Helen C. Garner

Changes to leave of absence in Scotland: the views of patients

Sixty-four patients were interviewed about changes to leave of absence brought about by the Mental Health (Patients in the Community) Act 1995 in the context of their views about services and medication. Few patients were clear about the change in the law,which suggests that more has to be done to inform patients of their rights and legal status. A number of patients reported difficulty in negotiating preferred medication with their psychiatrists and felt compelled to take medication that resulted in debilitating side-effects. A third of patients eligible to be interviewed agreed to an interview and ethical and practical difficulties in accessing patients for this type of research are discussed.

Issues in the development of advance directives in mental health care

Background: Interest in advance directives in mental health care is growing internationally. There is no clear universal agreement as to what such an advance directive is or how it should function. Aim: To describe the range of issues embodied in the development of advance directives in mental health care. Method: The literature on advance directives is examined to highlight the pros and cons of different versions of advance directive. Results: Themes emerged around issues of terminology, competency and consent, the legal status of advance directives independent or collaborative directives and their content. Opinions vary between a unilateral legally enforceable instrument to a care plan agreed between patient and clinician. Conclusion: There is immediate appeal in a liberal democracy that values individual freedom and autonomy in giving weight to advance directives in mental health care. They do not, however, solve all the problems of enforced treatment and early access to treatment. They also raise new issues and highlight persistent problems. Declaration of interest: The research was funded by the Nuffield Foundation grant number MNH/00015G.

The development of potential models of advance directives in mental health care

Background: The review of mental health law in the UK has involved consideration of mechanisms for advance directives in mental health care. Aims: To develop potential models of advance directives based on the views of stakeholders in mental health services in Scotland. Methods: Focus groups and individual interviews were conducted with service users, professionals and carers who had an interest in advance directives. Leaflets and policy documents from campaign groups and voluntary organisations were collected and along with data generated in interview and group discussion were analysed for themes. Results: Six potential models were developed that highlighted the overarching themes of co-operation versus autonomy and the legal status of any directive. Conclusions: There is a wide variety of opinion about what advance directives could or should bring to mental health care, they are not all achievable through the use of any one model. Declaration of Interest: The research was funded by the Nuffield Foundation grant number MNH/00015/G.

Views of consultant psychiatrists and mental health officers in Scotland on the Mental Health (Patients in the Community) Act 1995

In 1995 new legislation was introduced in Scotland limiting Leave of Absence to 12 months and introducing Community Care Orders (CCOs). Consultant psychiatrists and mental health officers in Scotland were surveyed by postal questionnaire to ascertain their views on the impact of this new legislation. The reduced powers for psychiatrists to ensure compliance with medication in the community and the introduction of a new form of supervision of patients (CCOs) that does not include compulsory treatment orders are unpopular with both groups of professionals but significantly more unpopular with consultants than mental health officers. This is examined in relation to a previous survey of professional attitudes. The place of the Care Programme Approach and the possible shortage of community care resources in relation to this group of patients are also discussed. The results are further discussed in the context of current reviews of mental health legislation.