is needed. In addition the shorter time to undertake an ECG is advantageous within the perinatal setting, as mothers are also busy caring for their infants.The greater acceptability in this cohort should lead to better physical health monitoring, both improving patient experience and prescribing safety.

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Harrison, Fleur, Monica Cations, Tiffany Jessop, Liesbeth Aerts, Lynn Chenoweth, Allan Shell, Perminder Sachdev, Sarah Hilmer, Brian Draper et Henry Brodaty. « Prolonged use of antipsychotic medications in long-term aged care in Australia : a snapshot from the HALT project ». International Psychogeriatrics 32, n^o 3 (23 janvier 2020) : 335–45. http://dx.doi.org/10.1017/s1041610219002011.

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ABSTRACTObjectives:Use of antipsychotic drugs in long-term aged care (LTC) is prevalent and commonly exceeds the recommended duration, but contributors to this problem are not well understood. The objective of this study is to provide a snapshot of the features of and contributors to prolonged use of antipsychotic medications (>12 weeks) among a sample of LTC residents.Design:We present retrospective and baseline data collected for the Australian Halting Antipsychotic Use in Long-Term Care (HALT) single-arm longitudinal deprescribing trial.Setting:Twenty-four long-term care facilities in Sydney, Australia.Participants:The HALT study included 146 older people living in 24 Sydney LTC homes who had been prescribed a regular antipsychotic medication for at least 3 months at baseline.Measurements:Detailed file audit was conducted to identify the date and indication recorded at initial prescription, consenting practices, longitudinal course of prescribing, and recommendations for review of antipsychotic medication. Behavioural and psychological symptoms of dementia (BPSD) and functional dependence at baseline were assessed via LTC staff interview. Cognition at baseline was assessed in a participant interview (where possible).Results:Antipsychotics were prescribed for 2.2 years on average despite recommendations by a doctor or pharmacist for review in 62% of cases. Consent for antipsychotic prescription was accessible for only one case and contraindications for use were common. Longer use of antipsychotics was independently associated with higher dose of the antipsychotic drug and greater apathy, but not with other BPSD.Conclusion:Antipsychotic medications appeared to be prescribed in this sample as a maintenance treatment in the absence of active indicated symptoms and without informed consent. Standard interventions, including recommendations for review, had been insufficient to ensure evidence-based prescribing.

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Horowicz, Edmund Marcus. « The zone of parental control, the “gilded cage” and the deprivation of a child’s liberty : getting around Article 5 ». Tizard Learning Disability Review 22, n^o 1 (3 janvier 2017) : 2–9. http://dx.doi.org/10.1108/tldr-05-2016-0014.

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Purpose The purpose of this paper is to specifically analyse whether parents should have the legal authority to authorise a deprivation of liberty for children with a learning disability. As a result of parental consent being recognised as holding legal authority, these children have their right to liberty under Article 5 engaged. It will be argued that the courts’ failure to support this view stems from the confusing concept of the “zone of parental control”. Design/methodology/approach A doctrinal methodology is used, examining domestic law and the European Convention on Human Rights (ECHR), with analysis of relevant literature. Findings Decisions regarding deprivation of liberty in children under the age of 16 should undoubtedly include parental consent. The concern expressed here is the sovereignty of parental consent over all else. The law is confusing. In one respect rights under the ECHR are universal. However, both UK and European courts have accepted the premise that it is entirely within the zone of parental control to effectively deprive a child of liberty without procedural or judicial review. Furthermore, there are wider potential issues for children being considered to be deprived of liberty following Cheshire West. Originality/value The paper is a discussion piece that is critical of the existing law and uses the literature and original opinions to recommend an alternative approach.

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Slogrove, Amy L., Shani Tamlyn de Beer, Emma Kalk, Andrew Boulle, Mark Cotton, Heinrich Cupido, Barbara Laughton et al. « Survival and health of children who are HIV-exposed uninfected : study protocol for the CHERISH (Children HIV-Exposed Uninfected - Research to Inform Survival and Health) dynamic, prospective, maternal-child cohort study ». BMJ Open 13, n^o 1 (janvier 2023) : e070465. http://dx.doi.org/10.1136/bmjopen-2022-070465.

