Mental disabilities is herein taken to include people with mental health problems (now sometimes ... more Mental disabilities is herein taken to include people with mental health problems (now sometimes called psychosocial disabilities) and learning disabilities. 6 See, eg., United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, General Assembly Resolution 46/119 (1991); European Convention for the Protection of Human Rights and Fundamental Freedoms, Art. 5(1)(e) and related jurisprudence; Council of Europe 7 This argument is made most frequently regarding previous UN instruments, most notably the Mental Illness
Journal of Forensic Psychiatry & Psychology, May 27, 2020
Forensic psychiatric care settings are intended to be more therapeutic than penal settings. They ... more Forensic psychiatric care settings are intended to be more therapeutic than penal settings. They attempt to be more homely, recovery-oriented, person-centered, and less overtly punitive. However, forensic inpatient settings are still highly secure, risk averse, and diminutive of patient autonomy. Accordingly, a body of research is investigating how patients experience their care and how these experiences are associated with treatment outcomes. The self-report Forensic Restrictiveness Questionnaire (FRQ) is a 15-item questionnaire of patients' perceptions of the restrictions upon their autonomy. There has been interest in validating the FRQ in several countries. Despite the promising preliminary empirical support for the FRQ, its psychometric properties are not well understood. In this paper we draw on Item-Response Theory (IRT) to investigate the properties of individual FRQ items to identify candidate items for alteration, removal or retention to assist researchers validating the FRQ in new contexts. The results suggest the FRQ is more sensitive to measuring the perceptions of patients that have above average amounts of restrictiveness. Measurement error rises sharply for the approximately 5% highest scoring respondents but is low for the majority of individuals. Users are likely to respond in a dichotomised manner and not use the 'Not Sure' option. The response category 'Not Applicable' should be removed from a revised FRQ.
Since Winterwerp v the Netherlands in 1979, the European Court of Human Rights and, later, the Eu... more Since Winterwerp v the Netherlands in 1979, the European Court of Human Rights and, later, the European Committee for the Prevention of Torture, have been developing law and policy on human rights and mental disability (taken in this chapter to include psychosocial disability/mental health problems, and mental disabilities related to old age). This paper charts the shape of those developments, relating to psychiatric detention, psychiatric treatment, and systems of guardianship. The new paradigm of human rights, manifest in both the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the 2015 United Nations Sustainable Development Goals (SDGs) is explored, and the potential and limitations of the ECHR in advancing that new agenda considered.
Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning ... more Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity e.g. through mania or severe depression. Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. Results: 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. 199 (36.6%) participants knew about the MCA. 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services. Conclusion: In BD the demand for advance plans about welfare with loss of capacity was high but utilisation of the MCA was low with barriers at service user, clinician and organisation levels.
Please check your proof carefully and mark all corrections at the appropriate place in the proof ... more Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. Note: if you opt to annotate the file with software other than Adobe Reader then please also highlight the appropriate place in the PDF file. To ensure fast publication of your paper please return your corrections within 48 hours.
(GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood ... more (GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood at $251 per month in 19833 and is indexed to the cost of living. The GIS is available to persons receiving the OAS whose income is below a certain level, roughly $9,000 for singles and $15,000 for couples per annum including the OAS. In 1983, the GIS stood at a maximum $252 per month for singles and $194 each for spouses. 4 Once again, the GIS is indexed to the cost of living. These are the only universal retirement income programmes in Canada. The Canada Pension Plan and the Quebec Pension Plan (C/QPP) make up the second tier. These plans provide a retirement pension at age sixty-five equal to one quarter of average lifetime annual earnings, up to a maximum. In 1983, the maximum monthly C/QPP pension was $345.5 These pensions are also indexed to the cost of living and vest immediately. Survivor benefits are available to spouses to a maximum 60 percent of the deceased's C/QPP pension. Because the plans do not use gender-based actuarial tables and because they vest immediately, implicit and explicit gender distinctions are minimal.6 The third tier of the system consists of private pension plans, registered retirement savings plans (RRSPs), annuities, and other savings. Pension plans are usually terms of specific employment contracts. Presently, only 30.6 percent of the women and 44.8 percent of the men in the Canadian workforce are covered by these plans.7 This figure is, in fact, misleadingly 3 National Action Committee on the Status of Women, "Pension Reform" (Toronto: NAC, 1983) at 3. 4 Ibid. at 4. 5 Ibid. 6 The National Action Committee on the Status of Women has pointed out that women remaining at home to raise children are likely to receive lower CPP benefits. In these years, their income is likely to be negligible. This lowers the average annual earnings of these women, reducing their CPP entitlement: see NAC, "Women and Pensions" (Toronto: NAC, 1982). This is remedied in the QPP by a "child-care drop-out" provision, whereby time spent at home with young children is excluded from calculation of lifetime average earnings. A similar issue exists in private pensions, where women raising children have smaller lifetime contributions to a money-purchase plan and smaller amounts of service under defined benefit plans, thereby entitling them to smaller pensions upon retirement. The drop-out provisions are justified under the QPP as a matter of social policy. The issue is how widely the financial burden of raising children ought to be spread. There is a strong social argument that women should not suffer in their old age because they raised children at home. It is not a problem with which private insurance and pension plans can deal, however. The principles of insurance law applicable to private pensions are based on expected returns to specific contributions. Movements away from this principle may be justified in some cases, but the drop-out provision would be a large departure from the standard practice. In addition, the advantage to women would be limited, as it may be likely that they will return to the same pension plan when they return to the workforce. 7 Statistics Canada, Pension Plans in Canada, 1982, (Ottawa: Ministry of Supply and Services, 1984) at 13. Participation in Ontario is roughly 1.7 percent higher than the national average overall (ibid. at 18). No sexual breakdown is available for the Ontario figures.
