International Journal of Law and Psychiatry最新文献

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Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland 非自愿入院患者感知胁迫和感知信息水平之间的关系:瑞士一项多中心观察性研究的结果。
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-20 DOI: 10.1016/j.ijlp.2023.101934
Florian Hotzy , Manuela Spiess , Regula Ruflin , Andres Schneeberger , Rafael Traber , Stéphane Morandi , Matthias Jaeger , Anastasia Theodoridou
{"title":"Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland","authors":"Florian Hotzy ,&nbsp;Manuela Spiess ,&nbsp;Regula Ruflin ,&nbsp;Andres Schneeberger ,&nbsp;Rafael Traber ,&nbsp;Stéphane Morandi ,&nbsp;Matthias Jaeger ,&nbsp;Anastasia Theodoridou","doi":"10.1016/j.ijlp.2023.101934","DOIUrl":"10.1016/j.ijlp.2023.101934","url":null,"abstract":"<div><h3>Background</h3><p>Involuntary admissions (IA) to psychiatric hospitals are controversial because they interfere with people's autonomy. In some situations, however, they appear to be unavoidable. Interestingly, not all patients perceive the same degree of coercion during IA. The aim of this study was to assess whether the level of knowledge about one's own IA is associated with perceived coercion.</p></div><div><h3>Methods</h3><p>This multicenter observational study was conducted on <em>n</em> = 224 involuntarily admitted patients. Interviews were conducted at five study centers from April 2021 to November 2021. The Macarthur Admission Experience Survey was administered to assess perceived coercion. Knowledge of involuntary admission, perceptions of information received, and attitudes towards legal aspects of involuntary admission were also assessed.</p></div><div><h3>Results</h3><p>We found that higher levels of knowledge about IA were negatively associated with perceived coercion at admission. Perceived coercion did not differ between study sites. Only half of the patients felt well informed about their IA, and about a quarter found the information they received difficult to understand.</p></div><div><h3>Discussion</h3><p>Legislation in Switzerland requires that patients with IA be informed about the procedure. Strategies to improve patients' understanding of the information given to them about IA might be helpful to reduce perceived coercion, which is known to be associated with negative attitudes towards psychiatry, a disturbed therapeutic relationship, avoidance of psychiatry, and the risk of further coercion.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101934"},"PeriodicalIF":2.3,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Multi-level protection of rights: India's Mental Healthcare Act, 2017 and the United Nations' Convention on the Rights of Persons with Disabilities (Articles 12 and 14) 多级权利保护:2017年印度《精神卫生法》和联合国《残疾人权利公约》(第12条和第14条)。
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-20 DOI: 10.1016/j.ijlp.2023.101937
Brendan D. Kelly
{"title":"Multi-level protection of rights: India's Mental Healthcare Act, 2017 and the United Nations' Convention on the Rights of Persons with Disabilities (Articles 12 and 14)","authors":"Brendan D. Kelly","doi":"10.1016/j.ijlp.2023.101937","DOIUrl":"10.1016/j.ijlp.2023.101937","url":null,"abstract":"<div><p>Mental health law is a feature of mental health systems around the world, so legislative reform is an important way to advance compliance with the United Nations' Convention on the Rights of Persons with Disabilities (CRPD). This paper provides an overview of India's Mental Healthcare Act, 2017 in the context of Articles 12 (‘Equal recognition before the law’) and 14 (‘Liberty and security of person’). Notwithstanding the potential of law to produce change, exclusive or disproportionate emphasis on law draws attention from other areas in need of equal if not greater reform, such as public education, mental health services, physical healthcare, social care networks, criminal justice systems, and gathering political backing for the profound reforms needed to transform the socio-economic landscapes in which mental illness develops, diagnoses are made, treatment is provided (or not provided), recovery occurs (or does not occur), and social citizenship is protected and promoted (or eroded and obstructed). There is a particular issue with misunderstandings of psychiatry in academic discussions of mental health legislation which appears to stem from lack of engagement with the full diversity of service-user views and the evidence base for psychiatric care. Greater recognition of upstream factors that shape both suffering and services would acknowledge that the decisions of politicians and service managers have a much greater impact on rights, especially the right to treatment and support, than the decisions of individual clinicians whose options are often very limited at the level of individual care. India's legislation seeks to address not only individual-level care, but also this higher level of reform through its articulation of an explicit ‘right to access mental healthcare and treatment’. Similar multi-level legislative reform elsewhere would increase cooperation from all stakeholders, improve compliance with the CRPD, and help move towards zero coercion in mental health services.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101937"},"PeriodicalIF":2.3,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure 中等安全服务中康复的预测因素:威尔士政府心理健康(2010)措施的影响