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IntroductionCHERISH is designed to establish a long-term sustainable system for measurement of in utero and postnatal exposures and outcomes in children who are HIV-exposed uninfected (HEU) and HIV-unexposed to compare survival, hospitalisation, growth and neurodevelopment in the Western Cape, South Africa.Methods and analysisDuring 2022–2025, the CHERISH dynamic cohort is prospectively enrolling pregnant people with and without HIV at 24–36 weeks gestation from one urban and one rural community, following mother–child pairs, including children who are HEU (target N=1200) and HIV-unexposed (target N=600) for 3 years from the child’s birth. In-person visits occur at enrolment, delivery, 12 months, 24 months and 36 months with intervening 3-monthly telephone data collection. Children and mothers without HIV are tested for HIV at all in-person visits. Data on exposures and outcomes are collected from routine standardised healthcare documentation, maternal interview, measurement (growth and neurodevelopment) at in-person visits and linkage to the Western Cape Provincial Health Data Centre (survival and hospitalisation). A priori adverse birth outcomes, advanced maternal HIV and maternal mental health are considered potential mediators of outcome disparities in children who are HEU and will be evaluated as such in multivariable models appropriate for each outcome.Ethics and disseminationMothers interested in joining the study are taken through a visual informed consent document for their and their child’s participation, with the option to consent to anonymised de-identified data being contributed to a public data repository. All data is captured directly into an electronic database using alphanumeric identifiers devoid of identifying information. The cohort study is approved by Human Research Ethics Committees of Stellenbosch University (N20/08/084), University of Cape Town (723/2021) and Western Cape Government (WC_2021_09_007). Findings will be shared with participants, participating communities, local and provincial stakeholders, child health clinicians, researchers and policymakers at local, national and international forums and submitted for publication in peer-reviewed journals.

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Wee, Ryan, Mikail Ozer et Lubna Anwar. « Prevalence and Outcomes of First-Episode Psychosis With Substance Misuse Within an Outpatient Setting ». BJPsych Open 9, S1 (juillet 2023) : S115. http://dx.doi.org/10.1192/bjo.2023.329.

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AimsMisuse of certain drugs is a common precipitant of first-episode psychosis (FEP). Substance misuse is known to exacerbate psychotic symptoms, and it is unclear if substance misuse at the time of initial presentation impacts outcomes of care in FEP. Here, in this quality improvement project (QIP), we aimed to quantify the prevalence of drug misuse within an outpatient early intervention service (EIS) and determine the outcomes (in terms of time-to-discharge and discharge destination) of service users based on their substance misuse history.MethodsIn this QIP, we randomly sampled 100 patients referred to and discharged from an outpatient service for psychosis (Barnet EIS). We excluded patients who were referred to the service but were discharged due to referral rejection, non-attendance at psychiatry review and/or other reasons. Data regarding demographic and clinical information, the nature of substance misuse, and discharge destinations were obtained through a review of electronic health records, including GP letters and hospital notes. The time-to-discharge was defined as the time between referral acceptance and discharge from EIS. As this work is part of a QIP, written consent was not obtained to conduct this project.ResultsOf 100 patients obtained from the discharged caseload, 38 patients were accepted and reviewed in Barnet EIS. 24 patients (63.2%) had no substance misuse history at the time of initial FEP, while 14 patients (36.8%) had some substance misuse history. Of the 14 patients with substance misuse, cannabis was most frequently used. The average age of patients was 27.2 ± 1.4 years old. The age of onset of psychosis was similar between patients with and without substance misuse (two-sample t-test, p = 0.74).In terms of discharge destination, patients with and without substance misuse were discharged back to their GPs at similar proportions (chi-square test, p = 0.81). Finally, the number of days patients spent under the care of Barnet EIS was similar between patients with and without substance misuse (two-sample t-test, p = 0.54).ConclusionIn this QIP, over 30% of patients presenting with FEP reported substance misuse. The most common recreational drug used was cannabis. Discharge destinations and the time spent in EIS were broadly similar between patients with and without substance misuse. The relatively high rates of substance misuse in FEP found in this study have important implications for commissioning additional services – such as urine drug testing or drug liaison services – within EIS teams.

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Griffiths, Maria, Jo Allen, Krisna Patel et Victoria Bell. « Promoting family inclusive practice in home treatment teams ». Journal of Mental Health Training, Education and Practice 15, n^o 5 (13 juillet 2020) : 261–73. http://dx.doi.org/10.1108/jmhtep-11-2019-0058.

