Transfers of mentally disordered adolescents from custodial settings to psychiatric hospital in England and Wales 2004–2014

This article has used data provided by the Ministry of Justice to track changes in the number of adolescents under the age of 18 transferred from secure custodial institutions, who have required transfer to psychiatric hospital using Section 47 and Section 48 of the Mental Health Act. During the period 2004–2014 there were large reductions in the population of young people detained in custody in England and Wales. The number of young people requiring hospital transfer fell during this period but to a much lesser degree. The possible reasons for this are discussed and include the increased complexity of young people in custody and the increased availability of secure psychiatric beds.     

Severe personality disorder,treatment engagement and the Legal Aid,Sentencing and Punishment of Offenders Act 2012: what you need to know

Empirical research has demonstrated a link between legal coercion and treatment engagement following conviction among those with severe personality disorder. Legal coercive pressures were often applied by the Indeterminate Sentence for Public Protection (IPP), until it was replaced by the Extended Determinate Sentence by the Legal Aid, Sentencing and Punishment of Offenders Act 2012. In this paper, it is proposed that use of the new determinate sentence will lessen motivation for treatment engagement. One effect of treatment refusal may be greater reliance by the Secretary of State for Justice on his jurisdiction to transfer prisoners due for release to secure hospital transfers under the Mental Health Act 1983. Not only will this risk posturing undermine the principal aim of the Offender Personality Disorder Implementation Pathway to improve treatment engagement among the target group, it will also have negative implications for medical practitioners working in secure forensic hospitals. To demonstrate what is at stake, the paper briefly recapitulates empirical findings familiar to readers of the journal, before drawing on original unpublished data.     

Violence ratings of female patients in broadmoor hospital

Abstract

A study is described which characterised the female population of Broadmoor Special Hospital on a scale (Robertson et al., 1987) which rates violence associated with the index offence and previous episodes of violence both in terms of prosecuted violence and unprosecuted incidents. This scale has been applied recently to the male population of Broadmoor (Wong et al., 1993). The findings here confirm the notion that the female population of a Special Hospital are less violent than the males in terms of rating of violence associated with the index offence and in previous convictions for violent offending. The females contain a larger proportion of patients convicted of the offence of Arson (index offence) and patients transferred from other hospitals because of being unmanageable in these settings (under Section 3 of the Mental Health Act). Extreme ratings of violence amongst the females is associated with a diagnosis of personality disorder rather than schizophrenia or psychosis.     

精神卫生法的理想与现实

《精神卫生法》的立法经历了一个极其漫长的过程,最终出台的法律文本仍然存在非常严重的问题,其立法所要解决的问题所要达到的目的非常高,而与中国的现实严重脱节。《精神卫生法》立法的三大理想中,保护精神病患者的合法权益是核心,并希望立法来解决包括被精神病等一系列的社会现实问题。但是,立法脱离现实,相关的内容甚至出现了错误,表现在精神病患者的收治、实施导致人体器官丧失功能的外科手术、急诊急救、基层医疗机构的精神卫生保障等方面。由于存在不切合中国实际国情的规定,《精神卫生法》在我国的实施将会大打折扣。建议《精神卫生法》重点关注严重精神疾病患者得不到治疗、肇事肇祸的严重精神疾病患者得不到强制医疗的现象,关注财政投入不足、强制收治不规范等方面的问题。     

Department of Health and Human Services Public Health Services. Notification of a new system of records: Three Mile Island mental health survey, respondent records

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new system of records entitled "Three Mile Island Mental Health Survey, Respondent Records, HHS/ADAMHA/NIMH." The Disaster Assistance and Emergency Mental Health Section, Division of Special Mental Health Programs, National Institute of Mental Health, is responsible for the system. The purpose of the system is to enable the Government to arrange followup study to the currently-funded research project entitled "The Mental Health of Residents Near the Three Mile Island Reactor: A Comparative Study of Selected Groups." PHS invites interested persons to submit comments on the proposed routine uses on or before November 3, 1980.     

