Mental health committal

CTO/IOC legislation is a bewildering array of presumptions and inconsistencies. It is a reaction to the inherent difficulties of de-institutionalizing treatment into the community and has been based on heated arguments of misconceptions and misunderstandings of various proponents and opponents of CTOs/IOC. Legislators in the United Stated have implemented widely varying legislation over the past twenty-five years yet there is little common basis for states to proceed on or even to analyse when conceptualizing IOC legislation...

BACKGROUND: Homicides by mentally ill persons have led to political concerns about deinstitutionalisation. AIMS: To provide accurate information about the contribution of mental illness to homicide rates. METHOD: Retrospective study of homicide in New Zealand from 1970 to 2000, using data from government sources. 'Mentally abnormal homicide'perpetrators were defined as those found unfitto stand trial, not guilty by reason of insanity, convicted and sentenced to psychiatric committal, or convicted of infanticide...

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Voluntary patients entering mental health units retain the right to accept or refuse treatment, including ongoing admission, as they see fit. However the nature of acute mental distress means that some patients have fluctuations in their mental status and competency to make informed decisions. Inpatient mental health nurses face the ongoing challenge of practising in a way that balances the requirement to support and promote the autonomy of voluntary patients with the need, occasionally, to take actions which although they may appear paternalistic are needed to protect those patients or other people...

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Mental health nursing occurs within a legal and ethical framework that presents conflicts between a paternalistic custodial role and an ethical commitment to autonomy. This paper considers the ethical conflict for nurses posed by acting as second health professional at judicial reviews under Section 16 of the Mental Health (Compulsory Treatment and Assessment) Act. Issues of advocacy and paternalism are discussed in light of the conflict between therapeutic and legislated roles. Strategies aimed at protecting the therapeutic relationship are outlined as a response to the current lack of guidelines in this area...

The law on assistance and precautionary measures in cases of mental illnesses (PsychKG) for North Rhine Westphalia came into force on 1.1.1970. It replaced the "law on committal" of 1956. Thus the PsychKG of North Rhine Westphalia has been in force for more than twice as long as its predecessor which had been, as in other Federal states of Germany, a special part of the police regulations. The new North Rhine Westphalian provision of 1970 was the first to take the step towards a genuine law for mental patients (Saage/Göppinger 1994)...

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AIM: To explore police officers' perceptions of the mentally ill and of their working relationship with mental health services. METHOD: A survey of 200 randomly selected front-line police officers was carried out over the summer of 1996/1997. RESULTS: The survey revealed that police identified people in the community as mentally ill, dealt with those so identified and related to the mental health services in a variety of ways. However, the survey uncovered a degree of frustration at the limitations of the Mental Health Act 1992 and the limited options available to the police in cases where individuals can not be committed...

Involuntary commitment appears to be an infrequently used intervention with anorexic patients, in part because of clinicians' uncertainty about its applicability to this population. In contrast to overtly suicidal patients, anorexic patients typically fail to express an intent to harm themselves, although their actions may result in severe harm. Examination of the language of civil commitment statutes, however, suggests that when the behavior of anorexic patients endangers their lives, they will usually be committable under grave disability standards...

In 1985 German mental health legislation underwent a transformation. In accordance with an international trend, the State of Berlin, a pacesetter in this field, introduced a Law for Mentally Diseased Patients (Gesetz für psychisch Kranke). In contrast to the former Law for the Committal of the Mentally Ill and Substance Abusers (Gesetz über die Unterbringung von Geisteskranken und Süchtigen) healing and recovery are the main aims which the legislation focuses on with the intention of avoiding committal by excluding patients with mild disorders from involuntary admission...

The Mental Treatment Act (1945) is currently undergoing review to enable Ireland to meet it's international obligations. The Green Paper on Mental Health (1992) makes a number of suggestions regarding this. One such is the deletion of Addiction as sufficient grounds for involuntary admission to a psychiatric hospital or unit. This study looked at the possible impact such a proposal might have on the doctor's clinical choice in the management of addiction. The casenotes and temporary certificates of 191 involuntary admissions to St...

In a survey of 102 patients admitted involuntarily to a psychiatric hospital, a statement of potential danger, required by law, was found to be provided on all the committal forms. Closer enquiry suggested that although 89% of these patients were admitted involuntarily in accordance with strict legal requirements the legal justification for involuntary admission was questionable in 11 cases. Of these 11 admissions, 10 were thought to be warranted if medical considerations were given priority and on humane grounds...

The authors compared the records of 59 psychiatric patients involutarily committed to a Veterans Administration hospital on an emergency basis with those of a control group of 59 psychiatric patients with respect to the number of assaults noted during the first 45 days of hospitalization. The committed group had a .41 probability and the control group a .08 probability of committing an assault. The difference between the two groups was mainly accounted for by assaults that occurred during the first 10 days of hospitalization...

The discussion concerning who should be committed and by whom, has dominated the psychiatric literature for many years (1). More recently, the issue of whether committal allows merely for incarceration in the least restrictive alternative or whether it also entitles patients to be treated against their will, if necessary, has also received attention (2-5). As yet, few studies have attempted to define the characteristics of the committed population (6-11). Even fewer studies have attempted to define what patients themselves thought of their committal to hospital (12-15) and for the most part, have not obtained their opinions regarding the broader issues of committal that are being debated in the professional literature...

The influence of time on patients' reactions to involuntary committal is a variable seldom considered in reports. The reactions to committal of thirty-four subjects interviewed one week/one month/three months/six months post committal are reported. Generally committal was viewed neutrally. The major changes in attitudes related to knowledge of the fact of committal and of rights of appeal. The importance of these findings for the management of committed patients is stressed.

Analysis of the data on committal to psychiatric institutions shows that there is a wide variation in risk of committal between hospital board areas and that this risk is strongly related to the availability of psychiatric institutional beds. The risk of remaining in an institution as a committed patient is even more strongly related to bed availability. These findings, which suggest that committal may be less related to objective clinical criteria than to other external factors, are of concern in view of the revision to compulsory treatment procedures currently before Parliament...

Massachusetts civil commitment criteria were compared in an emergency setting with a set of criteria developed by Dr. Alan Stone. Contrary to expectations, the Stone criteria proved to be more restrictive in a sample of 503 patients. Few patients would be newly committable under the Stone criteria; of the 35 patients committable under the Stone standard, 32 also met the current Massachusetts criteria for commitment. The clinical and policy implications of the adoption of the Stone criteria are discussed.

This study surveyed the content of committal forms completed at two B.C. hospitals. A profile of 50 patients at a provincial mental hospital and 50 patients on the ward of a general hospital was obtained by comparing the two groups on a number of demographic and psychiatric history variables. The medical certificates of the patients were then assessed for the inclusion of information required by the B.C. Mental Health Act. Of the 198 forms rated (two per patient), 137 (69.2%) were in compliance with the requirements of the B...

The new Care Act will come into force on 1 January 1992. It will abolish guardianship by reason of mental disease, mental deficiency, prodigality, habitual drunkenness and drug addiction as well as guardianship of persons of full age and curatorship of infirm adults. Legal provisions relating to care will take the place of guardianship, and these provisions will no longer have any automatic effect on the affected person's capacity to enter into legal transactions, to marry, or to make a will. Where there is encroachment upon the rights of such persons, there must be strict observance of the principle of necessity...