Policing mental illness: Police use of section 136 - Perspectives from police and mental-health nurses.

Ideological shifts in mental health-care policy such as deinstitutionalisation have meant police have had to make decisions about the care of persons with a mental-health crisis. This study examines how police in five English counties respond to crisis calls when employing the powers afforded in section 136 of the Mental Health Act 1983, and the effectiveness of the national Street Triage pilot scheme. Qualitative interviews with 30 police officers and mental-health nurses were collected as data sources. The analysis shows that police have previously struggled with the significant number of crisis calls, whilst also finding mental-health services inadequately sourced, leading to some detentions in police cells as alternatives to health-based places of safety. However, the scheme has made positive changes in alleviating these issues when mental-health nurses are co-located with police, highlighting the need to strengthen their partnership by facilitating the sharing of information, responsibilities and decision making in order to ensure police cells continue to be avoided as alternative places of safety.

Rapid return of children in residential care to family as a result of COVID-19: Scope, challenges, and recommendations.

BACKGROUND: As a result of the COVID-19 pandemic, some governments have mandated that residential care providers rapidly return children and youth to family. OBJECTIVE: The goal of the present study was to better understand the scope and characteristics of rapid return, and to provide data-informed recommendations for service providers working with this population. PARTICIPANTS AND SETTING: Representatives from 67 non-government organizations (NGOs) providing residential care that were government-mandated to rapidly return children and youth to family completed a brief online survey. They collectively serve 12,494 children in 14 nations. METHODS: Using a mixed methods design, results examined 1) characteristics of the rapid return mandate, 2) preparation received by children and families, 3) support services provided since the return, and 4) primary concerns for children and families. RESULTS: Data revealed that rapid return was characterized by compressed timelines that did not allow for adequate child and family assessment and preparation. However, all respondents indicated they believed at least some families would be able to remain intact safely with appropriate support. Primary concerns for children and families related to unresolved antecedents to separation, lack of economic capacity, limited monitoring, and lack of access to education. CONCLUSIONS: Based on the findings, 9 recommendations were made for service providers working with children and families that have been rapidly reunified as a result of the COVID-19 pandemic.

Optimization strategies for the organization of mental healthcare.

AIM: The aim of this paper is to analyse the main issues and obstacles to optimizing the organization of mental healthcare and the strategies that should be applied by presenting the examples from practice. RESULTS: Outcomes of mental healthcare are in relation with 'improved legislation' and the introduction of up-to-date management and economic concepts including continuous treatment model, in addition to the advantages and disadvantages in the provision of mental healthcare within primary and secondary inpatient and outpatient healthcare. Some of these lessons are learned from reforms implemented in Serbia.

[The implementation of the law 4509/2017 in the Forensic Department of the Psychiatric Hospital of Thessaloniki].

According to the Explanatory Memorandum of the law 4509/2017, a significant change is being made to the current institutional framework of Articles 69 and 70 of the ECHR concerning the penal treatment of mentally ill offenders, in order to ensure a high level of treatment for perpetrators with mental or intellectual disorder. In application of the law, it was examined in court the abolishment, maintenance or replacement of the treatment measure of 47 patients from the Department of Forensic Psychiatry in Thessaloniki. The results were compared with the previous status quo. In 22 cases, abolishment was ordered for the patients to be discharged and return to their parent's home or to Psychosocial Rehabilitation Units. In 11 of them, their stay was in direct violation of the law due to exceeding the cap as defined by the severity of the offense. However, 7 patients remain voluntarily in the Department, as no beds are available in reintegration structures. 13 patients who have committed homicide remain with the psychiatrist's agreement beyond the overrunning the ten years of treatment due to the severity of the disease or the risk for violent behavior. The Public Prosecutor has provided solutions in many cases and has appointed lawyers for all patients as prescribed by law. However, the judiciary remains cautious and the trend towards exhaustion of the limits is clear, despite the fact that their fears are not confirmed by international bibliographic data. The application of N 4509/2017 attempts to change the landscape for this particular group of patients and allows visions for de-institutionalization, elimination of the stigma and personalized treatment, despite any ambiguities or potential problems that may arise. However, as the predominant social viewpoint, shown by the media, treats the mentally ill as dangerous, any positive changes are doomed to fail. In addition, it is necessary to develop psychiatric services for the treatment of patients which will not only treat psychotic symptoms but also antisocial and aggressive behavior in general.

Risk factors for recidivism in individuals receiving community sentences: a systematic review and meta-analysis.

