反思精神障碍强制医疗的“危险性”原则

很多国家精神卫生立法在强制医疗人院标准方面都适用了“危险性”原则,我国《精神卫生法》也在其列。然而,“危险性”原则是基于三个错误的假设,因此实际上“危险性”原则可能会增加精神疾病对患者的伤害和较大程度增加社区危险的风险。本文呼吁参考Large及Richardson的观点及美国部分州与苏格兰精神卫生立法的实证经验,在“危险性”原则基础上补充“拒绝治疗的能力”评定作为精神障碍者强制医疗入院标准。     

论基本医疗卫生法的立法定位及其主要内容

基本医疗就是要让国民小病看得起、医保广覆盖、医疗服务质量有保障的满足患者基本医疗需求的医疗模式。基本医疗卫生法就是围绕这一核心予以规制和保障的法律。基本医疗卫生法是公民健康保障的基本法律,是跨领域跨专业的综合性法律,是各具体职能部门共同保障基本医疗服务的法律。基本医疗卫生法的立法基本原则是理论与实践相结合的原则、平衡各方利益的原则、厘清争议问题的原则。基本医疗卫生法立法的核心内容包括：基本医疗卫生法的基本原则、政府的基本医疗保障责任、医疗保险付费为主的多渠道医疗费用筹措机制、基层医疗机构担负国民健康守门员的职责、弱势群体医疗救助制度等。     

各利益相关者在医院与社区双向转诊合作中的责任与机制简

针对目前双向转诊中信息不能共享、药品获得和费用报销障碍、社区人力服务水平相对较差等问题,从双向转诊中各利益相关者角度分析在双向转诊实施过程中政府、医疗机构（医院与社区卫生服务机构）、患者与家属各自应当承担的责任,提出相应的措施及改进机制。     

论强制医疗启动程序决定主体

强制医疗制度是国家医疗保健制度的有机组成部分,强制医疗有广义与狭义之分。狭义的强制医疗,如实施危害行为的精神病患者、甲类传染病患者等;广义的强制医疗,包括预防接种、指定医保单位就医等。强制医疗程序启动的决定主体必须是国家赋予相应权力的机关,其他任何单位不具有这样的权力,因而无权决定强制医疗程序启动。强制医疗主体的确定取决于强制医疗对象的危害程度、广度及时间等因素。     

‘Monsters don’t bother me anymore’ forensic mental health service users’ experiences of acceptance and commitment therapy for psychosis

Acceptance and Commitment Therapy for psychosis (ACTp) is an approach that aims to change the relationship an individual with psychosis has with difficult thoughts, emotions and experiences. It promotes the use of acceptance, defusion, mindfulness and focussing on valued outcomes as opposed to struggling with psychotic experiences. This service evaluation project explored service users’ experiences and meanings of ACTp within a medium secure mental health service. Thematic analysis was used to analyse interviews with 10 male service users. Four main themes emerged from the data: ‘Recovery’, ‘Insight’, ‘Developing Skills’ and ‘Accessibility’. Overall, service users viewed their experience of ACTp positively and identified encouraging therapeutic outcomes. These findings suggest that ACTp is an approach that should be considered a therapeutic option within forensic mental health contexts. These outcomes were compared with previous research findings. Limitations of the study, clinical implications and ideas for future research have been discussed.     

Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.     

Conclusion: Mental health and legal responses to the adolescent mental health crisis: Raising the bar on best interests and promoting family connectedness in divorcing families

We are currently facing an unprecedented increase in adolescent mental health problems resulting in alarmingly high levels of depression, anxiety, and suicidality. Significant mental health problems among youth pose unique challenges to families in the process of separation and divorce, as well as to family law professionals across all disciplines. The current adolescent mental health crisis calls for new ways of approaching our work with high conflict families to promote family connectedness and shift away from adversarial approaches that may exacerbate conflict and further destabilize families. As a conclusion to the special issue on adolescent mental health needs, the authors make multidisciplinary best practices recommendations and advocate for systems level changes in recognition of the needs of youth in crisis at this pivotal developmental stage.     

Development of an Index of Subsidized Housing Availability and its Relationship to Housing Insecurity

Housing insecurity is a known threat to child health understanding predictors of housing insecurity can help inform policies to protect the health of young children in low-income households. This study sheds light on the relationship between housing insecurity and availability of housing that is affordable to low-income households.

We developed a county-level index of availability of subsidized housing needed to meet the demand of low-income households. Our results estimate that if subsidized units are made available to an additional 5% of the eligible population, the odds of overcrowding decrease by 26% and the odds of families making multiple moves decrease by 31%. Both of these are known predictors of poor child health outcomes. Thus, these results suggest that state and federal investments in expanding the stock of subsidized housing could reduce housing insecurity and thereby also improve the health and well-being of young children, including their families' food security status.     

Realising the Right to Health for Young People in South Africa—Some Reflections

Abstract

The right to health is enshrined in the South African Constitution as well as a range of international and regional human rights treaties which South Africa accepts. Yet empirical data reveals some of the challenges faced by South African youth—childhood diseases, HIV/AIDS and such like. There are evidently challenges realising the right to health in practice. Nevertheless, South African courts have led the international field in recognising the justiciability of economic and social rights such as the right to health. Having reviewed the applicable laws and jurisprudence, the paper will conclude that a more holistic human rights-based approach offers perhaps the best way forward.