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-15 DOI: 10.1016/j.ijlp.2023.101935
Marie Smothers , Charlotte Hill , Daniel Lawrence , Ruth Bagshaw , Andrew Watt
{"title":"Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure","authors":"Marie Smothers ,&nbsp;Charlotte Hill ,&nbsp;Daniel Lawrence ,&nbsp;Ruth Bagshaw ,&nbsp;Andrew Watt","doi":"10.1016/j.ijlp.2023.101935","DOIUrl":"10.1016/j.ijlp.2023.101935","url":null,"abstract":"<div><h3>Background</h3><p>Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes.</p></div><div><h3>Aims</h3><p>To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery.</p></div><div><h3>Methods</h3><p>The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (<em>n</em> = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories.</p></div><div><h3>Results</h3><p>Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery.</p></div><div><h3>Conclusions</h3><p>The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101935"},"PeriodicalIF":2.3,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10288301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distributed rights protection: The 2000 Hague Convention on the International Protection of Adults and the challenge of securing fundamental rights across borders 分布式权利保护:2000年《国际保护成年人海牙公约》和跨境保障基本权利的挑战
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-14 DOI: 10.1016/j.ijlp.2023.101936
Alex Ruck Keene KC (Hon) , Chiara Cordone
{"title":"Distributed rights protection: The 2000 Hague Convention on the International Protection of Adults and the challenge of securing fundamental rights across borders","authors":"Alex Ruck Keene KC (Hon) ,&nbsp;Chiara Cordone","doi":"10.1016/j.ijlp.2023.101936","DOIUrl":"10.1016/j.ijlp.2023.101936","url":null,"abstract":"<div><p>The 2000 Hague Convention on the International Protection of Adults (‘the 2000 Convention’) entered into force on 1 January 2009, is cast as a private international law convention (i.e. one providing tools to minimise procedural, debates about cross-border matters affecting individuals). However, in little-known, and even less explored fashion, it has significant implications for the exercise of both administrative and legal powers by States over those in their territory in zones that are conventionally held close to the metaphorical heart of State power, for instance those experiencing mental ill health, or with impaired decision-making capacity. Even less explored are the consequences for the individuals at the centre of such situations, in particular as regards the protection of their fundamental rights. As we examine in this paper, focusing on both problems of abduction and of cross-border placement into circumstances of deprivation of liberty, such protection has to be distributed between jurisdictions; we suggest that this is a phenomenon which requires to be addressed in a transparent fashion, so that all concerned can be clear as to the implications for its effectiveness.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101936"},"PeriodicalIF":2.3,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diminished criminal responsibility: A multinational comparative review 刑事责任减轻:多国比较研究
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-13 DOI: 10.1016/j.ijlp.2023.101919
E. Lea Johnston , Kendall D. Runyan , Fernando José Silva , Francisco Maldonado Fuentes
{"title":"Diminished criminal responsibility: A multinational comparative review","authors":"E. Lea Johnston ,&nbsp;Kendall D. Runyan ,&nbsp;Fernando José Silva ,&nbsp;Francisco Maldonado Fuentes","doi":"10.1016/j.ijlp.2023.101919","DOIUrl":"10.1016/j.ijlp.2023.101919","url":null,"abstract":"<div><p>This article reviews the legal frameworks of diminished criminal responsibility in eighteen civil law jurisdictions across the globe—Brazil, Chile, China, the Czech Republic, Finland, France, Germany, Greece, Italy, Japan, Luxembourg, Poland, Portugal, Russia, Spain, Switzerland, Taiwan, and Turkey. Specifically, it reports the legal standards and main features of partial responsibility, associated penalty reductions, and potential dispositions following a partial responsibility finding. It also surveys empirical data on the prevalence of diminished responsibility as compared to criminal nonresponsibility. This article, which reflects contemporary penal codes and draws from both English and non-English sources, is the only known existing source to compile these partial responsibility standards or to delineate their precise sentencing consequences. It is also the only known source in English to describe Portugal's and Chile's treatment of diminished responsibility. Providing a comparative overview of graduated responsibility in nearly twenty countries invites global discussion on whether and how society should recognize partial responsibility, as well as the punitive and therapeutic consequences that should attend this finding.