Formal justifications for compulsory psychiatric detention.

The formal justifications for all detentions under s.2 of the Mental Health Act 1983 within an inner-city mental health trust were examined over a 12-month period. The study explored: the nature of the justifications for detention; the extent to which these were associated with patient characteristics; and the extent to which the two medical practitioners involved in each case agreed on the justifications. The justifications reflected a greater emphasis on the protection of the individual concerned rather than the protection of others. A content analysis of the textual justifications revealed five broad themes: the nature of the risk posed by the patient; the patient's capacity to provide informed consent; their need for hospitalization; their lack of consent to informal admission; and their reliability or likely compliance. There was a significant association between patients' sex, ethnic group, diagnosis and the nature of risk indicated in the documentation, but further research is needed to clarify the nature of this association. The study found that in nearly a quarter of cases, the two professionals did not agree about whether or not the patient presented a danger to others. This lack of agreement was not associated with any patient or professional characteristics, and may reflect the complexity of this area of risk assessment. The authors suggest that the issue of 'risk' needs to be addressed in a more sophisticated manner within the Mental Health Act. Specifically, further guidance is needed as to the nature and levels of risk that constitute grounds for detention. Further guidance is also needed regarding the issues that need to be recorded on the legal documentation for detention.

Revamping the peer review process.

The time has come for peers to establish criteria to evaluate each other. No longer can this vital activity be left to the students alone. This is not to say that student evaluation has no place but rather to identify the need for peer review based on mutually determined and acceptable criteria. With the change to an integrated curriculum, in which there is emphasis on team work in both planning and execution of the program, the need for a tool to document areas previously considered to be too subjective becomes obvious. Faculty must be able to collaborate, cooperate, communicate, and be mutually supportive to each other in order to affect a successful operation of the program. Some faculty feel that these behaviors are an inherent part of being responsible, accountable and professional, and therefore do not need to be measured. Yet these are the same behaviors that we stress repeatedly and measure with students. We believe that our tool provides nurse educators with a method of peer evaluation that is both equitable and easy to use. We believe that it will also help the faculty member determine his or her goals based on an evaluation process that is broader as a result of input from three levels: students, peers, and self. Lastly, we believe that this tool meets the needs of the Peer Review Committee by providing valid input from peers to round out the evaluation procedure.(ABSTRACT TRUNCATED AT 250 WORDS)