Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.     

Immigrants en banlieue et politiques publiques municipales : le cas lavallois (Québec,Canada)

Abstract: The growing number of new immigrants settling in suburban communities has caused researchers and policy‐makers to shift their focus from large cities to the communities that surround them, thereby side‐swiping several stereotypes commonly associated with “white” and “wealthy” suburban cities in North America. My article responds to this recent interest by proposing an analysis of the public policies that apply to immigrants and ethno‐cultural minorities in Laval, north of Montreal. The article establishes that Laval has had a policy in place since the early 1990s, with a specific institutional configuration that changes over time. I discerned two institutional configurations shaping two distinct sequences for this policy. The first sequence (1990–2003) involved an institutional configuration that shut down the channels for the representation of the interests of immigrants and ethno‐cultural minorities on the municipal level, and the second sequence (2003–2009) was marked by the regionalization of the shutdown of the mediation channels for the representation of these interests. In each sequence, the shutdown of the mediation channels is illustrated in three areas of this public policy: intergovernmental agreements, the recognition of associations, and affirmative action in the municipal public service.