Extra information about treatment is too much for the patient with psychosis

BackgroundCase law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.AimsTo determine whether giving extra information impairs the mental capacity to make decisions about treatment.MethodThe MacCAT-T, MacCAT-FP, PANSS and GAF were administered to 88 detained forensic patients with psychosis. Two positive and two negative facts were given about each of two anti-psychotic drugs, and no treatment (twelve items). A choice was elicited. The criterion for incompetence was inability to express a choice. Two extra positive and two extra negative facts about each of the three options were given (twelve extra items) and a choice was again elicited, while repeating the MacCAT-T.ResultsGiving extra information led to a decline in the total score on the MacCAT-T. Twenty one were initially unable to make a choice (24%). After additional information, 33 were incapable (37.5%, Chi-squared p < 0.001). Those initially incapable had the lowest scores on all measures of functional capacity and GAF, with highest scores for symptoms. Those able to choose a treatment option had the highest levels of function and least symptoms. Those who became incapable had intermediate scores.ConclusionsGiving extra information made an extra 15% unable to choose. Clinical judgement must be exercised concerning the amount of information disclosed. Deciding what is material to the individual is arbitrary when so few items of information can be processed. Greater use of guardianship and independent second opinions is recommended.     

Forensic services in Australia

Australia is comparable in size to the United States without Alaska, but two-thirds of the continent is desert or semidesert. The population of approximately 15 million is largely centered around major cities near the coastline. There is a federal system of government, and independent forensic services are based in the capital cities of each of the six states and two territories. The need to service both the densely populated urban areas as well as sparsely populated outback regions has created logistic problems. The forensic services in each state and territory have evolved independently and have resulted in a diversity of organizational forms. The organization of forensic services in Australia is described and contact addresses are provided.     

UNEMPLOYMENT POLICY: A CASE STUDY IN AGENDA MANAGEMENT

Abstract: Agenda management is a process in which governments attempt to prevent policy issues from emerging, to influence the public perception of issues and to shape or delete issues on the current agenda of policy making. Numerous techniques are available and governments may often resort to them for political purposes. Unemployment policy from 1976–82 provides a case study for assessing the significance of agenda management in the policy process. The many initiatives and announcements of the government and their presentation in the media are described. It is concluded that the government often appeared to employ agenda management techniques such as tokenism, symbolic reassurance, postponement and the selective presentation of social indicators. It is noted that the government's handling of the issue followed an annual cycle, superimposed on which was an electoral cycle. Its attempts to influence public perceptions of the issue had direct links with the nature of policy outputs.