Therapeutic jurisprudence and mental health tribunals: changing patterns of demand and its impact

For decades the mental health system has been ‘in crisis,’ with too little funding, too much demand and fragmented services. In England and Wales, decisions made concerning the care and treatment of those suffering from a mental disorder is governed by the Mental Health Act 1983 (as amended) (MHA 1983). Detention under the legislation is fraught with conflict; patient and clinical views are often at odds. Mental health tribunals enable patients to seek a review of their case and the legality of their detention. This paper argues that with the increased use of formal detention under the MHA 1983, the caseloads of mental health tribunals have similarly risen. Whether it is possible to advance therapeutic benefit to psychiatric patients attending tribunals is open to question. While mental health tribunals have a role to play in generating a positive psychological impact on an applicant, there is a risk that time and resource pressures may inhibit the adoption of a therapeutic approach. This paper considers the key drivers that are currently pushing detention rates up, the impact this is having on mental health tribunal caseloads and whether it is possible to bring therapeutic jurisprudence to the patient.     

Psychological models of mental disorder, human rights, and compulsory mental health care in the community

Recent amendments to the 1983 Mental Health Act in the UK (Mental Health Act 2007) include the controversial provision for: “supervised treatment in the community for suitable patients following an initial period of detention and treatment in hospital”. This provision is widespread, and more formal, in other English-speaking jurisdictions. Reviews of the international literature, human rights considerations and the perspective of psychological approaches to mental health care suggest that proposed ‘supervised community treatment orders’ are valuable, lawful, and compatible with the European Convention on Human Rights if certain specific conditions are met. Provisions for ‘supervised community treatment orders’ in the UK should be supported, but with the provisos that: the powers of the Mental Health Act are limited as in Scotland, to persons whose “ability to make decisions about the provision of [care] is significantly impaired”, that each order is time-limited and subject to review by a properly constituted Tribunal, and that the use of such orders should represent a benefit to people in terms of more appropriate treatment, or be a least restrictive alternative, or better preserve the person's private and family life.     

The ‘Hybrid Order’: origins and usage

The hospital direction (Hybrid Order) was inserted into the Mental Health Act (MHA) in 1997 (Crime (Sentences) Act, 1997). It enables higher courts to direct hospital admission for offenders, whilst still imposing a prison sentence. The origins of the ‘Hybrid Order’ and its patterns of usage are examined. Comparisons are made with its Scottish equivalent, Section 59A of the Criminal Procedure (Scotland) Act 1995. Both the ‘Hybrid Order’ and Section 59A have been used infrequently. This may reflect the fact that they were strongly resisted on ethical grounds at their point of inception and that they force the psychiatrist into the position of ‘punisher’, rather than ‘treater’. Since the 2007 Amendment of the MHA in England and Wales which expanded the remit of the ‘Hybrid Order’ to include all legal categories of mental disorder, not solely psychopathy, its use has unsurprisingly increased – this article delineates the considerations that need to be given in its recommendation.     

Grants, loans and loan guarantees for construction and modernization of hospitals and medical facilities--PHS. Reinstatement of rule

This rule amends Title 42 of the Code of Federal Regulations by reinstating the provision at Section 53.134 concerning notification of the Department of the transfer of a medical facility assisted under Title VI of the Public Health Service Act (the Hill-Burton Act) or termination of services provided in the facility. The provision was incorrectly deleted in a rule published on August 6, 1979, 44 FR 45946.     

Final notice regarding section 602 of the Veterans Health Care Act of 1992 duplicate discounts and rebates on drug purchases--HRSA. Final notice

Section 602 of Public Law 102-585, the "Veterans Health Care Act of 1992," enacted section 340B of the Public Health Service Act, "Limitation on Prices of Drugs Purchased by Covered Entities." Section 340B provides discounts on covered outpatient drugs to eligible entities. Section 340B(a)(5)(A) provides that a drug purchase shall not be subject to both a discount under section 340B and a Medicaid rebate under section 1927 of the Social Security Act. The Department is directed to establish a mechanism to assure that covered entities comply with this prohibition. The purpose of this notice is to announce the final mechanism to prevent duplicate discounts and rebates. The proposed mechanism was announced in the Federal Register at 58 FR 27293 on May 7, 1993. A comment period of 30 days was established to allow public comment on the proposed mechanism. Two comments were received. Both comments concerned issues involving implementation of the mechanism and did not raise substantive issues concerning the mechanism itself; therefore, we will address both comments in the Effective Date section. The mechanism, in its final form, is adopted as proposed.     