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101919"},"PeriodicalIF":2.3,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10263562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Men placed on waiting lists for psychiatric admission from Irish Prisons over five years: Clinical outcomes during a forensic “bed crisis” 爱尔兰监狱五年来被列入精神病入院等候名单的男子:法医“床位危机”期间的临床结果
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-12 DOI: 10.1016/j.ijlp.2023.101923
Margaret Gallagher , Damian Smith , Philip Hickey , Mark Nolan , Eimear Ní Mhuircheartaigh , Michael Murray , Enda Taylor , Michelle Connaughton , Conor O'Neill
{"title":"Men placed on waiting lists for psychiatric admission from Irish Prisons over five years: Clinical outcomes during a forensic “bed crisis”","authors":"Margaret Gallagher ,&nbsp;Damian Smith ,&nbsp;Philip Hickey ,&nbsp;Mark Nolan ,&nbsp;Eimear Ní Mhuircheartaigh ,&nbsp;Michael Murray ,&nbsp;Enda Taylor ,&nbsp;Michelle Connaughton ,&nbsp;Conor O'Neill","doi":"10.1016/j.ijlp.2023.101923","DOIUrl":"10.1016/j.ijlp.2023.101923","url":null,"abstract":"<div><h3>Background</h3><p>Ireland has low provision rates of general and forensic beds compared with other western countries. In recent years there have been difficulties and delays in accessing forensic beds for prisoners with severe mental illness.</p></div><div><h3>Aims</h3><p>We aimed to determine clinical outcomes for male prisoners assessed as requiring psychiatric admission over an extended period, with time frames for admission and other outcomes. We aimed to determine whether admissions to forensic and non-forensic locations were risk-appropriate.</p></div><div><h3>Methods</h3><p>Participants included all male prisoners placed on psychiatric admission waiting lists in Ireland over five years 2015–2019. We described demographic, clinical and offending variables. We measured clinical outcomes including forensic admission, other admission and recovery with voluntary treatment in prison. We also measured times to clinical outcomes. Security requirements and clinical urgency were assessed using the DUNDRUM Toolkit scales 1 and 2.</p></div><div><h3>Results</h3><p>541 male prisoners were placed on admission waiting lists and spent an aggregate of over 114 years on admission waiting lists during 2015–2019. Almost one quarter improved with voluntary treatment allowing removal from waiting lists, while over 75% did not. Admission was achieved for a majority of cases, albeit after lengthy delays for some. The most frequent outcome was diversion from remand to non-forensic inpatient settings. Non-forensic admissions arranged by the Prison Inreach and Court Liaison Service (PICLS) at Ireland's main remand prison at Cloverhill contributed 54% (179/332) of all admissions achieved and 76% (179/235) of all non-forensic admissions from prison waiting list. Median delay to admission was 59 days for forensic admissions and 69 days for admissions to non-forensic hospitals from sentenced settings, compared with 16.5 days for admissions to non-forensic hospitals from remand.</p></div><div><h3>Conclusions</h3><p>Long delays for forensic admission during a five-year period of limited access to such beds were partly mitigated by transfers to non-forensic hospitals, mainly diversion of minor offenders from remand settings.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101923"},"PeriodicalIF":2.3,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10296592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When the security measure meets bordered penality: Release procedures for persons who are not criminally responsible without residence rights in Belgium 当安全措施受到边境惩罚时:对在比利时没有居留权的无刑事责任人员的释放程序
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-09 DOI: 10.1016/j.ijlp.2023.101922
Ellen Vandennieuwenhuysen , Christelle Macq , Lars Breuls , Marjolein De Pau
