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.     

Stress,coping, and psychological well‐being among forensic health care professionals

Purpose. Although forensic services are often regarded as highly stressful environments, there has been a surprising lack of research into the phenomena of occupational stress among forensic health care professionals (FHCP) in the United Kingdom. This study investigated stress, coping, and psychological well‐being among FHCP employed within inpatient settings. Methods. One hundred and thirty‐five FHCP were recruited from four Medium Secure Units in the United Kingdom. A postal research pack was used to collect background information and measures of psychological well‐being, burnout, occupational stress, work satisfaction, and coping. Results. The study found that a substantial proportion of FHCP experienced elevated levels of occupational stress and psychological distress, while moderate levels of burnout were demonstrated in terms of emotional exhaustion, depersonalization, and reduced personal accomplishment. The findings confirmed that FHCP utilized a range of problem‐focused (e.g., positive), emotion‐focused (e.g., religious, negative, and supported), and palliative coping strategies (e.g., excessive smoking and drinking). Conclusions. The results appeared to support the commonly held assertion that forensic services are an inherently stressful and dangerous working environment, which can cause FHCP to experience marked levels of psychological distress, burnout, and occupational stress.     

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。     

Whistleblower protection for nurses and other health care professionals

Because most employees in the United States, including health care professionals, are employed "at will" (which means their employment can be terminated for any reason or no reason, as long as the reason isn't illegal), retaliatory actions by employers toward employees who speak out (i.e., blow the whistle) are not uncommon. Additionally, the law protecting whistleblowing employees varies greatly depending on the state where the employee works or if he or she works for the federal government. This article examines when and under what conditions a nurse or other health care professional may be protected from having an adverse employment action taken against him or her for reporting such issues as patient safety violations or health care fraud. The authors offer issues a nurse or other health care professional should consider before making the decision to blow the whistle. Finally, the authors also discuss the remedies such as reinstatement, back pay, or other compensatory mechanisms that may be available to employees terminated for reporting wrongdoing.     

公共健康和强制许可制度

TRIPS协定将传统的专利保护客体扩大到所有技术领域的任何发明,将医药产品及方法纳入了专利保护的范围,以致受专利保护的药品价格大幅上扬,在一些国家尤其是发展中国家和不发达国家产生健康危机。本文试图在分析《多哈宣言》及其《执行决议》中关于强制许可制度规定的基础上,提出我国可将其作为解决公共健康危机的基本途径。     

Violence against mental health care professionals: prevalence,nature and consequences

In this study, the prevalence, nature and consequences of violence against mental health care professionals are examined. Dutch mental health professionals working in clinical psychiatry were approached to fill in an online questionnaire on their personal experiences with physical violent incidents. It appeared that 67% of the 1534 respondents were victim of at least one physical violent incident in the past five years. In total, the 1534 respondents reported they had encountered 2648 physical violent incidents. In some cases, the consequences were very severe, not only for the victim but also for the employer. Some groups of professionals appear to have an increased risk of being victimized. The findings show that the violence that mental health professionals encounter is a substantial and severe problem that no longer should be disregarded.     

Potential legal protection problems in the use of compulsory commitment in mental health care in Norway

Compulsory commitment in mental health care represents a dramatic infringement on an individual's life. In Norway, this deprivation of liberty is based on a professional medical assessment that does not require a court verdict. This article presents possible changes that may increase legal protection for the mentally ill. The concept of legal protection has at least two definitions: the state's protection of the individual's legal rights (including the right to health care) and the protection afforded to citizens from abuse and arbitrary actions by the state. Infringements on personal liberty without consent require such legal authority as is found in the Human Rights Conventions. These Conventions have precedence over national laws. Norwegian legislation is based on confidence in psychiatry as a profession. This confidence allows professionals to treat patients against their will. In some countries, initial court action is necessary before compulsory mental health care can be implemented. This should also be possible in Norway in most cases, with the exception of life-threatening situations.     