Consultations with state and local officials prior to awarding community health center grants--HRSA. Notice

Section 1923 of the Public Health Service (PHS) Act (42 U.S.C. 300y-2) requires that if a State does not apply for a Primary Care Block Grant under section 1924 of the PHS Act (42 U.S.C. 300y-3), or does not qualify for such a grant, a Secretary of Health and Human Services will use those funds not allotted to States participating in the block grant to make grants under section 330 of the PHS Act (42 U.S.C. 254c) to individual community health centers (CHCs). Section 1923 also requires that the Secretary consult with the chief executive officer of the State and with appropriate local officials before making such grants for community health centers in a State. This notice describes the manner in which the Health Resources and Services Administration (HRSA) will fulfill the requirement for consultation. In addition, it solicits comments from local officials regarding CHCs in their areas. A State may elect to supply comments under the system established in accordance with 45 CFR Part 100, "Intergovernmental Review of the Department of Health and Human Services Programs and Activities." (See 48 FR 29188, June 24, 1983.)     

Section 47 of the Enterprise and Regulatory Reform Act 2013: A Flawed Reform of the UK Cartel Offence

On 1 April 2014, section 47 of the Enterprise and Regulatory Reform Act 2013 (ERRA) entered into force, ensuring significant changes to the UK cartel offence. The criminal offence, contained in section 188 of the Enterprise Act 2002, was enacted to secure the deterrence of cartel activity affecting the UK. Following almost ten years of enforcement, the cartel offence had failed to live up to expectations. Consequently, following a public consultation, it was reformed in substance. Section 47 ERRA, removed the (controversial) definitional element of ‘dishonesty’ from the offence, created a number of ‘carve outs’ from the offence, and created three additional defences. This article examines in detail the specific reforms of the cartel offence and argues that, although considerable improvement has been made, the UK offence is fundamentally flawed and unworkable in practice. Further reform is therefore advised.     

Privacy Act of 1974; proposed major alterations to an existing system of records--Public Health Service. Notice of proposed major alterations

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing a notice proposing major alterations in the Privacy Act system of records entitled "Grants Act system of records entitled "Grants: Research, Research Training, Research Scientist Development, Education, Demonstration, Fellowships, Clinical Training, Community Services, Cooperation Agreements, "HHS/ADAMHA/OA, 09-03-0027. The system contains the official documentation of the grant programs of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). The proposed alterations are necessary to ensure compliance with recently added provisions in the Public Health Service Act (PHSA). Section 303 (42 U.S.C 242a), concerning clinical training awardees' payback obligations.     

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital

Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.     

Characteristics and outcome of patients brought to an emergency department by police under the provisions (Section 10) of the Mental Health Act in Victoria,Australia

ObjectiveThe aim of this study is to describe the characteristics and outcome of patients brought to an emergency department by police under Section 10 of Mental Health Act (Victoria, Australia).MethodsRetrospective medical record review. Patients referred under Section 10 provisions treated in calendar year 2009 were identified from ED database. Data collected included demographics, incident details, patient management, final diagnosis and disposition. Primary outcomes of interest were ED diagnosis and disposition. Secondary outcomes were length of stay in ED and use of restraint or sedation.ResultsOne hundred and ninety seven presentations by 164 patients were identified. Patients were predominantly male (58%) with median age of 35 years (IQR 22–44, range 16–69). The most common presenting complaint (65%) was threat of self harm. No sedation or restraint was used in 61%. Sixty seven percent were deemed safe for discharge home while 26% were admitted to a psychiatric ward (equally divided between voluntary and involuntary admission). The predominant discharge diagnosis was self harm ideation or intent (35%). Median ED length of stay was 156 min (inter-quartile range 79–416).ConclusionMost patients brought to ED by police under Section 10 provisions were for threat of self harm and did not require sedation or restraint. The majority are discharged home. Further work exploring less restrictive or traumatic processes to facilitate psychiatric assessment of this group of patients is warranted.     