{"title":"When the security measure meets bordered penality: Release procedures for persons who are not criminally responsible without residence rights in Belgium","authors":"Ellen Vandennieuwenhuysen ,&nbsp;Christelle Macq ,&nbsp;Lars Breuls ,&nbsp;Marjolein De Pau","doi":"10.1016/j.ijlp.2023.101922","DOIUrl":"10.1016/j.ijlp.2023.101922","url":null,"abstract":"<div><p>Offenders considered to be persons not criminally responsible (hereafter Persons NCR) in Belgium, are subjected to a security measure. This is executed by means of a forensic care trajectory, often beginning in high-security prison units or forensic psychiatric facilities, and moving through medium and lower security psychiatric facilities, with the intention to ultimately integrate them back into society. Within this group there are 145 persons without residence rights. This article is attentive to how the forensic care trajectories for people without residence rights are currently navigated. Six qualitative interviews were conducted with key decision-makers in the forensic care trajectories of Persons NCR. Moreover, we analyse the legislative framework regarding the security measure and illustrate how features of ‘bordered penality’ are clearly present. Our results indicate that when working towards a return to the country of origin fails, Persons NCR without residence rights become neglected, either in high-security prison units or forensic facilities. We explore avenues to improve this precarious situation, and consider possibilities to guarantee mental healthcare according to a persons' security needs rather than their residence rights.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101922"},"PeriodicalIF":2.3,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10204882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder 重返社区:同时使用阿片类药物和精神健康障碍的成年人未满足需求的种族/民族差异
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-08 DOI: 10.1016/j.ijlp.2023.101924
Ayorkor Gaba, Abigail Helm, Paige M. Shaffer, Bailey Pridgen, Dara Drawbridge, David Smelson
{"title":"Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder","authors":"Ayorkor Gaba,&nbsp;Abigail Helm,&nbsp;Paige M. Shaffer,&nbsp;Bailey Pridgen,&nbsp;Dara Drawbridge,&nbsp;David Smelson","doi":"10.1016/j.ijlp.2023.101924","DOIUrl":"10.1016/j.ijlp.2023.101924","url":null,"abstract":"<div><h3>Background</h3><p>Adults with co-occurring opioid use and mental health disorder (COD) recently released from incarceration have many social and health needs that place them at the most significant risk for overdose and poor reentry outcomes. Little is known about racial/ethnic differences in this population.</p></div><div><h3>Methods</h3><p>To examine racial/ethnic differences in social and health needs, data were analyzed for 293 adults with COD within two weeks of release, a high-risk period for overdose, from six Massachusetts jails.</p></div><div><h3>Results</h3><p>Overall, participants (62.6% non-Hispanic White, 23.1% Hispanic, 14.3% non-Hispanic Black, and 73.5% male) reported multiple health and social needs across groups. Chi-square tests and Kruskal-Wallis one-way ANOVAs were used to compare social and health needs among racial/ethnic groups. Non-Hispanic Black participants reported more problems with crack/cocaine, whereas Non-Hispanic White and Hispanic participants reported more problems with opioids (<em>p</em> &lt; .001). Despite similar lifetime rates of illicit substance use, non-Hispanic Black and Hispanic participants received less treatment (<em>p</em> &lt; .001). Non-Hispanic White participants reported more opioid and alcohol use (<em>p</em> &lt; .006), trauma symptoms (<em>p</em> = .020), utilization of behavioral health treatment (<em>p</em> = .008), and more medical needs than Hispanic and/or non-Hispanic Black participants (<em>p</em> = .001). Non-Hispanic Black and Hispanic participants reported more needs related to social determinants of health (<em>p</em> = .008).</p></div><div><h3>Conclusions</h3><p>While re-entry is a vulnerable period for all adults with COD, this paper identifies specific needs by race/ethnicity and proposes strategies to advance equity and improve care for all formerly incarcerated adults with a COD.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101924"},"PeriodicalIF":2.3,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10204888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Forensic psychiatry patients, services, and legislation in Nunavut and Greenland 努纳武特和格陵兰的法医精神病学患者、服务和立法
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-08 DOI: 10.1016/j.ijlp.2023.101921
Casey Upfold , Christian Jentz , Parnuna Heilmann , Naaja Nathanielsen , Gary Chaimowitz , Lisbeth Uhrskov Sørensen
