Psychotropic Medication Experiences of Incarcerated Women: A Qualitative Inquiry into Conundrums of Access and Identity

The study examines narrative data from in-depth, semi-structured interviews with 25 women in a medium security prison with the hope of deepening the knowledge base related to women’s beliefs about their mental health problems, mental health care during incarceration, and especially their experiences with psychotropic medication. The findings highlight the functional role of psychotropic medication in the lives of incarcerated women, while also emphasizing problems with limited access to prescribers, preferred medications, and other forms of mental health treatment. Trauma, substance use, and the impact of medication use on sense of self all emerged as interfacing with quality of life.     

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.     

Mediating effects of stalking victimization on gender differences in mental health

Studies suggest that stalking victimization may have a serious mental health impact. The present article investigates gender differences in mental health and possible mediating effects of stalking victimization in a community sample. The study includes a postal survey of 665 German community residents on the experience of stalking and various mental health indicators. In a majority of mental health scales, women score poorer than men, and a higher percentage of women fulfill criteria for a current mental disorder and used psychotropic medication. However, effects of gender decrease to a nonsignificant level when stalking victimization is entered into the respective models. Furthermore, associations of stalking victimization with poor mental health, psychosocial functioning, and use of medication are largely comparable across gender.     

The use of harmful to others-criterion for involuntary treatment in Finland

During the past decades the Western countries have paid attention to their Mental Health legislation, in particular, by making changes concerning involuntary treatment. In Western countries legislation allows involuntary treatment of the mentally ill. Involuntary psychiatric treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self-harm (for the good of the patient). The aims of this study were to describe to what extent the danger to others criterion is used as a motivation for involuntary hospitalization and detainment in Finland, and to what kind of patients this criterion is applied. The study involves a retrospective chart review of all the treatment periods of a six month admission sample in three Finnish university hospitals. We found that potential harm to others has been rarely used as a motivation for involuntary referral or detainment together with other motivations, and virtually never as the sole motivation. With the exception of gender, which was most often male, patients with potential harm to others did not differ significantly from other involuntarily treated patients. Coercion (defined as seclusion, the use of restraints, forced medication, physical restraint or restrictions in leaving the ward) was not used with these patients more regularly than with the patients motivated by the other criteria. Length of stay (LOS) in a psychiatric hospital did not differ between the patients determined harmful to others and the other involuntarily treated patients.     

Role of occupational health services in workplace drug testing

In Finland, workplace drug testing is mainly performed in accordance with the Act on the Protection of Privacy in Working Life (759/2004), (http://www.finlex.fi/en/laki/kaannokset/2004/20040759) [1], the Occupational Health Care Act (1383/2001), (http://www.finlex.fi/en/laki/kaannokset/2001/20011383) [2] and the Decree on Workplace Drug Testing (218/2005) [3]. The role of occupational health services is stated in the Occupational Health Care Act. All workplace drug tests are carried out by health services according to good occupational health care practice. A referral for a drug test is given by a physician or a nurse working in health care services. When giving the referral, the physician or nurse should inform the person to be tested of the purpose and content of the test, record any medication they may be using, and make sure they are aware that they can later dispute the result of the test. The identity of the person should be checked before taking a sample. The analysis laboratory sends the result of the drug test to the health care service unit that has given the referral. If the test result is positive, the laboratory gives a detailed analysis of the test result. The health care service personnel provide the testee with the result. If it is negative, it may be given by a nurse. When the test result is positive, a Medical Review Officer (MRO) should interpret the answer and evaluate whether the positive result is due to medication, or another reasonable explanation offered by the person tested. The MRO informs the person of the options of rehabilitation treatment available to drug abusers stated in the written drug testing policy/programme of the employer/company. The testee takes the test result report to his/her employer personally.     

The impact of the right to refuse treatment in a forensic patient population: six-month review

In December of 1987, the Wisconsin supreme court held that all involuntarily committed mental patients in the state had the right to refuse psychotropic medication unless a court held that they were incompetent to make treatment decisions. The authors studied the effects of this decision in a 165-bed forensic hospital over the first six months after implementation of the decision. They found that 29 percent of patients already on psychotropic medication initially refused further treatment as opposed to 75 percent of newly admitted patients. Of refusers, 32 percent eventually resumed taking medication voluntarily; courts overturned the refusals of all the 51 percent who maintained their refusals, after an average delay of over a month. The length of procedural delays actually increased over the six months of the study as the courts learned of the decision. The authors compare their findings with other reported studies of implementation of right to refuse treatment decisions and discuss differences between the right to refuse treatment for civilly and criminally committed patients.     

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.     

Implementing the Mental Health Act 2007 in British general practice: Lessons from Ireland

Changes in mental health legislation (e.g. Mental Health Act 2007 in England and Wales, Mental Health Act 2001 in Ireland) have generally improved adherence to international human rights standards, but also present challenges to primary care providers. When mental health legislation was substantially reformed in Ireland, 62.9% of general practitioners (GPs) felt the new legislation was not user-friendly. Majorities of GPs who felt the legislation affected their practice reported increased workloads (85%) and various other difficulties (53%). GPs who had received training about the legislation were more likely to find it user-friendly (43% versus 30.9%), and informal training (e.g. from colleagues) was just as likely as formal training to be associated with a GP finding it user-friendly. With similar changes to mental health legislation being introduced in England and Wales, it is significant that informal training is just as good as formal training in helping GPs work with new mental health legislation.     

