Peter Bartlett

Mental health law : policy and practice

1. Conceptualising mental health law 2. An overview of the contemporary mental health system 3. Community care 4. The Mental Capacity Act 5. Deprivation of liberty under the Mental Capacity Act 2005 6. Civil detention under the Mental Health Act 7. Policing mental disorder 8. Mental disorder and criminal justice 9. Medical treatment 10. Control in the community 11. Ending compulsion under the Mental Health Act 12. Legal responses and advocacy for clients

The WPA-Lancet Psychiatry Commission on the Future of Psychiatry

Background This Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness. Part 1: The patient and treatment Who will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital technology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central. Part 2: Psychiatry and health-care systems Delivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries. Part 3: Psychiatry and society Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatrys development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences. Part 4: The future of mental health law Mental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation. Part 5: Digital psychiatry—enhancing the future of mental health Digital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatments. However, it also carries the risk of commercialised, unproven treatments entering the medical marketplace with detrimental effect. Novel research methods, transparency standards, clinical evidence, and care delivery models must be created in collaboration with a wide range of stakeholders. Psychiatrists need to remain up to date and educated in the evolving digital world. Part 6: Training the psychiatrist of the future Rapid scientific advance and evolving models of health-care delivery have broad implications for future psychiatry training. The psychiatrist of the future must not only be armed with the latest medical knowledge and clinical skills but also be prepared to adapt to a changing landscape. Training programmes in an age in which knowledge of facts is less important than how new knowledge is accessed and deployed must refocus from the simple delivery of information towards acquisition of skills in lifelong learning and quality improvement. Conclusion Psychiatry faces major challenges. The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change. Psychiatrists must work with key stakeholders, including policy makers and patients, to help to plan and deliver the best services possible. The contract between psychiatry and society needs to be reviewed and renegotiated on a regular basis. Mental health law should be reformed on the basis of evidence and the rights of the individual. Psychiatry should embrace the possibilities offered by digital technology, and take an active role in ensuring research and care delivery in this area is ethically sound and evidence based. Psychiatry training must reflect these multiple pressures and demands by focusing on lifelong learning rather than simply knowledge delivery.

Mental illness, discrimination, and the law : fighting for social justice

This book describes clearly how legislation can be used to advance the rights and entitlements of people with mental health problems. Straightforward and practical, it provides useful information on how to address disabilities so these people may enjoy full citizenship. It presents the key issues succinctly and illustrates these with legislative examples from around the world. This book documents the role that law can play, at all levels, in combating such discrimination and abuse.

Mental Disability and the European Convention on Human Rights

About the Authors About the Artist Acknowledgements Foreword by Sir Nicholas Bratza Table of Cases Table of International Instruments List of Abbreviations Note on Language and Terminology Chapter One Introduction: The European Convention on Human Rights and Mental Disability Chapter Two Admission to and Discharge from Psychiatric and Related Institutions Chapter Three Inside Institutions: Institutional Standards and Institutional Controls Chapter Four Medical Treatment Chapter Five Life and Death Chapter Six Legal Capacity, Guardianship and Supported Decision-Making Chapter Seven Participation in Society Chapter Eight Procedure of the European Court of Human Rights Chapter Nine Representing People with Mental Disabilities Chapter Ten Conclusion Appendices Index.

Mental health service users' and practitioners' experiences of engagement in assertive outreach: a qualitative study.

Assertive outreach services have been central to community mental health policy within the UK. These multidisciplinary teams were established to engage with service users who have severe and enduring mental health problems and have found traditional community services unable to meet their needs. Mental health nurses have a pivotal role in these multidisciplinary teams, yet the nature of these relationships from the perspective of those who work in and receive care is poorly understood. This study set out to explore the nature and meaning of engagement for practitioners and service users within assertive outreach services. A qualitative approach, informed by philosophical hermeneutics, underpinned the study. Participants were recruited from a single assertive outreach team in the UK. To be eligible for the study, mental health practitioners needed to be employed within the assertive outreach team. All service users residing in the community and receiving care from the team were also eligible for inclusion. In total 14 interviews were conducted with mental health practitioners and 13 with service users. Data analysis was informed by Turners method. Four themes emerged from the data; contact, dialogue, transformation and shared understanding. Meaningful engagement was found to manifest itself through experiences such as providing and receiving practical assistance, having a genuine two-way conversation and valuing the experiences and personal attributes of the other person. The findings indicate that engagement is an active, dynamic and skilled process, which leads practitioners and service users to transform together to create a new relationship.

‘THE NECESSITY MUST BE CONVINCINGLY SHOWN TO EXIST’: STANDARDS FOR COMPULSORY TREATMENT FOR MENTAL DISORDER UNDER THE MENTAL HEALTH ACT 1983

Current English law has few controls on the involuntary treatment of persons detained under the Mental Health Act 1983. In 2001, R (Wilkinson) v. Broadmoor Special Hospital Authority provided some hope that, in conjunction with the Human Rights Act and the European Convention on Human Rights (ECHR), meaningful substantive and procedural standards for compulsory psychiatric treatment might be developed, but that hope has not been fulfilled. Using Wilkinson and the ECHR jurisprudence as a starting point, this article considers when, if at all, compulsory psychiatric treatment might be justified. In particular, it considers the difference between the ‘appropriateness’ standard of the English legislation and the ECHR requirement of ‘therapeutic necessity’, the requirements for appropriate procedure and appropriate legislative clarity, how the courts should deal with disagreements among treating physicians, and the relevance of the capacity and best interests of the detained person.

The asylum, the workhouse, and the voice of the insane poor in 19th-century England.

The history of psychiatry is not merely the history of psychiatrists; it is also the history of patients. In this paper, admission records and case notes of a county asylum are used to consider the attitudes of those confined within it, and how the asylum was understood by patients relative to other options for care, most notably the workhouse.

A mental disorder of a kind or degree warranting confinement: examining justifications for psychiatric detention

It has long been the case in jurisprudence under the European Convention on Human Rights that mental disorder must be of a certain severity in order to justify detention, but there has been little meaningful debate as to what that means. The question is relevant not merely to the European Court of Human Rights, but also to the Committee for the Prevention of Torture, as the potential of inhuman or degrading treatment that arises from the coercive elements in institutions is particularly clear if persons are wrongfully detained in an institution and ought in fact to be somewhere else. Considerable improvement in the substantive clarity of domestic law is therefore required. The specifics of the domestic standards are a matter for individual governments but, within the Council of Europe, they will need to meet the requirements of both the European Convention on Human Rights and the United Nations Convention on the Rights of Persons with Disabilities. The article considers the traditional justifications for civil detention in psychiatry – dangerousness, need for treatment and capacity – in the light of these two conventions.

Mental health law in the community: thinking about Africa

The new United Nations Convention on the Rights of Persons with Disabilities creates a new paradigm for mental health law, moving from a focus on institutional care to a focus on community-based services and treatment. This article considers implementation of this approach in Africa.

Adults, mental illness and incapacity: convergence and overlap in legal regulation

While not entirely congruent, there will be substantial overlap between the classes of individuals governed by the proposed Mental Incapacity and Mental Health Acts, and by the courts inherent jurisdiction. This paper argues that the mental health proposals are procedurally strong but substantively weak, while the incapacity reforms are, largely, the reverse. For individuals who may be subject to either legal régime, therefore, the safeguards of one statute may be avoided by resort to the other. Lying across both reforms is the courts inherent jurisdiction. It remains to be seen whether or how the scope of this jurisdiction will be developed in the event that the legislative reforms are passed.