{"title":"Forensic psychiatry patients, services, and legislation in Nunavut and Greenland","authors":"Casey Upfold ,&nbsp;Christian Jentz ,&nbsp;Parnuna Heilmann ,&nbsp;Naaja Nathanielsen ,&nbsp;Gary Chaimowitz ,&nbsp;Lisbeth Uhrskov Sørensen","doi":"10.1016/j.ijlp.2023.101921","DOIUrl":"10.1016/j.ijlp.2023.101921","url":null,"abstract":"<div><p>Circumpolar regions face unique challenges in establishing and maintaining mental health care systems, including forensic psychiatry services. The scarcity of data and lack of evidence concerning the forensic psychiatry patient (FPP) populations of Nunavut and Greenland exacerbates the challenges of informing best practices and healthcare planning.</p><p>By comparing the prevalence of forensic psychiatry patients, the mental health care services, and the legislation in these two relatively similar but unique regions, insight may be gained that can help inform healthcare planning.</p><p>This cross-sectional study includes all forensic psychiatry in- and outpatients in one year from Nunavut (2018) and on February 29, 2020, in Greenland.</p><p>The Greenland sample (<em>n</em> = 93) was nearly four times larger than the Nunavut sample (<em>n</em> = 15) at the population level. Despite considerable differences in forensic legislation and service supply, the forensic psychiatry patients in the two areas share several similarities. A total of 87% (<em>n</em> = 13) in the Nunavut sample were diagnosed with a DSM-5 schizophrenia spectrum disorder or other psychotic disorder. In Greenland, 82% (<em>n</em> = 76) were diagnosed with an ICD-10 F2 diagnosis (schizophrenia, schizotypal and delusional disorders). Approximately 2/3 of the patients in both populations were diagnosed with substance use disorder, and 60% of the Nunavut FPP received long-acting antipsychotic injections versus 62% in Greenland. Nearly half of the FPPs in both populations had never been convicted prior to entering the forensic psychiatry system; Nunavut 45% versus Greenland 47%. A substantial proportion of Greenlandic FPPs were outpatients compared to Nunavut (83% versus 47%).</p><p>This study is an essential first step toward describing a Model of Care for forensic psychiatry patients in circumpolar regions; furthermore, the clinical similarities between the two populations provide support for future joint Arctic research and the inclusion of artic forensic patients in international studies.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"91 ","pages":"Article 101921"},"PeriodicalIF":2.3,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10204885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Contextual factors influencing the use of coercive measures in Portuguese mental health care 影响葡萄牙精神卫生保健使用强制措施的环境因素
IF 2.3 4区 医学
International Journal of Law and Psychiatry Pub Date : 2023-09-01 DOI: 10.1016/j.ijlp.2023.101918
Deborah Oyine Aluh , Margarida Santos-Dias , Manuela Silva , Barbara Pedrosa , Ugnė Grigaitė , Ricardo Caetano Silva , Maria Ferreira de Almeida Mousinho , João Paulo Antunes , Mariana Remelhe , Graça Cardoso , José Miguel Caldas-de-Almeida
{"title":"Contextual factors influencing the use of coercive measures in Portuguese mental health care","authors":"Deborah Oyine Aluh ,&nbsp;Margarida Santos-Dias ,&nbsp;Manuela Silva ,&nbsp;Barbara Pedrosa ,&nbsp;Ugnė Grigaitė ,&nbsp;Ricardo Caetano Silva ,&nbsp;Maria Ferreira de Almeida Mousinho ,&nbsp;João Paulo Antunes ,&nbsp;Mariana Remelhe ,&nbsp;Graça Cardoso ,&nbsp;José Miguel Caldas-de-Almeida","doi":"10.1016/j.ijlp.2023.101918","DOIUrl":"10.1016/j.ijlp.2023.101918","url":null,"abstract":"<div><p>The use of coercive measures in mental health care is an important indicator of the quality of care being provided, and non-patient-related factors are increasingly recognized to contribute to their use. The study aimed to explore the perspectives of mental health care professionals who have first-hand experience with the use of coercion on the contextual factors that influence the use of coercion in the Portuguese mental health care. Five focus group discussions were conducted among 23 doctors and 17 nurses from five psychiatric departments in urban and rural regions of Portugal. Discussions were audio recorded, transcribed, and analyzed with the aid of MAXQDA. Four broad themes related to insufficient resources, staff-related factors, inefficient services, and socio-legal factors were derived. Participants highlighted how inadequate structures, staff shortages, staff attitudes, a lack of training, restrictive ward rules, an inefficient organization of services, the mental health legislation, and public attitudes contributed to the use of coercive measures. The COVID-19 pandemic complicated existing shortfalls in the system and increased the use of coercive measures. The study confirms that the use of coercive measures in mental health care is influenced by factors that are independent of patient characteristics. Addressing existing systemic problems is crucial for the successful implementation of interventions to reduce coercion in mental health care.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"90 ","pages":"Article 101918"},"PeriodicalIF":2.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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