Mental Health Review Tribunals: A comparison of the content of tribunal reports for discharged and not discharged patients and for the effect of legal classification

Abstract

This study examined the content of reports provided for Mental Health Review Tribunals. A retrospective design was used to compare the tribunal reports of fifty patients. Two groups of twenty five patients were compared, one including patients discharged by tribunals and the other patients not discharged. Social combination theory and valence theory were used to analyse the content of the reports and to assess whether they were associated with tribunal outcome. Opinion statements discussing suitability for discharge were more closely associated with outcome than fact statements. For the statements presenting subjects positively or negatively, fact statements were more closely associated with outcome. The valence of both types of statements was also found to be related to outcome, with more positive values being achieved for discharged subjects. Comparison of reports written for previous tribunals before any of the subjects in the study were discharged indicated that those subjects who went on to be discharged at their next tribunal had the least negative valences. In addition to this, the effect of legal classification on outcome was explored, and indicated a difference in the valence of reports for discharged and not discharged patients, depending on classification of mental illness or psychopathic disorder.     

Coping with the Cuts? The Management of the Worst Financial Settlement in Living Memory

The scale of the cuts to local government finance, coupled with increasing demand for services, has led to unprecedented ‘budget gaps’ in council budgets. Arguably, two competing narratives of the trajectory of local government have emerged in which contrasting futures are imagined for the sector – a positive story of adaptation and survival and more negative one of residualisation and marginalisation. Drawing on case study evidence from three English local authorities, the paper distinguishes and provides examples of three strategic approaches to managing austerity – efficiency, retrenchment and investment. It demonstrates how and why the balance of these strategies has shifted between the early and later phases of austerity and considers the extent to which the evidence of the case studies provide support for either the survival or marginalisation narrative. The paper concludes by arguing that a third narrative – responsibilisation – captures more fully the trajectory of local government in England.     

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.     

精神障碍患者非自愿收治程序设计的若干法律问题研究(上)刘瑞爽

对于精神障碍患者的非自愿收治,应注意保障患者的人身权利,尤其是合理程序保障的权利。比较分析国际上的各国立法,在收治程序各个环节上,均须体现出对人权的保护,其主要问题有：制定强制收治的标准、送治主体、收治主体、初步裁定的步骤和时限、对初步裁定的救济、法律代表人制度、司法审查的介入（或独立第三方的介入）、危险的证明、避免无限期拘留而进行的后续定期审查、患者方获取信息的权利保障、上诉等。我国应坚持程序正义原则,借鉴国际上先进立法经验,弥补我国精神障碍患者非自愿收治程序设计的立法漏洞。     

病危/重病人的医疗安全管理及卫生监督机制探讨

医患矛盾逐步激化,医患关系趋于紧张,缓解医患关系是摆在医疗管理者面前刻不容缓的任务。研究发现,重点环节重点管理可以降低医疗安全风险。本文从病危/重病人重点管理的角度来探讨促进医疗安全管理的有效方法,并以期推广至所有病人,同时也进一步讨论了在病危/重病人重点管理中要注意的问题。     

Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

城市青少年弱势群体问题探析

文章对当前城市青少年弱势群体的定义进行描述,试图分析该群体成为弱势群体的原因,指出其中存在的问题及影响,并针对城市青少年弱势群体所存在的若干问题提出相应的对策。     

高等农业院校贫困生资助育人体系实践研究

随着我国高等教育体制改革的深入开展,高校贫困生问题日益突出。经不完全统计分析,目前我国高等农林、师范类学校中,贫困生的比例高达30%。在当前形势下,探索建立高效合理的资助育人体系,切实解决学生困难,是我国高等农业院校教育亟待解决的难题。现以山东农业大学为例,在广泛调查的基础上分析了解学生情况,在建立健全评价体系的基础上探讨解决方法,切实改善高校贫困生的学习生活和心理状况。     

齐格蒙特·鲍曼“新穷人暠思想初探--基于《工作、消费、新穷人》的文本分析

齐格蒙特·鲍曼在《工作、消费、新穷人》一书中认为随着西方资本主义国家进入消费社会,穷人的涵义发生了变化。在消费社会里,穷人不是指物质产品匮乏的绝对穷人,而是指“有缺陷的消费者暠。鲍曼分析了新穷人产生的原因,主要有观念层面上消费美学的兴盛、政策层面上福利国家的衰落、生产层面上全球化的发展。他认为新穷人对社会而言成为无用的人,他们已难以像过去那样团结起来把自身的苦难变为公共关怀。“新穷人暠思想对当代中国社会穷人问题具有理论和现实两个维度的参考价值。     

论患者权利类型

患者权利类型的确定是构建患者权利保护体系的理论基础，应分为两大类：患者作为“人”在医疗领域所享有的个体权利和作为“公共卫生体系使用人”的集体权利。前者是患者在接受医疗服务过程中基本人权的实现，包括人格尊严权、不受歧视的权利、私生活和秘密被尊重的权利、生命健康权、获得有质量的医疗服务的权利等。后者则包括患者群体通过自己的社团——患者组织——在卫生法规决策过程中的介入权、在卫生机构中的代表权、在卫生监督部门中的参与权等等，与国家公权力机关共同实现卫生领域的民主，以构建和谐的医患关系及促进医疗水平提高。在现有立法、司法及理论对患者个人权利已逐步承认并加强保障的情况下，认识患者集体权利的实现具有更强的理论意义及实践价值。