The relationship between the court and the doctor on the issue of an inpatient's refusal of psychotropic medication

New procedures, tailored after such court decisions as Rogers v. Commissioner of the Department of Mental Health, have restricted the doctor's ability to treat psychiatric inpatients with psychotropic medication and have increased the protection of a competent patient's right to refuse. This study investigates how the relationship between the doctor and the court has adapted to these new procedures. All 40 court cases of a maximum security forensic hospital over a two-year period were reviewed. Results suggest that the new procedures have had no dramatic effect upon either the treatment patients receive or the doctor-court relationship. While abstract arguments both in favor of and against these new procedures can be drawn from the same data, the concrete relationship still remains poorly understood.     

Psychotropic Medication and Competence to Stand Trial

At any given time, as many as 15,000 persons are hospitalized for study or treatment regarding their competence to stand trial. Although most of the defendants found incompetent to stand trial "could rapidly be returned to competence and so maintained were the facilities and treatments of modern psychiatry made available to them", the impact of recent advances in psychiatry—particularly drug therapy—has not been fully absorbed by the legal system. Defendants restored to competence by psychotropic drugs frequently require ongoing medication. Some courts, mistakenly assuming that psychotropic drugs produce a "chemical sanity" that is unacceptable for participation in a trial, have adopted a practice—the "automatic bar rule"—of automatically prohibiting the return for trial of defendants under the influence of such drugs. A lack of statutory, regulatory, or judicial guidance leaves the question largely to the discretion of individual trial judges. This article critically examines the automatic bar rule in light of the effects of various psychotropic drugs and of the consequences of the rule both to defendants and to the state.     

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.     

Victims of fraud: comparing victims of white collar and violent crime

Mental health professionals have focused attention on the psychiatric sequelae of criminal victimization. This article compares the experience of white collar and violent crime victims on several parameters including statistical risk of victimization and psychiatric outcome after victimization. Emphasis is given to data obtained from interviewing 77 victims of a fraudulent financial scheme.     

美国精神卫生制度的发展——兼论我国新《精神卫生法》

美国精神卫生制度的形成经历了从漠视和侵犯人权到尊重和重视人权的发展过程。然而美国现有精神卫生制度领域仍然存在着诸多问题和缺陷,特别体现在医疗服务可获得性缺乏这一问题上。《中华人民共和国精神卫生法》力求在医疗服务可获得性与强制住院之间达到平衡。     

Detention and treatment down under: human rights and mental health laws in Australia and New Zealand

Mental health law reform in recent decades has drawn on the international human rights movement. The entering into force of the Convention on the Rights of Persons with Disabilities (CRPD) on May 3 2008 has been hailed by some as signalling a new era in relation to how domestic mental health laws should be reformed. Both Australia and New Zealand have ratified the CRPD and Australia has acceded to its Optional Protocol. New Zealand and the Australian Capital Territory and Victoria have statutory bills of rights which have an interpretive effect, but are unable to render other statutes invalid. Drawing on the results of interviews conducted with fifty-two representatives of consumer and carer organisations, lawyers, and mental health professionals across Australia and New Zealand, this paper examines the current thinking on human rights and mental health laws in these countries and outlines what changes, if any, may be brought to domestic legislation in light of the Convention.     

Conducting Veteran Dependency and Indemnity Compensation Exams: Establishing a Nexus Between Mental Health and Death

Forms of financial compensation have been paid to the beneficiaries of deceased service members since the Revolutionary War. In its current version, Dependency and Indemnity Compensation (DIC) is a tax-free monetary benefit paid to eligible survivors of veterans whose death resulted from a service-related disability. Mental health professionals are called upon to provide medico-legal opinions in DIC claims involving questions of whether a veteran’s service-connected mental illness contributed substantially to their death. The U.S. Department of Veterans Affairs (VA) does not currently employ training programs, competency standards, or best practice recommendations for these specialized evaluations. This article seeks to fill this gap and provide a resource for mental health professionals providing medical opinions in DIC claims.     

Why some market reforms lack legitimacy in health care

Market-oriented health policy reforms in the 1980s and 1990s generally included five kinds of proposals: increased cost sharing for patients through user fees, the separation of purchaser-provider functions, management reforms of hospitals, provider competition, and vouchers for purchasing health insurance. These policies are partly derived from agency theory and a model of managed competition in health insurance. The essay reviews the course of reform in five countries that had a national health service model in place in the late 1980s: Italy, New Zealand, Spain, Sweden, and the United Kingdom. Special consideration is given to New Zealand, where the market model was extensively adopted but short lived. In New Zealand, surveys and polls are compared to archival records of reformers' deliberations. Voters saw health care differently from elites, and voters particularly felt that health care was ill suited to commercialization. There are similarities across all five countries in what has been adopted and rejected. Some market reforms are more legitimate than others. Reforms based on resolving principal-agent problems, including purchaser-provider splits and managerial reforms, have been more successful, although cost sharing has not. Competition-based reforms in financing and to a lesser extent in provision have not gained legitimacy. Most voters in these countries see health care as different from other parts of the economy and view managerial reforms differently from policies that try to make health care more like other sectors.     

Bar code label requirement for human drug products and biological products. Final rule

The Food and Drug Administration (FDA) is issuing a new rule to require certain human drug and biological product labels to have bar codes. The bar code for human drug products and biological products (other than blood, blood components, and devices regulated by the Center for Biologics Evaluation and Research) must contain the National Drug Code (NDC) number in a linear bar code. The rule will help reduce the number of medication errors in hospitals and other health care settings by allowing health care professionals to use bar code scanning equipment to verify that the right drug (in the right dose and right route of administration) is being given to the right patient at the right time. The rule also requires the use of machine-readable information on blood and blood component container labels to help reduce medication errors.     

Current psychopathology in previously assaulted older adults

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.