Mental health legislation and human rights in England, Wales and the Republic of Ireland

In 2005, the World Health Organization (WHO) published its Resource Book on Mental Health, Human Rights and Legislation (Geneva: WHO) presenting a detailed statement of human rights issues which need to be addressed in national legislation relating to mental health. The purpose of this paper is to determine the extent to which revised mental health legislation in England, Wales (2007) and Ireland (2001) accords with these standards (excluding standards relating solely to children or mentally-ill offenders).Legislation in England and Wales meets 90 (54.2%) of the 166 WHO standards examined, while legislation in Ireland meets 80 standards (48.2%). Areas of high compliance include definitions of mental disorder, relatively robust procedures for involuntary admission and treatment (although provision of information remains suboptimal) and clarity regarding offences and penalties Areas of medium compliance relate to competence, capacity and consent (with a particular deficit in capacity legislation in Ireland), oversight and review (which exclude long-term voluntary patients and require more robust complaints procedures), and rules governing special treatments, seclusion and restraint. Areas of low compliance relate to promoting rights (impacting on other areas within legislation, such as information management), voluntary patients (especially non-protesting, incapacitated patients), protection of vulnerable groups and emergency treatment. The greatest single deficit in both jurisdictions relates to economic and social rights.There are four key areas in need of rectification and clarification in relation to mental health legislation in England, Wales and Ireland; these relate to (1) measures to protect and promote the rights of voluntary patients; (2) issues relating to competence, capacity and consent (especially in Ireland); (3) the role of “common law” in relation to mental health law (especially in England and Wales); and (4) the extent to which each jurisdiction wishes to protect the economic and social rights of the mentally ill through mental health legislation rather than general legislation.It is hoped that this preliminary analysis of mental health legislation will prompt deeper national audits of mental health and general law as it relates to the mentally ill, performed by multi-disciplinary committees, as recommended by the WHO.     

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.     

从《精神卫生法》看精神障碍患者的知情同意权

知情同意权是医患关系中的主要问题之一,新出台的《精神卫生法》在多个条文中明确规定了精神障碍患者的知情同意权,成为精神病患者知情同意权的基本法律依据。本文立足于知情同意权的一般法理,梳理《精神卫生法》中精神障碍患者知情同意权的法律规定,以此为基础探讨精神障碍患者知情同意权的基本内容。     

Detention under the Mental Health Act: balancing rights,risks and needs for services

Mental health law has to balance considerations of both justice, and health and welfare. In the political climate of the 1990s mental health services have become targeted on those with serious mental illness, to address the objectives of containing risks and limiting service expenditure. This paper identifies that increasing rates of detention under the Mental Health Act through the 1990s in a particular region, disproportionately involve longer-term detentions (under section 3), men, and people with serious mental illnesses. Those detained are likely to experience social difficulties. Changes in legislation are imminent, and the paper concludes that thought should be given to the amount of statutory intervention in the lives of seriously mentally ill people, and to the principle of reciprocity in relation to those coerced for lesser periods. Services should seek to address the issues of social exclusion which are reflected in the circumstances of those detained.     

Mental disorder and probation policy and practice: A view from the UK

This article is concerned with the manner in which offenders with mental illnesses serving community sentences are identified and treated by the probation service in the UK. It presents the results of recent research examining the prevalence levels of current and lifetime mental illness, substance misuse, and dual diagnosis and suicide rates amongst those serving community sentences in the UK. These high levels of mental disorder are not being addressed by probation policy or practice in a manner that is effective or sensitive. The article concludes by considering the relevance of innovative approaches to the treatment of offenders with mental illnesses in the community currently being adopted in the US to the UK.     

Generating and using evidence to guide public policy and practice: Lessons from the Campbell Test-bed Project

This paper offers lessons from a three-year Test-bed project that tested systematic review practices developed by the Campbell Collaboration and the Cochrane Collaboration. Under the Test-bed project 14 systematic reviews were completed of interventions in crime prevention, social welfare, and education. (References to the products of these test-bed reviews are included in the reference list, preceded by an asterisk). Building on this experience, the authors recommend structuring future reviews around well-defined review topics more explicitly focused on particular interventions, and constraining literature search to evaluations of relevant interventions. Reviewers should analyze and report findings from RCTs separately from non-RCT studies and report on impact estimates in natural units, instead of relying solely on effect size metrics. Further, reviewers should report intent-to-treat estimates as the causally valid outcomes from RCTs. Analyses of impacts for treated sub-groups should be reported as non-experimental findings. More attention should be given to the minimum detectable effect a study can support, as well as any information on the possible costs and benefits of the intervention. Pooling results from studies of disparate interventions, populations, and contexts is not recommended. Meta-analysis should be reserved for homogeneous clusters of interventions studies. Forest plots are helpful for presenting study findings and confidence limits. However, simple bar charts preserve important information on the base levels for the outcomes. Finally reviewers should define a priori the minimum data set or required elements that allow study inclusion, and use this information systematically in making decisions about what evidence to admit into the review.     

新冠肺炎疫情下司法精神医学鉴定的应对

新冠肺炎疫情已被公认为全球性重大挑战。已经、正在,同时仍将对人类社会的诸多方面产生深远的影响。新冠肺炎疫情下司法精神医学鉴定面临诸多挑战,通过梳理疫情下已实施的有关司法鉴定方面的做法、经验,分析涉疫情主要犯罪类型,开展司法精神医学远程鉴定具有必要性和可行性。但应关注其局限性,实施之前应制定相应的操作规范。     

中国问题银行公共资金救助体系的法律构建——以金融危机中美国的救助行为为鉴

金融危机的爆发引发了美国对问题银行的新一轮大规模公共资金救助。此轮救助不仅是对传统救助方式的再次使用,更是基于对金融危机爆发机理和监管缺陷的反思,通过金融监管改革法案,实现对传统救助方式的创新发展。中国应以美国为鉴,结合本国国情,通过立法逐步建立以存款保险公司、中国人民银行和财政部为救助主体,银监会、存款保险公司、中国人民银行、财政部四家机构之间分工明确又相互协调的问题银行公共资金救助体系。