OBJECTIVE: We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences. METHODS: We searched seven bibliographic databases and additionally conducted targeted searches for studies that investigated risk factors for any repeat offending in individuals who had received community (non-custodial) sentences. We included investigations that reported data on at least one risk factor and allowed calculations of odds ratios (ORs). If a similar risk factor was reported in three or more primary studies, they were grouped into domains, and pooled ORs were calculated. RESULTS: We identified 15 studies from 5 countries, which reported data on 14 independent samples and 246,608 individuals. We found that several dynamic (modifiable) risk factors were associated with criminal recidivism in community-sentenced populations, including mental health needs (OR = 1.4, 95% confidence interval (CI): 1.2-1.6), substance misuse (OR = 2.3, 95% CI: 1.1-4.9), association with antisocial peers (OR = 2.2, 95% CI: 1.3-3.7), employment problems (OR = 1.8, 95% CI: 1.3-2.5), marital status (OR = 1.6, 95%: 1.4-1.8), and low income (OR = 2.0, 95% CI: 1.1-3.4). The strength of these associations was comparable to that of static (non-modifiable) risk factors, such as age, gender, and criminal history. CONCLUSION: Assessing dynamic (modifiable) risk factors should be considered in all individuals given community sentences. The further integration of mental health, substance misuse, and criminal justice services may reduce reoffending risk in community-sentenced populations.

Deinstitutionalization and other factors in the criminalization of persons with serious mental illness and how it is being addressed.

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals' mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

Perception of family members regarding the support group conducted in a psychiatric intervention ward. / Percepção dos familiares acerca do grupo de apoio realizado em uma unidade de internação psiquiátrica.

OBJECTIVE: To analyze the perception of relatives of patients with mental disorders about the support group in a psychiatric hospitalization ward. METHOD: This is a research with a qualitative, exploratory an descriptive approach, performed at a General Hospital in Rio Grande do Sul with ten relatives of patients who had been participating in a weekly support group. Data collection took place in October 2016, through semi-structured interviews. A thematic content analysis was used for the treatment of data, whence emerged the category: Perception of family members about the support group. RESULTS: The relatives perceive the group as a space that gives them strength and support, allowing for listening and experience exchange among its members, giving information on the disease and treatment, safety, and inserting the family in the treatment. FINAL CONSIDERATIONS: The support group can be understood as a strategic action of caring for the family, affecting their lives and the treatment of those who are hospitalized.

Drafting a dual diagnosis program: a tailored intervention for patients with complex clinical needs

Background: Clinical practice of mental health services changed in 1978 after the Basaglia Law was passed, and it is now characterized by usually voluntary treatments offered by community-based services. That broadened the interventions' focus from the single subject to their environment. Dual diagnosis is defined by WHO as «the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder¼. It is considered to be a "border territory" since entails networking between different medical services. Materials and methods: A literature search was performed in PubMed, Web of Science, Scopus and Google Scholar. Search terms were: "guidelines", "treatment", "comorbidity", "substance abuse", "alcohol", "dual-diagnosis", "psychiatric illness", "outpatient", "inpatient", "health care service", "clinical practice". National and regional regulations about health and addiction were screened too. Out of 598 titles, 31 studies were included in this article for their relevance on treatments and networking between services for dual diagnosis cases. Results: There are not any guidelines for clinical practice in the literature, neither there are any shared treatment strategies on a national level. Considering the autonomy that every regional health service has, several different courses of action are possible. Here there are reported the ones available. Conclusions: After discussing the weak points of the treatment options, we suggest the "Multidisciplinary Healthcare" model to best address the difficulties represented by dual diagnosis cases.

The Life Esidimeni tragedy: Moral pathology and an ethical crisis.

The Life Esidimeni tragedy highlights several ethical transgressions. Health professionals' ethics are put to the test when their own interests are balanced against competing claims. Core values of compassion, competence and autonomy, together with respect for fundamental human rights, serve as the foundation of ethical practice in healthcare. These values are increasingly being challenged by governments and other third parties. The duties conferred on healthcare practitioners require them to act responsibly and be accountable for their actions. Codes in healthcare serve as a source of moral authority. The Gauteng health authorities exerted tremendous power and created a culture of fear and disempowerment among healthcare practitioners. When health professionals choose to support state interests instead of those of patients, problematic dual-loyalty conflicts arise.

The Patient-to-Prisoner Pipeline: The IMD Exclusion's Adverse Impact on Mass Incarceration in United States.