Reforming the Mental Health Act 1983: an approved social worker perspective

The government green paper, 'Reform of the Mental Health Act 1983', was published in November 1999, for consultation by end of March 2000. This article offers comment on the operation of the Mental Health Act 1983 and the proposals for change, from an approved social worker perspective. Under the Mental Health Act 1983, approved social workers undertake social assessments of mental health crises, deciding upon the need for compulsory admission and treatment. To the debate on legislative change they bring a detailed social perspective on the processes and outcomes of statutory mental health intervention. Approved social workers' main concerns relate to the social context of mental health need, the availability of social resources, civil liberties, protections for people subject to statutory mental health interventions and the effective regulation of practice and services. Current proposals include options that would significantly reduce approved social worker involvement in decisions about compulsory admission and treatment; the implications of this are discussed.     

Payment of reimbursement for emergency treatment furnished by non-VA providers in non-VA facilities to certain veterans with service-connected or nonservice-connected disabilities. Final rule

This document amends the Department of Veterans Affairs (VA) medical regulations concerning emergency hospital care and medical services provided to eligible veterans at non-VA facilities. The amendments are required by section 402 of the Veterans' Mental Health and Other Care Improvements Act of 2008. Among other things, the amendments authorize VA to pay for emergency treatment provided to a veteran at a non-VA facility up to the time the veteran can be safely transferred to a VA or other Federal facility and such facility is capable of accepting the transfer, or until such transfer was actually accepted, so long as the non-VA facility made and documented reasonable attempts to transfer the veteran to a VA or other Federal facility.     

Reforming best interests: the road towards supported decision-making

Decisions under the Mental Capacity Act (MCA) may be made in a person’s best interest. This concept is objective, unclear and places discretion in the hands of the decision-maker. Currently, a person’s wishes, feelings, beliefs and values are not accorded primacy status amongst the checklist of factors to be considered under Section 4 MCA. In 2017, the Law Commission (LC) in their report on Mental Capacity and Deprivation of Liberty proposed amending the best interest test under Section 4 of the MCA to require the decision-maker to ascertain wishes and feelings and elevate the status of the ascertained wishes and feelings amongst the other factors under Section 4. These proposals, contained in a Draft Bill, would be of general application under the Act. This paper argues that the trajectory begun by Lady Hale in the Supreme Court in Aintree in asserting the individual at the heart of her destiny and the LC proposals are to be welcomed but do not go far enough to be aligned with the principle of supported decision-making set out in international frameworks, such as the Convention on the Rights of Persons with Disabilities.     

Notice regarding Section 602 of the Veterans Health Care Act of 1992; new drug pricing--PHS. Final notice

Section 602 of Public Law 102-585, the "Veterans Health Care Act of 1992," enacted section 340B of the Public Health Service Act ("PHS Act"), "Limitation on Prices of Drugs Purchased by Covered Entities." Section 340B provides that a manufacturer who sells covered outpatient drugs to eligible entities must sign a pharmaceutical pricing agreement with the Secretary of Health and Human Services in which the manufacturer agrees to charge a price for covered outpatient drugs that will not exceed an amount determined under a statutory formula. The purpose of this notice is to inform interested parties of final guidelines regarding new drug pricing.     

Revised federal allotments to states for social services expenditures pursuant to Title XX--Social Services Block Grant Act; promulgation for fiscal year 1984--HHS. Notification

The Federal allotments of +2.5 billion to States for social services under Section 2003 of the Social Security Act (Act) which were published in the Federal Register November 26, 1982 (47 FR 53502) were based upon the authorization set forth in Section 2003 of the Act at that time and were contingent upon Congressional appropriations actions for the fiscal year. Public Law 98-135, enacted October 24, 1983, amended Section 2003 of the Act, by increasing the authorization to +2.7 billion for Fiscal Year 1984 and each succeeding fiscal year. The allocation of this authorized amount for Fiscal Year 1984 is shown in Column 1 of the table below, and it too is contingent upon Congressional appropriations actions. Public Law 98-139, enacted October 13, 1983 appropriates +2.675 billion for allocation to the States under Section 2003 of the Act for Fiscal Year 1984. The allocation of this appropriated amount is shown in Column 2 of the table below. Accordingly, the promulgation made in 47 FR 53502, November 26, 1982, is rescinded and the promulgation, as revised, is set forth in Column 2 of the table below.