International Journal of Offender Therapy and Comparative Criminology, Jan 24, 2020
Where safe, forensic mental health systems should provide care in the least restrictive environme... more Where safe, forensic mental health systems should provide care in the least restrictive environment possible. Doing so can maximize patient autonomy and empowerment whilst minimizing unnecessary social disconnection and stigmatization. This study investigated whether patients' perceptions of restrictiveness were associated with demographic, clinical and legal characteristics. The Forensic Restrictiveness Questionnaire (FRQ) was used to measure perceptions of restrictiveness in 235 patients in low, medium and high secure settings in England. The results showed that restrictiveness scores were significantly higher for patients that experienced an adverse event in the past week or were diagnosed with a personality disorder compared to those with a mental illness. A regression analysis suggested that only diagnosis was predictive of FRQ scores when controlling for perceptions of ward atmosphere and quality of life. Age, length of stay, ethnicity, level of security, legal section and offence type were not associated with FRQ scores. Future research should investigate the roles that individual symptoms, insight into illness, mood, personality and expectations of care have in influencing perceptions of restrictiveness.
International Journal of Forensic Mental Health, Jul 17, 2019
Forensic care settings are often isolated spaces with high levels of security. Where these settin... more Forensic care settings are often isolated spaces with high levels of security. Where these settings are overly restrictive, this can affect recovery, autonomy and the therapeutic milieu. It is not clear what phenomena patients themselves identify as restrictive and how, subjectively, they experience these. Semi-structured interviews were conducted with 18 patients in secure hospitals in England. Respondents included male and female patients with mental illness or personality disorders on both civil and criminal detentions. The results suggest a model of restrictiveness consisting of five themes: 1) the antecedent conditions to restrictive phenomena; 2) restrictive phenomena themselves; 3) how these are enacted, 4) how these phenomena were subjectively experienced by patients; and 5) the consequences of these phenomena as expressed by patients. Restrictiveness understood in this way is broader than 'least restrictive practices' typically understood as restraint, seclusion and forced medication. Respondents' comments encourage us to rethink the unintended effects of placing individuals within secure hospitals.