A component of the 1965 Medicaid Act, the Institutions for Mental Diseases ("IMD") Exclusion was supposed to be a remedy for the brutal, dysfunctional mental healthcare system run through state hospitals. In the years since Medicaid was created, the IMD Exclusion has instead barred thousands of those in need of intensive, inpatient treatment from receiving it. As a result, many severely mentally ill individuals are left without adequate care and without a home. They struggle in the street where they are otherized by those in their community and are susceptible to confrontational episodes with law enforcement. Many are ultimately incarcerated, where they are thrust into an abusive environment known to exacerbate mental health issues. This Note's central contention is that the IMD Exclusion creates an access gap for the poorest Americans who suffer from mental illness. Subsequently, prisons and jails fill that gap to the detriment of those individuals. The Note will proceed first by explaining the IMD Exclusion and how it applies to state-run medical care services and facilities. This Note will discuss the nationwide movement, in the 1950s through the 1960s and '70s, to deinstitutionalize notoriously abusive state psychiatric hospitals, a movement that culminated in the passage of the Medicaid Act in 1965, along with the IMD Exclusion. This Note will then shift focus to criticize the practical effects of the IMD Exclusion and its extensive role in the mass incarceration issue today. In doing so, this Note will identify the major weaknesses of the IMD Exclusion and explain how these weaknesses create an access gap for mentally ill persons, while simultaneously making them more vulnerable to contact with the police and the criminal justice system.

Management of psychiatric patients before deinstitutionalization: an inquiry into the years 1907-1913 in Pisa

Aim: Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure's activities considering all admissions from 24th April 1907 to 31st January 1913. Methods: We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student's t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Results: Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a "sieve-institution" to prevent asylum overcrowding from treatable, non-chronic conditions. Discussion: These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

40th birthday of the Italian Mental Health Law 180 - perception and reputation abroad, and a personal suggestion.

How things are perceived from a distance may help better understand their nature. Perceptions at home are likely to shape perceptions abroad. The mutual cross-references between local and distant perspectives on the Italian Mental Health Law 180 may help understand the process which preceded and resulted in the reform. This editorial argues that Law 180 came about at a unique - enabling - time in history. It argues that the run-up to and passing of Law 180 constituted a great accomplishment by professionals, the wider public and politicians/administrators. This editorial goes on to argue that the profession managed to cope with (many) adverse effects of the reform. The attention that Law 180 has received internationally should be devoted to other national (or regional) mental health reform processes as this may help us to understand how mental health care systems evolve and what defines 'windows of (operative) opportunity' or 'moments for (public) action'.

Percepção dos familiares acerca do grupo de apoio realizado em uma unidade de internação psiquiátrica / Percepción de los familiares acerca del grupo de apoyo realizado en una unidad de internación psiquiátrica / Perception of family members regarding the support group conducted in a psychiatric intervention ward

Resumo OBJETIVO Objetiva analisar a percepção de familiares de pacientes com sofrimento psíquico acerca do grupo de apoio em uma internação psiquiátrica. MÉTODO Pesquisa com abordagem qualitativa, exploratória, descritiva, realizada em hospital geral do Rio Grande do Sul com dez familiares que participavam de grupo de apoio semanal. A coleta de dados ocorreu no mês de outubro de 2016 através de entrevistas semiestruturadas. Empregou-se a análise de conteúdo temática para tratamento dos dados, na qual emergiu a categoria: Percepção dos familiares sobre o grupo de apoio. RESULTADOS Os familiares percebiam o grupo como um espaço de apoio e fortalecimento, de escuta e trocas entre os integrantes, de informação sobre a doença e tratamento e de segurança e inserção da família no tratamento. CONSIDERAÇÕES FINAIS Portanto, o grupo de apoio pode ser entendido como uma ação estratégica de cuidado ao familiar, repercutindo na sua vida e no tratamento de quem está internado.

Resumen OBJETIVO Analizar la percepción de familiares de pacientes con trastorno mental acerca del grupo de apoyo en una internación psiquiátrica. MÉTODO Investigación con abordaje cualitativo, exploratorio y descriptivo, realizada en el hospital General de Rio Grande do Sul, con diez familiares que participaban en un grupo de apoyo semanal. La recolección de datos ocurrió en el mes de octubre de 2016 por medio de entrevistas semiestructuradas. Se empleó al análisis temático de contenido para tratar a los datos, y emergió la categoría: Percepción de los familiares sobre el grupo de apoyo. RESULTADOS Los familiares perciben al grupo como un espacio de apoyo y fortalecimiento, de escucha e intercambios entre los integrantes, de información sobre la enfermedad y tratamiento, y de seguridad e inserción de la familia en el tratamiento. CONSIDERACIONES Finales El grupo de apoyo puede ser entendido como una acción estratégica de cuidado al familiar, repercutiendo en su vida y en el tratamiento de quien está internado.

