Attitudes among stakeholders towards compulsory mental health care in Norway

Objectives

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. Even though the current practice has been criticized, little empirical data exist about the attitudes towards compulsory mental health care.

Method

This study used Q-methodology to identify prototypical attitudes and to test possible differences of attitudes between groups of stakeholders towards the use of coercion in mental health care. Sixty-two respondents who represented six groups with different roles in mental health care participated: former patients, relatives of psychiatric patients, members of supervisory commissions, psychiatrists, other physicians, and lawyers.The participants were asked to assess the degree to which they agreed on 30 statements concerning use of coercion for the mentally ill.

Results

Three factors that in a meaningful way express different attitudes towards the question were found. The most widely shared attitude stated that a trusting relationship between patient and therapist is more important than the right to have an attorney. This attitude gives partial support to the present Mental Health Care Act. However, the second most common attitude argues that involuntary hospitalization, if necessary, should be decided in a court and not by the hospital doctor.

Conclusions

Differences in attitude could partly be explained by the respondents' role in mental health care. Both psychiatrists and “somatic” physicians expressed more agreement with the present legislation than the other stakeholders. The findings may have implications for the legal protection of mental health care patients.     

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.     

Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

犯罪嫌疑人强制医疗制度初探

在当前社会关注的热点话题中，看病难、看病贵已经成为人民群众反映最为集中的问题之一。其实，不光是在广大群众中有这样的迫切反映，在司法机关实际办案过程中，也屡屡遇到类似的情况。在百度搜索“犯罪嫌疑人”“传染病”等关键字，搜索到的都是某些犯罪嫌疑人因身患传染病，公安机关无法处理或者用有限的经费为嫌疑人治疗的事例。本文探讨了这一现实中客观存在的法律及社会难题。     

Perceptions and use of videoconferencing in forensic mental health assessments: A survey of evaluators and legal personnel

ABSTRACT

The use of videoconferencing (VC) to conduct forensic mental health assessments (FMHA) is increasing. Yet, little is known about its acceptability among clinicians or legal professionals. In Study 1 (N?=?156), forensic evaluators were asked about their use of VC, reasons for its use, and opinions about the validity, usefulness, ethics, and legality of its use. An estimated one-third of evaluators have used VC in the past. Although evaluators overall expressed moderate concern over the ethics and legality of use, prior experience appeared to mitigate concerns. Younger practitioners were also more open to using VC. Reduced costs for courts was the most frequently endorsed benefit associated with VC, while restricted ability to administer psychological testing and potential technological problems were seen as the biggest disadvantages. In Study 2 (N?=?27), attorneys and judges were surveyed about frequency with which they encounter VC for FMHA and their perceptions about the validity of those assessments. Findings indicated legal personnel expressed rather negative views without having much first-hand experience of VC, including concerns about establishing rapport and technical difficulties. These studies have implications for whether VC will be adopted more frequently in FMHA.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Objective

Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation.

Method

We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation.

Results

One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria.

Conclusions

The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T.     

Preventing crime in cooperation with the mental health care profession

Although major mental disorders do not have a central position in many criminological theories, there seems to be an evident relationship between these disorders and criminal behavior. In daily practice police officers and mental health care workers work jointly to prevent nuisance and crime and to keep the city livable. Examining the situations where the criminal justice system and mental health institutes are jointly involved to prevent crime, some pitfalls emerge that seem to threaten successful cooperation. There appear to be unrealistic expectations of the possibility to reduce the risk of reoffending by means of treatment and of the possibility to predict which offender poses a risk to society. Another complexity is the fact that both parties work from different backgrounds and pursue different goals. The way society and the criminal justice system deal with persons who are assumed to be a risk to the community because of a mental disorder demands a further investigation from a criminological perspective.     

论精神障碍患者强制住院异议机制的完善

以维护精神障碍患者的合法权益为立法宗旨、经过27年反复斟酌的《精神卫生法》终于出台，填补了精神卫生领域立法的空白，也将人权保障写入法律。精神障碍患者以自愿住院为原则，强制住院为补充，减少了“被精神病”的发生，但是对于强制住院的异议机制规定甚少且可操作性不强，不利于维护精神障碍患者的权利。在借鉴国外精神障碍强制住院异议制度的基础上，从提出异议的主体、异议机构以及异议程序方面，结合我国国情，对强制住院异议机制进行完善。     

自然保护区法律问题学术研讨会综述

由浙江林学院人文学院、浙江清凉峰国家级自然保护区管理局共同主办的自然保护区法律问题学术研讨会于 2 0 0 4年 5月 16日在浙江省临安市召开。中国社科院法学所、中国人民大学、浙江省人大法制委员会、浙江省高级人民法院、浙江省社会科学院、浙江省林业厅、浙江林学院环境法研究所及天目山、清凉峰、凤阳山等国家级自然保护区的领导与专家学者 6 0余人就自然保护区事业中存在的问题和法律对策进行了广泛而深入的探讨。此次研讨会主要集中讨论了如下问题 :1 制定自然保护区法的现实必要性。与会专家认为目前急需制定自然保护区法 ,其现实…