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Purpose Families play an instrumental role in helping relatives experiencing mental health issues to stay well. In the context of wider initiatives promoting family and carer needs, this study aims to evaluate the feasibility, acceptability and potential benefits of bespoke training to develop clinicians’ skills in working with families in crisis. Design/methodology/approach The study was an uncontrolled evaluation of a one-day workshop for home treatment team staff using pre- and post-questionnaires. Findings In total, 83 staff members participated. Overall, there was a strong agreement for the involvement of families, which increased marginally after training. There were significant changes in views about talking to family members without service user consent (p = 0.001) and keeping them informed of their relative’s well-being (p = 0.02). Qualitative feedback indicated that participants enjoyed the interactive elements, particularly role-playing. Training provided an opportunity to practice skills, share knowledge and facilitate the integration of family work into their professional role. Research limitations/implications Confident support for families contributes to effective mediation of crisis and continuation of care; factors important in reducing admission rates and protecting interpersonal relationships. Overall, the consistency of responses obtained from participants suggests that this workshop offers a helpful introduction to a family approach at times of a mental health crisis. Originality/value This pilot evaluation suggests this new one-day workshop, is a feasible and acceptable training program, which is beneficial in developing clinicians’ skills in working with families in a crisis.

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Shah, Anish, Michele Darling, Olivia Arstein-Kerslake, Tiffany Morgan, Aubreen Vance Tovrea, James Young et Helen Laines. « Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory : Survey Study ». JMIR Formative Research 5, n^o 7 (29 juillet 2021) : e29952. http://dx.doi.org/10.2196/29952.

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Background Recent research has shown that the impacts of the COVID-19 pandemic and social isolation on people’s mental health are quite extensive, but there are limited studies on the effects of the pandemic on patients with mental health disorders. Objective The objective of this study was to assess the negative impacts of the COVID-19 pandemic on individuals who have previously sought treatment for a mental health disorder. Methods This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII) survey. This tool was designed to assess tangible impacts of epidemics and pandemics across personal and social life domains. From November 9, 2020, to February 18, 2021, a total of 245 adults recruited from a mental health clinic completed the consent form and responded to the survey link from the Siyan Clinical Corporation and Siyan Clinical Research practices located in Santa Rosa, California, USA. Results We found that the least affected age group included individuals aged 75 years or older. This was followed closely by the 65- to 75-year-old age group. People with children under the age of 18 years also reported both more negative indicators associated with the pandemic and more positive indicators compared to those without children at home. Gender queer, nonconforming, and transgender individuals may also be at higher risk for more negative impacts associated with the pandemic. When respondents were assessed with regard to their mental health diagnosis, no differences were noted. Substance use also increased during the pandemic. Conclusions In conclusion, the data collected here may serve as foundational research in the prevention, care, and treatment of mental health disorders during pandemics such as COVID-19. Populations such as those with previously diagnosed mental health disorders are particularly at risk for negative effects of pandemic-related stressors such as social isolation, especially if they have children in the household, are part of a younger age group, or have substance use disorder. Gender may also be a factor. Further, the EPII survey may prove to be a useful tool in understanding these effects. Overall, these data may be a critical step toward understanding the effects of the COVID-19 pandemic on populations with a mental health diagnosis, which may aid mental health practitioners in understanding the consequences of pandemics on their patients’ overall well-being. Trial Registration ClinicalTrials.gov NCT04568135; https://clinicaltrials.gov/ct2/show/NCT04568135

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Hargreaves, Roger. « The Deprivation of Liberty Safeguards – essential protection or bureaucratic monster ? » International Journal of Mental Health and Capacity Law, n^o 19 (8 septembre 2014) : 117. http://dx.doi.org/10.19164/ijmhcl.v0i19.247.

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The Deprivation of Liberty Safeguards ( DoLS), which came into force on the first of April 2009 as an amendment to the Mental Capacity Act 2005, are still commonly referred to as the “Bournewood safeguards,” but in fact the concern about the underlying issue long predates the final decision of the European Court of Human Rights on the Bournewood case. It goes back at least to 1983, when the new Mental Health Act brought in much greater protection for patients who were formally detained in hospital, and in particular for those who lacked the capacity to consent to treatment and who acquired additional safeguards under Part IV of that Act. However, this in turn highlighted the total absence of protection for those patients without capacity who were “de facto detained” under the common law.

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Diorditsa, I. V., I. A. Kovalenko et O. M. Koval. « Legal protection of personal data in the field of health care in Ukraine ». Uzhhorod National University Herald. Series : Law 2, n^o 82 (23 mai 2024) : 141–46. http://dx.doi.org/10.24144/2307-3322.2024.82.2.22.