Abstract OBJECTIVE To analyze the perception of relatives of patients with mental disorders about the support group in a psychiatric hospitalization ward. METHOD This is a research with a qualitative, exploratory an descriptive approach, performed at a General Hospital in Rio Grande do Sul with ten relatives of patients who had been participating in a weekly support group. Data collection took place in October 2016, through semi-structured interviews. A thematic content analysis was used for the treatment of data, whence emerged the category: Perception of family members about the support group. RESULTS The relatives perceive the group as a space that gives them strength and support, allowing for listening and experience exchange among its members, giving information on the disease and treatment, safety, and inserting the family in the treatment. FINAL CONSIDERATIONS The support group can be understood as a strategic action of caring for the family, affecting their lives and the treatment of those who are hospitalized.

An analysis of the federal funding for mental health care in Brazil.

This article analyzes spending on mental health by the Brazilian Ministry of Health between 2001 and 2014. It is documental research of the Brazilian Ministry of Health's databases. It analyzes the data using descriptive statistical analysis. Total spending on mental health for the period 2001 to 2014 shows a percentage increase in resources destined for outpatient care, but this increase is a reallocation from hospital services to community-based services and total resources for the mental health program remain at an average of 2.54% of the total health budget. Within outpatient expenditure, spending on medications remains high. Professionals committed to psychiatric reform fight to guarantee that a small fraction of the surplus appropriated by the state is directed towards social policies.

Right to mental health in prison system: reflections on the process of deinstitutionalization of the HCTP. / Direito à saúde mental no sistema prisional: reflexões sobre o processo de desinstitucionalização dos HCTP.

This study aimed to discuss the close relationship between mental health, the criminal justice system and the prison system, whose specific interfaces are the HCTP (Hospital de Custódia e Tratamento Psiquiátrico, or Judicial Psychiatric Hospital) conflict and the person with mental disorder in conflict with the law. There will be presented extensive discussions on the Penal Execution Law and the Brazilian Psychiatric Reform Law, as well as cross-sector actions taken by the judiciary and the federal government (Brazilian National Health System - SUS and National Social Assistance System - SUAS) to bring the criminal justice system and the prison system to the anti-asylum combat. Two successful experiences in the states of Minas Gerais and Goiás will also be presented for they reflect the emergence of a new strategy on public health policy: The Evaluation Service and Monitoring Therapeutic Measures for the Person with Mental Disorder in Conflict with the Law, device connector between systems, willing to operate in the process of deinstitutionalization of people with mental disorders of HCPT.

Direito à saúde mental no sistema prisional: reflexões sobre o processo de desinstitucionalização dos HCTP / Right to mental health in prison system: reflections on the process of deinstitutionalization of the HCTP

Resumo O presente estudo tem por objetivo discutir a estreita relação entre a saúde mental, o sistema de justiça criminal e o sistema prisional, cujas interfaces concretas são o hospital de custódia e tratamento psiquiátrico (HCTP) e a pessoa com transtorno mental em conflito com a lei. Serão apresentadas amplas discussões sobre a Lei de Execução Penal e a Lei da Reforma Psiquiátrica brasileira, bem como das ações intersetoriais adotadas pelo Judiciário e pelo Governo Federal (Sistema Único de Saúde - SUS e Sistema Único de Assistência Social - SUAS) para adequar o sistema de justiça criminal e o sistema prisional à luta antimanicomial. Serão também apresentadas duas experiências exitosas nos estados de Minas Gerais e de Goiás, que lastraram o surgimento de uma nova estratégia na política pública de saúde: o Serviço de Avaliação e Acompanhamento de Medidas Terapêuticas Aplicáveis à Pessoa com Transtorno Mental em Conflito com a Lei, dispositivo conector entre os Sistemas, disposto a atuar no processo de desinstitucionalização das pessoas com transtornos mentais dos HCTP.

Abstract This study aimed to discuss the close relationship between mental health, the criminal justice system and the prison system, whose specific interfaces are the HCTP (Hospital de Custódia e Tratamento Psiquiátrico, or Judicial Psychiatric Hospital) conflict and the person with mental disorder in conflict with the law. There will be presented extensive discussions on the Penal Execution Law and the Brazilian Psychiatric Reform Law, as well as cross-sector actions taken by the judiciary and the federal government (Brazilian National Health System - SUS and National Social Assistance System - SUAS) to bring the criminal justice system and the prison system to the anti-asylum combat. Two successful experiences in the states of Minas Gerais and Goiás will also be presented for they reflect the emergence of a new strategy on public health policy: The Evaluation Service and Monitoring Therapeutic Measures for the Person with Mental Disorder in Conflict with the Law, device connector between systems, willing to operate in the process of deinstitutionalization of people with mental disorders of HCPT.

The changing purpose of mental health law: From medicalism to legalism to new legalism.

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.