The application of civil commitment law and practices to a case of delusional disorder: a cross-national comparison of legal approaches in the United States and the United Kingdom

The give and take of freedom: The role of involuntary hospitalization and treatment in recovery from mental illness

The authors reviewed and synthesized scholarly literature on the topic of involuntary confinement and treatment for severely mentally ill adults. Objectively, all facets of the issue are reported, including recurrent positive outcomes, negative outcomes, and patient experiences in common. Patient experiences are organized into related subthemes of autonomy, patient satisfaction, relationships with staff, perceived coercion, traumatization, and humiliation. The literature suggests that short-term involuntary hospitalization is sometimes necessary in order to prevent the mentally ill from psychiatrically decompensating or harming themselves or others. Understandably, hospitalization is often experienced by the mentally ill as a demoralizing violation of their rights and tends to lead them to disengage further from the professional help they need in order to recover. In turn, disengagement leads to further decompensation and resulting risk for rehospitalization. In order to intervene in this cycle and instill severely mentally ill patients with hope in the recovery process, the use of coercive tactics must be decreased in favor of cooperative engagement measures to the greatest extent possible. Patients must be empowered to make choices within the limits of their illnesses through positive interactions with staff, particularly in potentially negative, autonomy-compromising situations. Cooperative measures may help to minimize the potentially traumatic and humiliating effects of being involuntarily hospitalized and medicated. In turn, trusting patient-provider relationships may develop. Thereafter, the severely mentally ill may become more likely to seek professional help on their own volition in the future.

Becoming an Approved Mental Health Professional: an analysis of the factors that influence individuals to become Approved Mental Health Professionals

BACKGROUND

In England and Wales, the Approved Mental Health Professional (AMHP) has final responsibility for applying under the Mental Health Act 1983 to admit an individual compulsorily and convey them to psychiatric hospital. The AMHP role is challenging and legally accountable and unique to the UK context.

AIMS

To analyse the motivation of individuals to become AMHPs, and identify factors which may affect motivation.

METHOD

Semi-structured interviews were conducted with 12 AMHPs from local authorities across Southern England. Ten participants were social workers, one was qualified as both a nurse and social worker, and one was a mental health nurse.

RESULTS

Participants identify career progression and professional development as significant as well as the status and independence of the role and enhanced job security. Social work participants value the Mental Health Act assessment as a contained piece of work, with a high degree of professional discretion.

CONCLUSIONS

AMHPs are motivated by an increase in professional status and job security, but also exercising independent judgment and authority in a time-limited intervention is emotionally and professionally rewarding.

Mental health legislation in the commonwealth

PURPOSE OF REVIEW

Mental health law is changing in some common law jurisdictions. Questions are being asked about whether special legislation is still needed, whether it is a health or a legal issue, and how this part of the law relates to cognate laws about patient consent to healthcare and determinations about competence. The role of tribunal or court adjudication of the need for admission is also debated, along with the capacity of the law to harness resources or manage care. It is therefore timely to review these debates.

RECENT FINDINGS

Renewed support is evident in the literature for subsuming mental healthcare within the general laws governing consent to care or determinations of competence. Socio-legal and interdisciplinary research suggests that health perspectives are already quite dominant in mental health law, while involuntary detention may correlate poorly with levels of need. The mesh between the law and service systems remains problematic, and there is little evidence that law has yet developed a significant capacity for leveraging treatment resources.

SUMMARY

This review suggests that the priority for future research lies in exploring the factors which enhance treatment access and outcomes for the mentally ill rather than debating the shape or content of mental health law.