The nearest relative in the Mental Health Act 2007: still an illusionary and inconsistent safeguard?

Abstract

The role of nearest relative (NR) is intended as a safeguard in the Mental Health Act 1983 (as amended in 2007) to curb the excesses of professional discretion and protect patients from unwarranted compulsory hospitalisation. It is unique to the mental health compulsory detention process in England and Wales. There are, however, evident tensions in the role and a lack of clarity surrounding the precise functions of the NR. There is also some uncertainty and confusion among practitioners about the scope of the NR involvement, and government plans announced recently to review mental health legislation will include a focus on the role of family and carers in the care of detained patients. Despite long-standing concerns about the role, there is remarkably little published research available to date on its use and effectiveness, in so far as evaluating the extent to which it provides an adequate safeguard for patients, as intended by the legislation. This article will briefly explore the background to the role, highlight some of the difficulties and tensions within it and conclude with some observations about where further research and reform may be needed to provide greater protection and clarity for patients, relatives and health and social care practitioners.     

A National Survey of Mental Health Services Available to Offenders with Mental Illness: Who Is Doing What?

The purpose of this study was to examine the national practices of psychotherapy services for male offenders with mental illness (OMI) in state correctional facilities. Participants consisted of 230 correctional mental health service providers from 165 state correctional facilities. Results indicated that mental health professionals provided a variety of services to OMI that can be conceptualized by six goals considered important in their work: mental illness recovery, emotions management, institutional functioning, re-entry, risk-need, and personal growth. Mental health professionals in this study generally viewed mental illness recovery, institutional functioning, and personal growth as significantly more important and spent more time focused on these goals than emotions management, re-entry, and risk-need. Mental health professionals tended to believe the services they provided were effective across four key treatment foci including mental illness, skill development, behavioral functioning, and criminogenic needs with more progress perceived in areas related to mental illness and skill development than their ability to effectively change behavioral functioning. Implications of these findings and directions for future research are discussed.     

Swedish Police Officers’ Job Strain,Work-Related Social Support and General Mental Health

This study investigated the association between psychosocial job characteristics and general mental health among police officers and the extent to which social support at work plays a role in this association. The findings are based on a cross-sectional survey. A written questionnaire was assessed by 714 police officers volunteered to participate in the study. The participants completed a series of validated instruments assessing job demand, control and social support at work (JDCS); general mental health (GHQ); and sociodemographic characteristics. High job strain was associated with low levels of work-related social support. Moreover, poor mental health was associated with low levels of work-related social support, active work and high job strain. The joint effect of high job strain and low levels of work-related social support had a significant effect on poor mental health. Work-related social support buffered job strain to some extent. Workforce health promotion policies should attempt to reduce job strain and emphasise the importance of work-related social support. Knowledge about police officers’ general mental health and policymakers’ support for police officers may have positive effects on the performance of the police force.     

Dr. Death? Professionalism,Virtue, and U.S. Physician Participation in the Death Penalty

In the United States at present, the death penalty is a possible sentence in 31 out of 50 states, as well as within the military and for federal cases. In the U.S., numbers of executions are declining, in part due to moratoriums in place and challenges to execution by lethal injection. Participation by physicians in lethal injection executions has been steadfastly viewed by professional medical organizations as contrary to their ethical standards. However, physicians have participated in lethal injection executions, and the morality of the death penalty itself is a matter of intense social and political debate. Medical ethics commentators and professional organizations have typically held that the prohibition on physician participation in the death penalty is independent of the ethical status of the death penalty itself. This article argues that this view is untenable, and that it is tied to a view of professional role virtue that is similarly untenable. At the same time, it argues that, given the morally uncertain status of the death penalty, it is plausible that virtuous physicians may either refuse or choose to participate in some aspects of the death penalty.     

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: A Litany of Fundamental Flaws?

This article argues that the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are fatally flawed notwithstanding the apparent rigour of the process which produced them. These Regulations were the product of considerable deliberation following a sensitively executed public inquiry yet, it is argued, they rely too heavily on the rhetoric of criminal law while failing to take into account the competing norms for compliance and the impact of NHS budget constraints. Further, they push the CQC towards a heavy‐handed deterrence approach to enforcement, which will increase hostility between regulatees and the inspectorate, and ultimately reduce the scope for developing the transparency about failures which is sorely needed in the NHS. This article challenges the contemporary wisdom that it is primarily knee‐jerk regulatory responses that suffer from fatal flaws of this nature.     

Do the Mental Health Consequences of Sexual Victimization Differ Between Males and Females? A General Strain Theory Approach

Sexual assault is a traumatizing event linked to numerous mental health consequences. Although extant research has thoroughly examined the collateral consequences experienced by females, limited literature exists regarding how sexual violence comparatively affects males and females. Using data from the National Violence Against Women Survey (1995–1996) and a strain theoretical framework, the current study addresses this research gap to understand the effects of sexual assault and sex on depression. Results indicate that victims of sexual assault have higher depression scores than persons who have not been sexually assaulted in their lifetime. Moreover, we found no sex effect for sexual assault on depression. The methodology used eliminated a bias typically associated with regression analyses, caused from statistical inference after improper model selection. Policy implications and directions for future research are discussed.     

Mental Health Problems among Prison Inmates: the Effect of Welfare Deficiencies,Drug Use and Self‐Efficacy

In this paper, we investigate the differential contribution of accumulated welfare deficiencies, drug use, and self‐efficacy on inmates' current symptoms of mental health problems. Few studies so far have investigated inmates' mental health based on empirical data covering both social and psychological predictors. Our analyses are aimed at the following research questions: (a) what is the relationship between welfare deficiencies, drug use, and symptom reporting among prison inmates? (b) is this relationship influenced by inmates' perceived self‐efficacy? and (c) how might this information be used to inform the discussion of challenges in prisoner re‐entry? Findings are based on a national survey among prison inmates in Norway, focusing on living conditions generally, as well as mental distress, drug use, and self‐efficacy. The findings indicate serious accumulation of disadvantage, and more welfare deficiencies among drug users and those suffering from mental distress. When it comes to prediction of mental distress, accumulation of welfare deficiencies and self‐efficacy both turned out as significant contributors. The findings are discussed both in terms of practical implications, and in terms of how they illustrate some of the shortcomings inherent in a traditional welfare research perspective.     

W.A. Schabas,Nowak’s CCPR Commentary: U.N. Covenant on Civil and Political Rights, 3rd rev. edn.

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