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The growing number of breaches of the privacy and security of electronic data is raising outrage and concern among users and professionals in many industries, particularly in the medical field. Risks associated with insufficient security of medical data include the possibility of unauthorized access to personal medical information, its falsification, as well as the disclosure of confidential data without the consent of patients. This can have serious consequences for patients, including violations of their privacy, fear of losing confidential information, and even the possibility of inaccurate diagnosis or treatment due to falsification of medical records. Therefore, to protect medical data and ensure their confidentiality, it is necessary to pay special attention to the implementation of appropriate cyber security measures and compliance with relevant legal norms and standards. This includes the development of modern data encryption technologies, regular training of medical personnel on cyber security issues, as well as strict implementation of regulations on the protection of confidential information. Confidentiality of medical information in the field of health care must be considered in the context of a wide range of cultural, social and religious beliefs and traditions. Some medical data can be particularly sensitive and private, such as information about reproductive health, mental disorders, HIV/ AIDS treatment, and adolescent health services. According to the Law of Ukraine «On Protection of Personal Data» personal data is information or a set of information about a natural person who is identified or can be specifically identified. Article 2 of the 1981 Convention for the Protection of Individuals with regard to Automatic Processing of Personal Data defines personal data as any information relating to a specifically identified person or a person who can be specifically identified. This means that any information that allows or can allow the identification of a specific person is considered personal data and is subject to protection under this convention. This definition is a general standard used in many countries and international legal acts to ensure the protection of privacy and confidentiality of personal data. It covers a wide range of information, including name, address, phone number, email, health information, financial information, and much more.

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Yosep, Iyus, Rohman Hikmat, Suryani Suryani et Ai Mardhiyah. « Experiences of Sexual Harassment by Patients among Nurses at the Mental Hospital of West Java Province : A Qualitative Study ». International Journal of Environmental Research and Public Health 20, n^o 8 (14 avril 2023) : 5525. http://dx.doi.org/10.3390/ijerph20085525.

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Sexual harassment is behavior related to forced sex without the consent of the victim. Incidents of sexual harassment on nurses can be in the form of physical behavior and verbal behavior. The factor of power relations between men and women and the patriarchal culture in Indonesia are the causes of the sexual harassment of mental health nurses, so many incidents of the sexual harassment of women occur. The forms of sexual harassment that occur include kissing, hugging from behind, and verbal abuse related to sex. The purpose of this study was to explore the experience of sexual harassment of psychiatric nurses at the Mental Hospital of West Java Province. This study implemented a qualitative descriptive approach using the NVIVO 12 software application. The sample in this study was 40 psychiatric nurses at the Mental Hospital of West Java Province. The sampling technique in this study was focus group discussions with semi-structured and in-depth interviews. The data analysis in this study used a thematic analysis. This study shows that sexual harassment behavior is carried out by patients in physical and verbal forms. Sexual harassment is mostly carried out by male patients towards female nurses. Meanwhile, sexual harassment took the form of hugging from behind, kissing, naked patients in front of nurses, and disturbing nurses with verbal abuse related to sex. Nurses feel disturbed, afraid, anxious, and shocked by the incidents of sexual harassment committed by patients. Sexual harassment by patients towards nurses causes psychological problems for nurses and causes nurses to want to leave their jobs. Gender adjustment between nurses and patients is a preventive effort to prevent the sexual harassment of nurses. Sexual harassment by patients causes a decrease in the quality of work of nurses in providing nursing care, creating a work environment that is less safe and comfortable.

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Amering, M. « Current Hot Topics in Working with Service Users and Family Carers Towards a Human Based Psychiatry ». European Psychiatry 41, S1 (avril 2017) : S16—S17. http://dx.doi.org/10.1016/j.eurpsy.2017.01.104.

