Jacqueline M. Atkinson

Orthognathic surgery: patient expectations; psychological profile and satisfaction with outcome

61 orthognathic surgery patients were studied (39% male, 61% female). It confirms that the group of patients we see in the West of Scotland are well adjusted psychologically and that the majority seek orthognathic surgery for aesthetic reasons. The degree of satisfaction is high (87%). Dissatisfaction is not related to sex, age or procedure. Patients who were dissatisfied tend to have higher neuroticism scores on the Eysenck Personality Inventory and those patients who had had unreal expectations of post surgical pain, numbness and swelling, were likely to express dissatisfaction with the outcome in the early stages. Several patients initially expressed some dissatisfaction with the outcome after 3 months then went on to increase their score and by 12 months became satisfied with the procedure. The authors outline the importance of adequate patient preparation prior to surgery and the use of printed literature is recommended.

Models of advance directives in mental health care: Stakeholder views

The aim of this study was to examine perceptions of the place of advance directives in mental health care. Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions between patient ‘autonomy’ and ‘right to treatment’ which underpin many of the concerns raised. Autonomy provided by advance directive can be contrasted with a co–operative partnership approach to advance planning. The legal status of advance directives is important for some people in relation to treatment refusal. There was general concern about the practical issues surrounding their implementation. There is a wide range of views in all stakeholder groups about the possible form advance directives should take. Although there is a widespread desire to increase patient involvement in treatment decisions, which advance directives could possibly help to realise, they may also have unwanted consequences for mental health services and individuals.

Prevalence and experience of harassment of people with mental health problems living in the community

BACKGROUND The levels and experiences of harassment of people with mental health problems in the community compared with those of the general population have not been explored. AIMS To measure the levels and experience of harassment experienced by people with mental health problems in the community in Scotland and compare them with the general population. METHOD Experiences of harassment were collected by interviewing 165 individuals with mental health problems and a control group of 165 people from the general population. RESULTS Harassment in the community was found to be twice as common for individuals with mental health problems (41%) than for those in the general population (15%). The harassment commonly involved verbal abuse referring to the individuals mental health problems and was committed primarily by teenagers and neighbours. CONCLUSIONS Harassment has a significantly higher prevalence among individuals with mental health problems living in the community and is believed to have a detrimental effect on mental health.

Does writing a list help cancer patients ask relevant questions

We examined the use of written lists to give patients an opportunity to have their questions answered. Patients undergoing radical radiotherapy for cancer were given a sheet of paper with the simple prompt to write questions and give to the hospital doctor at their appointment 3 weeks later. At 3 months, patients were asked about their use and opinions of the written list. About half of the 478 patients attended with a written list. Fewer patients living in deprived areas used the list compared to more affluent areas. Doctors thought that 34% of patients would not otherwise have asked those questions and 91% of prompted discussions were a worthwhile use of time.

Predictors of neurotic symptom severity among female drug users in Glasgow, Scotland

Aims: The prevalence and predictors of neurotic symptom severity among 266 female drug users recruited from three services in Glasgow, Scotland, is described. Methods: The Revised Clinical Interview Schedule (CIS-R) measured current neurotic symptoms. Questions on abuse and eating disorders were adapted from the Female European Addiction Severity Index. Findings: In their lifetime, 71% (184/260) had been emotionally abused, 65% (168/260) physically abused and 50% (129/259) sexually abused. In addition, 85% (227/266) met threshold for a neurotic disorder (CIS-R ≥ 12) and 71% (188/266) reported a severity of current neurotic symptoms likely to need treatment (CIS-R ≥ 18). Stepwise multiple logistic regression found that ever suffering from bulimia, anorexia and/or binge eating (OR 4.10, 95% CI 1.76–9.58), adult emotional abuse (OR 2.98, 95% CI 1.57–5.65), being prescribed psychiatric medication in the last 30 days (OR 2.95, 95% CI 1.18–7.38), and 12-month dependence on illicit tranquillizers (OR 2.51, 95% CI 1.29–4.89) were associated with CIS-R ≥ 18. Results were compared for participants attending each of the three services. Conclusions: The findings demonstrate the multiple and complex needs of female drug users that may require medical, mental health and drug use treatment.

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.

Retrospective evaluation of extended leave of absence in Scotland 1988-94

Abstract Extended leave of absence (ELOA) is defined as leave of absence over 6 months and could be unlimited in Scotland until 1996. Patients have previously been detained under s.18 of the Mental Health (Scotland) Act 1984. A retrospective evaluation of use of ELOA was carried out using data held by the Mental Welfare Commission for Scotland. Records were used to describe reasons for using ELOA, support and service use. Over the period 1988–94 there were 534 people who had at least one episode of ELOA over 6 months and, of these, 250 had at least one episode of ELOA over 12 months. A diagnosis of schizophrenia occurs in 73% of patients. Lack of insight and threat of stopping medication are the most common reasons for using ELOA. Although threat to others is recorded more often than threat to self, self-neglect is recorded more often than either. The outcome of ELOA by year results in 30% of patients being discharged and 23% recalled to hospital. Of the total, 75% receive good support from at least one r...

Citizenship and adult protection in the UK: an exploration of the conceptual links

Purpose – This article seeks to consider the links between emerging concepts of citizenship in the twenty‐first century and the legitimization of this agenda by providing an overview of UK policy as it relates to adult protection as well as consideration of concepts of citizenship and the links between the two areas.Design/methodology/approach – The paper provides an overview of adult protection in the UK and then takes the reader through concepts of vulnerability and citizenship and considers the implications of these concepts on the citizenship of those most likely to be subject to adult protection procedures in the UK.Findings – This article shows how models of citizenship have altered over time to reflect societal norms and customs and in particular how this paradigm shift has legitimized intervention in the lives of adults. It further highlights the likely impact of adult protection procedures on the citizenship rights of those most likely to experience them.Originality/value – The paper brings toget...