system. At the basic level is Old Age Security (OAS) and the Guaranteed Income Supplement (GIS). ... more system. At the basic level is Old Age Security (OAS) and the Guaranteed Income Supplement (GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood at $251 per month in 19833 and is indexed to the cost of living. The GIS is available to persons receiving the OAS whose income is below a certain level, roughly $9,000 for singles and $15,000 for couples per annum including the OAS. In 1983, the GIS stood at a maximum $252 per month for singles and $194 each for spouses. 4 Once again, the GIS is indexed to the cost of living. These are the only universal retirement income programmes in Canada. The Canada Pension Plan and the Quebec Pension Plan (C/QPP) make up the second tier. These plans provide a retirement pension at age sixty-five equal to one quarter of average lifetime annual earnings, up to a maximum. In 1983, the maximum monthly C/QPP pension was $345.5 These pensions are also indexed to the cost of living and vest immediately. Survivor benefits are available to spouses to a maximum 60 percent of the deceased's C/QPP pension. Because the plans do not use gender-based actuarial tables and because they vest immediately, implicit and explicit gender distinctions are minimal.6 The third tier of the system consists of private pension plans, registered retirement savings plans (RRSPs), annuities, and other savings. Pension plans are usually terms of specific employment contracts. Presently, only 30.6 percent of the women and 44.8 percent of the men in the Canadian workforce are covered by these plans.7 This figure is, in fact, misleadingly 3 National Action Committee on the Status of Women, "Pension Reform" (Toronto: NAC, 1983) at 3. 4 Ibid. at 4. 5 Ibid. 6 The National Action Committee on the Status of Women has pointed out that women remaining at home to raise children are likely to receive lower CPP benefits. In these years, their income is likely to be negligible. This lowers the average annual earnings of these women, reducing their CPP entitlement: see NAC, "Women and Pensions" (Toronto: NAC, 1982). This is remedied in the QPP by a "child-care drop-out" provision, whereby time spent at home with young children is excluded from calculation of lifetime average earnings. A similar issue exists in private pensions, where women raising children have smaller lifetime contributions to a money-purchase plan and smaller amounts of service under defined benefit plans, thereby entitling them to smaller pensions upon retirement. The drop-out provisions are justified under the QPP as a matter of social policy. The issue is how widely the financial burden of raising children ought to be spread. There is a strong social argument that women should not suffer in their old age because they raised children at home. It is not a problem with which private insurance and pension plans can deal, however. The principles of insurance law applicable to private pensions are based on expected returns to specific contributions. Movements away from this principle may be justified in some cases, but the drop-out provision would be a large departure from the standard practice. In addition, the advantage to women would be limited, as it may be likely that they will return to the same pension plan when they return to the workforce. 7 Statistics Canada, Pension Plans in Canada, 1982, (Ottawa: Ministry of Supply and Services, 1984) at 13. Participation in Ontario is roughly 1.7 percent higher than the national average overall (ibid. at 18). No sexual breakdown is available for the Ontario figures.
The new United Nations Convention on the Rights of Persons with Disabilities creates a new paradi... more 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.
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is rightly seen a... more The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is rightly seen as a break from the past in mental capacity law. At the same time, implementation will occur in the specific existing legal and administrative contexts of each State. This article uses English mental capacity law to explore these issues. The English Mental Capacity Act 2005 (MCA) can be considered the best of the "old" paradigm. The article argues that there are continuities between it and a CRPD-compliant approach. These continuities should be built upon. Further, the implementation of the MCA is still in recent memory. The lessons of that implementation will have considerable application to moves toward CRPD compliance. CRPD compliance is not just about specialist stator guardianship reǵimes. It is also about a myriad of law, currently capacity based, located in specific legal areas such as contract, wills and succession, and criminal law. Reform in these areas will involve not just disability law, but successful integration into those other legal areas, a matter requiring the involvement of those knowledgeable in those other areas. Since change in these areas will involve the removal of disability as a gateway criterion, they will affect the public as a whole, and the thus, determination of the degree and sort of intervention that the broader public will consider appropriate.
Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly r... more Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = −0.72) and ward climate (Spearman's ρ = −0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery ... more BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, p...
Aims and method To determine features associated with better perceived quality of training for ps... more Aims and method To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act 2005 (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder. An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed. Results Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation. Good or better quality and two or more sessions of MCA training were associated with more positive attitudes and reported use of ADRTs, although many psychiatrists would never discuss them clinically with people with bipolar disorder. Clinical implications Consistent delivery of better-quality training is required for all psychiatrists to increase use of ADRTs in...
Journal of mental health (Abingdon, England), Jan 23, 2017
The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both hea... more The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression. To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectivel...
