Adolescents and mental disorder: who consents to treatment?

Although English law recognises that developing adolescents may acquire the capacity to make decisions about medical treatment themselves it does not address the problem of mentally disturbed or disordered adolescents. This article examines the nature of adolescent refusal of treatment and suggests that a line be drawn between three categories of adolescent disturbance--the competent young person who refuses treatment that an adult too may refuse, the rebellious teenager whose refusal is triggered by simple teenage angst, and the mentally ill teenager whose refusal is triggered by mental illness. It suggests that adolescent autonomy needs to be more fully understood and the Mental Health Act more readily used in treating young people.     

Australian mental health tribunals--'Space' for rights, protection, treatment and governance?

This paper draws on a multi-year Australian collaborative study of mental health review tribunals ('MHTs') in three jurisdictions (Victoria, New South Wales and the Australian Capital Territory) undertaken in conjunction with the NSW Law and Justice Foundation, using qualitative and quantitative methods to examine the role of MHTs in advancing goals such as fairness, legality and access to treatment. Study findings regarding stakeholder and client concerns - about access to quality treatment and associated support services, review of treatment adequacy and drug regimes, and their 'participation' or dignity of engagement in review processes - are presented as variants of the need for adequate hearing 'space': temporal, jurisdictional, cognate/relational, physical and symbolic, and 'connective'. Building on earlier arguments for MHTs to engage not only legal, but also clinical and social domains, and for adopting some processes more characteristic of case-conferencing, this paper examines the implications of tribunal 'flexibility' and a wider overall 'governance' jurisdiction in mental health.     

"I want you to listen to my side of this": is there a role for mediation early in the health care complaints process?

The resolution of disputes that arise out of the provision of health care services has historically taken place at an institutional level, with the hospital administrative unit conducting the process, or through the legal system with the parties traversing the relevant courts and tribunals. Increasingly, the wide range of decisions which must be made in relation to the delivery of patient and client care and the broad scope of variations in expectations as to what a health service is capable of delivering, are providing fertile ground for conflict. This column considers the potential role of mediation as an early intervention strategy to resolve health care disputes.     

Who Am I?: Using Reflective Practice and Self-determination to Redefine ‘Employability’ in Legal Education

Liverpool Law Review - This study examines the value of undergraduate law students undertaking structured and assessed reflective practice as part of their studies, in the context of competing...     

Forensic mental health law reform in Japan: from criminal warehousing to broad-spectrum specialist services?

Since the 1980s Japan has undergone a number of mental health law reforms culminating in the 2005 forensic law. This added to its enactments on involuntary commitment, long-term aged care and substitute decision making, bringing Japan into focus as an industrialized state now possessed of a full package of civil and forensic provisions. This article seeks to demonstrate that the new forensic law cannot achieve its own stated goals without seeking to put into place financial and administrative supports aimed to integrate the myriad of patient populations that will be inevitably affected by the new forensic system. In order to avoid the widespread syndrome that has already been experienced internationally of warehousing mentally ill offenders in jails, it is critical that the Japanese government develop effective and culturally sensitive techniques for dealing with low risk populations through a diversionary process. Furthermore, although the legislation addresses serious crimes, it is imperative that policies be put into place to avoid directing young offenders, violent patients from the general hospital system, the developmentally handicapped, already convicted persons found in hospital settings and problematic cases in the correctional system, to the new forensic units established by the legislation. It is only though contemplating unintended outcomes of the legislation that the Japanese government will be able to avoid the ongoing stigmatization and prolonged institutionalization of mentally ill populations. Despite apparent cultural differences internationally vetted human rights requirements must be properly protected, not only in the forensic context, but throughout the mental health system at large. The coordination of services and the development of specialty training are necessary conditions for the realization of improved and humane conditions for mentally ill persons in Japan.     

Why do mental health courts work? A confluence of treatment,support & adroit judicial supervision

The article contributes to the understanding of ‘what works’ in mental health courts (MHCs). There are now almost 400 MHCs in the US and more worldwide. A substantial body of evidence demonstrates that MHCs can succeed in reducing recidivism among offenders who suffer mental disorders. This article argues that MHCs succeed when they have achieved the right confluence of essential elements, including providing evidence-based treatment and psychosocial supports and using adroit judge-craft. After a brief review of some of the studies demonstrating MHC success, this article discusses the research into the necessary foundations of rehabilitation programs. It is argued that, although treatment and psychosocial services should be supplied within an evidence-based framework, neither of the two leading conceptual models – Risk–Needs–Responsivity and the Good Lives Model – are empirically proven with offenders who suffer from mental disorders. Despite the absence of proof, the Good Lives Model is argued to be appropriate for MHCs because it is normatively consonant with therapeutic jurisprudence. The MHC judge is another essential element. The judicial role is assayed to elucidate how it functions to promote the rehabilitation of offenders with mental disorders. It is argued that the role of the MHC judge during supervisory status hearings is to establish a therapeutic alliance and practice motivational psychology with each MHC participant.     