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ContextThe significant role of family as a resource for mental health, psychiatric care and recovery and rehabilitation is well documented. However, despite ongoing family advocacy the situation in most settings is still characterized by significant unmet needs and lack of resources and expertise in working with families.Key messagesThis presentation will highlight pertinent issues and present data, concepts and experiences towards an improvement of partnership work with users of services and their families in a human based context.Topics will include the needs of specific types of relatives, such as siblings, children, partners, grandparents, members of the peer group of friends as well as the need for support for families without patient consent. Recent developments with regard to individual and group therapy as well as multilevel interventions to further family advocacy and the fight against stigma and discrimination will be presented and discussed.Special attention will be given to new roles and responsibilities arising from the historical challenge of the UN-Convention on the Rights of persons with disabilities for mental health professionals, users of services as well as relatives and friends including changes in national guardianship laws, new rights to patient autonomy as well as new entitlements for support for living in the community including the right to family life, reasonable accommodation and supported decision-making.ConclusionCurrent developments with regard to needs and rights of users of services and their families and friends urgently warrant attention and common efforts in Trialogue and other participatory approaches.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Evans, F., R. Deslandes, P. Deslandes et S. Young. « Opinions of stakeholders about integrating pharmacists into Community Mental Health Teams ». International Journal of Pharmacy Practice 30, Supplement_1 (1 avril 2022) : i43. http://dx.doi.org/10.1093/ijpp/riac019.060.

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Abstract Introduction Pharmacists are routinely involved in optimising medicines for mental health patients during inpatient admissions through attending ward rounds and providing a clinical pharmacy service. (1) Despite literature demonstrating the benefits, specialist pharmacists are not routinely integrated in Community Mental Health Teams (CMHTs) (2) and there is little research to identify the barriers to pharmacists’ integration. The opinions of stakeholder who influence the design of community mental health services, are key to understanding these issues. Aim To explore the views of relevant stakeholders in one health board (HB) in Wales, regarding integration of pharmacists into CMHTs, and to make recommendations to overcome identified barriers to integration. Methods Semi-structured interviews using open questions with key stakeholders within two CMHTs and the HB’s adult mental health clinical board. Participants were selected purposively to allow recruitment of individuals who would provide insight into the proposed question(s). Written, informed consent was obtained. A deductive approach was used to define interview questions. Interviews were transcribed and analysed thematically using an inductive approach to explore the data without any pre-conceived ideas and identify additional key themes. The study was registered with the HB. Results Interviews (3 pharmacists, 2 consultant psychiatrists, 1 integrated manager, 2 clinical nurse leads and 2 general managers) lasted between 30-45 minutes. Analysis revealed five main themes; relationship with the pharmacist, including previous experiences and individual pharmacist’s personal attributes; CMHT workload relevant to pharmacists’ skills; workforce and financial pressures; the need for ongoing support for and from pharmacists; and pharmacists’ expertise including non-medical prescribing. Previous experience of working with specialist mental health pharmacist influenced participants’ views, those with limited experience were less clear about what a pharmacist’s role would be in CMHTs“…we haven’t had specialist pharmacist linked to us ………“Always can get in touch with pharmacy by e-mail or phone. Can see advantage of a pharmacist in the building, the medics would really like that it wouldn’t need to be every week maybe a morning every two weeks. We know where pharmacy are, not a dire need. Others identified a clear role for pharmacists, “running clinic for us especially when we have referrals from GP purely asking for medication reviews having [pharmacist] here the benefit surpasses most of the options we can offer through medic”. Participants believed pharmacists needed training in risk assessment and consultation skills and they should be prescribers to contribute effectively. Nine participants had worked previously with pharmacists, all advocated their integration into CMHTs. Conclusion This small-scale study suggests there is a desire to integrate pharmacists into CMHTs with a strong emphasis on their role in addressing medicine-related workload pressures. Positive relationships formed from prior experience of working with pharmacists strongly influenced support for integration. There are potential roles for pharmacists that would improve timeliness and quality of care for people supported by CMHTs. Resource constraints such as lack of funding and availability of appropriately trained pharmacists need to be resolved. Further work is necessary to investigate how these barriers can be addressed and to evaluate the cost-effectiveness of any pharmacy service delivered. References (1) Royal Pharmaceutical Society England (2018). No health without mental health: How can pharmacy support people with mental health problems? London. Royal Pharmaceutical Society England (2) Robinson, J. (2017). Challenging the Stigma. The Pharmaceutical Journal, November 2017, Vol 299, No 7907, [online] | DOI: 10.1211/PJ.2017.20203915 [Accessed 1 Mar. 2019]

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O'Donoghue, Brian, John Lyne, Michele Hill, Linda O'Rourke, Sally Daly et Larkin Feeney. « Patient attitudes towards compulsory community treatment orders and advance directives ». Irish Journal of Psychological Medicine 27, n^o 2 (juin 2010) : 66–71. http://dx.doi.org/10.1017/s0790966700001075.

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AbstractObjectives: The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan.Methods: Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI).Results: Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan.Conclusions: With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.

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