Reporting health care professionals to state licensing boards--VA. Final rule

It continues to be the policy of the Department of Veterans Affairs (VA) to report to State Licensing Boards any separated physician, dentist, or other licensed health care professional whose clinical practice so significantly failed to meet generally accepted standards of clinical practice as to raise reasonable concern for the safety of patients. This document provides that, in addition, VA will report to State Licensing Boards any currently employed physician, dentist, or other licensed health care professional (one who is on VA rolls) whose clinical practice so significantly failed to meet generally accepted standards of clinical practice during VA employment as to raise reasonable concern for the safety of patients. Some health care professionals who are VA employees also provide health care outside VA's jurisdiction. Accordingly, the reporting of currently employed licensed health care professionals who meet the standard for reporting is necessary so that State Licensing Boards can take action as appropriate to protect the public. Examples of actions that meet the criteria for reporting are set forth in the text portion of this rulemaking. Also, nonsubstantive changes are made for purposes of clarity.     

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.     

Establishing a compulsory drug treatment prison: Therapeutic policy, principles, and practices in addressing offender rights and rehabilitation

A Compulsory Drug Treatment Correctional Center (CDTCC) was established in Australia in 2006 for repeat drug-related male offenders. Compulsory treatment law is inconsistent with a therapeutic jurisprudence approach. Despite the compulsory law, a normative offender rehabilitation framework has been established based on offender moral rights. Within moral rights, the offender rehabilitation framework addresses the core values of freedom (supporting autonomous decision-making) and well-being (supporting support physical, social, and psychological needs). Moral rights are underpinned by a theory or principle which, in this instance, is a humane approach to offender rehabilitation. While a law that permits offenders to choose drug treatment and rehabilitation is preferable, the article discusses the establishment of a prison based on therapeutic policy, principles, and practices that respond to participants as both rights-violators and rights-holders. The opportunity for accelerated community access and a therapeutic alliance with staff has resulted in offenders actively seeking to be ordered into compulsory drug treatment and rehabilitation.     

Mental health professionals in forensic arenas

The authors discuss a variety of forensic matters using cases in which they have been involved as experts. Pertinent issues are illustrated in cases in which the offender is charged with homicide. The need for a comprehensive evaluation, the importance of corroboration of the offender's statements, and the value of preparing a thorough report are discussed.     

Unusual cases of suicide among health care workers

We describe three unusual cases of suicide committed by health care workers. The aim of this paper was to analyze and evaluate the evidence of general diagnostic elements of poisoning in these cases.     

Special report on medical staff relationships. Handling "impaired" health care professionals

Applying the doctrine of corporate negligence, courts will, in appropriate circumstances, deem hospitals and other institutional health care providers responsible for the quality of patient care in their institutions and for the consequences of negligent physician performance that could have been discovered and prevented. See, e.g., Darling v. Charleston Community Memorial Hosp., 33 Ill. 2d 326 (1965), cert, denied, 383 U.S. 946 (1966); Johnson v. Misericordia Community Hosp., 99 Wis. 2d 709 (1981); Elam v. College Park Hosp., 132 Cal. App. 3d 332 (1982). In such a climate, and with Data Bank reporting now a reality, neither institutional providers nor health care professionals on their medical staffs can afford to ignore problems of practitioner impairment. Recognizing this reality, some state laws now mandate an organized approach--such as the establishment of an impaired practitioners committee--to problems of professional impairment. However, whether state-mandated or not, providers must have policies and procedures in place to insure not only that impaired professionals are referred to available treatment programs, but that they fully participate in and complete such programs, and achieve rehabilitation, before they return to practice at the institution. The earlier detection and treatment are initiated, preferably before peer review action becomes necessary, the better for patients, institutions, and practitioners themselves.     

Medical: informed consent--designate health care professionals to obtain informed consent. Final rule

This document amends U.S. Department of Veterans Affairs (VA) medical regulations on informed consent. The final rule authorizes VA to designate additional categories of health care professionals to obtain the informed consent of patients or their surrogates for clinical treatment and procedures and to sign the consent form.     

Sanctioning risky life-styles: Attitudes toward solidarity or equitable distribution of health care

Rising costs of medical care and increasing knowledge about behavior-related health risks favor the use of the equity principle in health care allocation. This paper deals with attitudes to the question of whether or not one's payments should be contingent upon the risks one takes. From an explorative analysis of arguments espoused by letter writers from a Dutch health magazine, it becomes apparent that equity plays a major role in the respondents' views of the distribution of health care facilities. Next, the role of attribution in adopting attitudes toward risky life-styles is studied on the basis of a survey using a representative sample of Dutch households. Beliefs about the individual ability to influence health have no effect on risk solidarity, whereas beliefs about the proper amount of effort to avoid health risks do have an effect.