What does recovery mean to a forensic mental health patient? A systematic review and narrative synthesis of the qualitative literature

This is a systematic review and narrative synthesis of qualitative literature for forensic mental health patients’ perceptions of recovery. Relevant databases were searched and a total of 11 studies that fit the inclusion criteria were identified. Thematic Synthesis was applied to synthesise the collated themes into six superordinate themes: connectedness, sense of self, coming to terms with the past, freedom, hope and health and intervention. Two superordinate themes were particularly prevalent: connectedness and a sense of self. It is argued that a focus on increasing opportunities for forensic mental health patients to develop a sense of self and connectedness could help improve recovery. Future recommendations to expand on these findings include using grounded theory methods to develop theoretical understanding of the data.     

Combining work and family in the Netherlands: Blessing or burden for one's mental health?

In this article we study which characteristics of combining work and family put people at risk for mental illness. Two alternative perspectives on the impact of multiple social roles on mental health are tested: the role accumulation perspective and the role strain perspective. Both perspectives are studied with data from a cross-sectional national survey held among a large, representative sample of Dutch people (N=1008). Multivariate analyses provided support for both perspectives. Having more social roles was related to better mental health. We also found a positive mental health effect of having a full-time job in combination with having children. However, having a partner who contributes less to household duties or having a job with low decision latitude or lower skill discretion was related to mental illness. So, certain aspects of social roles may also threaten people's mental health. Overall, our findings do not support the idea that combining work and family is necessarily a burden and harmful for people's mental health. Whether multiple social roles are a blessing or burden for people's mental health seems to depend on the characteristics of the social roles.     

Who Will Graduate? Disruption of High School Education by Arrest and Court Involvement

Little research has assessed the effects of juvenile justice involvement during high school on educational outcomes. Using the National Longitudinal Survey of Youth 1997, this study assesses the effect of first‐time arrest and court involvement during high school on educational attainment. In addition, differential effects by structural location are examined. Findings suggest support for the labeling perspective. First‐time court appearance during high school increases the chances of dropping out of high school independent of involvement in delinquency. Furthermore, the effect of court appearance is particularly detrimental to less delinquent youths.     

Who should I look at? Eye contact during collective interviewing as a cue to deceit

Pairs of liars and pairs of truth tellers were interviewed and the amount of eye contact they made with the interviewer and each other was coded. Given that liars take their credibility less for granted than truth tellers, we expected liars to monitor the interviewer to see whether they were being believed, and to try harder to convince the interviewer that they were telling the truth. It was hypothesised that this monitoring would manifest itself through more eye contact with the interviewer and less eye contact with each other than in the case of truth tellers. A total of 43 pairs of participants took part in the experiment. Truth tellers had lunch in a nearby restaurant. Liars took some money from a purse, and were asked to pretend that instead of taking the money, they had been to a nearby restaurant together for lunch. Pairs of liars looked less at each other and displayed more eye contact with the interviewer than pairs of truth tellers. The implications of these findings are discussed.     

Same law–same rights? Analyzing why Sweden's disability legislation failed to create equal rights in mental health

This article analyzed the apparent paradox of disability rights in Sweden. Despite strong welfare state traditions and stated Government ambitions to create generous statutory entitlements for all disabled people using a single, comprehensive Disability Act, psychiatric disabilities were principally excluded from the Disability Act's rights and provisions. The study focused on Sweden's Mental Health Reform and Disability Reform using governance perspectives that traced and analyzed the policy-processes of both reforms. Theoretically guided analytical frameworks were developed to help understand the divergent reform outcomes. The first focused on legislative arguments of regulatory specificity and legal enforcement mechanisms to consider whether the Disability Act was formulated in a manner that was easier to apply to certain disabilities. The second analyzed ideological arguments and the influence of Government political beliefs that signaled specific reform ‘visions’ to implementers and thereby influenced policy implementation. The main findings are that both perspectives matter as the dual influences of legislative and ideological differences tended to exclude mental health service users from the Act's generous disability rights. The overall conclusion was that while legislation was an important regulatory mechanism, the Government's underlying ideological reform vision was also an essential governance instrument that signaled Government intentions to implementing agencies and thus influenced the creation of enduring disability rights.