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
ABSTRACT In lieu of an abstract, here is a brief excerpt of the content: Bulletin of the History ... more ABSTRACT In lieu of an abstract, here is a brief excerpt of the content: Bulletin of the History of Medicine 79.1 (2005) 147-148 Steven Cherry. Mental Health Care in Modern England: The Norfolk Lunatic Asylum/ St Andrew's Hospital, 1810-1998. Woodbridge, U.K.: Boydell Press, 2003. xi + 335 pp. Ill. $75.00; £45.00 (0-85115-920-6). As the title suggests, this is an institutional history of the Norfolk Lunatic Asylum from its opening in 1810 to its eventual closure in 1998. This was one of the first English county asylums; its history therefore allows an overview of the full chronology of the institutional care of the insane—from Poor Law and other local roots, to large-scale asylum, through eugenics and two world wars, to its eventual erosion in the era of community care. This is not a book that introduces grand new theories about asylumdom; its strength is instead in its assembly of detail. Steven Cherry bases his study primarily on the records of the asylum itself, particularly its annual reports, account books, and minutes of its governors' meetings. Case notes and other primary sources are referred to, but less extensively. In the course of more than three hundred pages, Cherry charts the changes in asylum administrative structure, changes to the asylum building, the staffing conditions, the treatments offered and their effectiveness, and the patient population. While he approaches his subject and his protagonists with a generosity of spirit, this is not a new Whiggish account. The historical context of change is acknowledged, and Cherry is careful and perceptive in acknowledging benefits, weaknesses, successes, and failures of provision. The book is particularly interesting in its account of the changes in administrative structures, and the expectations placed on nursing staff. There is also a good account of the development of the asylum farm, both as a source of occupation for the patients and as a practical benefit to the asylum diet and economy. Particular mention is warranted of the discussion of the asylum during the war years, most notably the Great War. Other asylum histories tend to gloss over these years; Cherry instead provides a good account of the administration of the asylum during the war, and the ways in which the asylum coped with its occupation by the war effort as a military hospital. The institutional history is a frustrating discursive form, for the coverage of two centuries of care inevitably turns the project into something of a historical survey, precluding detailed discussion of particular points. Inevitably, therefore, there were a number of tantalizing points that I felt were incompletely covered, perhaps because of space constraints. For example: (1) Cherry argues that the original design of the asylum can be understood as part of a spirit of moralization (p. 34). Such "moral architecture" is generally a later trend; its appearance in the second decade of the nineteenth century is therefore interesting, and it is unfortunate that it is not discussed at greater length. (2) Norfolk introduced a medical superintendent only in 1861, and the run-up to this appointment was controversial in its alleged neglect of medical viewpoints. This represented a complex transition for the asylum, and more detailed discussion would have furthered a variety of historical arguments regarding the role of the Poor Law and local administration in asylum management, the efficacy of the Lunacy Commission, and the professional status of asylum doctors in the period. (3) Cherry notes that medical personnel appear to have been dissuaded from pursuing their more radical ideas while at Norfolk. He points out that it was only after leaving Norfolk in 1863 that MacKenzie Bacon put his ideas regarding the importance of curbing masturbation into practice, and similarly that David Thomson (superintendent, 1887-1922) did not pursue his interest in sterilization at Norfolk (p. 307). While these may in hindsight have been fortunate outcomes, it suggests a dynamic of dissuading medical innovation in the asylum that is never fully explained. These examples are not given in the spirit of criticism; rather, I am pointing out some research and analysis that Cherry may yet wish to pursue. Peter Bartlett University of Nottingham ...
Mental disabilities is herein taken to include people with mental health problems (now sometimes ... more Mental disabilities is herein taken to include people with mental health problems (now sometimes called psychosocial disabilities) and learning disabilities. 6 See, eg., United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, General Assembly Resolution 46/119 (1991); European Convention for the Protection of Human Rights and Fundamental Freedoms, Art. 5(1)(e) and related jurisprudence; Council of Europe 7 This argument is made most frequently regarding previous UN instruments, most notably the Mental Illness
Journal of Forensic Psychiatry & Psychology, May 27, 2020
Forensic psychiatric care settings are intended to be more therapeutic than penal settings. They ... more Forensic psychiatric care settings are intended to be more therapeutic than penal settings. They attempt to be more homely, recovery-oriented, person-centered, and less overtly punitive. However, forensic inpatient settings are still highly secure, risk averse, and diminutive of patient autonomy. Accordingly, a body of research is investigating how patients experience their care and how these experiences are associated with treatment outcomes. The self-report Forensic Restrictiveness Questionnaire (FRQ) is a 15-item questionnaire of patients' perceptions of the restrictions upon their autonomy. There has been interest in validating the FRQ in several countries. Despite the promising preliminary empirical support for the FRQ, its psychometric properties are not well understood. In this paper we draw on Item-Response Theory (IRT) to investigate the properties of individual FRQ items to identify candidate items for alteration, removal or retention to assist researchers validating the FRQ in new contexts. The results suggest the FRQ is more sensitive to measuring the perceptions of patients that have above average amounts of restrictiveness. Measurement error rises sharply for the approximately 5% highest scoring respondents but is low for the majority of individuals. Users are likely to respond in a dichotomised manner and not use the 'Not Sure' option. The response category 'Not Applicable' should be removed from a revised FRQ.
Since Winterwerp v the Netherlands in 1979, the European Court of Human Rights and, later, the Eu... more Since Winterwerp v the Netherlands in 1979, the European Court of Human Rights and, later, the European Committee for the Prevention of Torture, have been developing law and policy on human rights and mental disability (taken in this chapter to include psychosocial disability/mental health problems, and mental disabilities related to old age). This paper charts the shape of those developments, relating to psychiatric detention, psychiatric treatment, and systems of guardianship. The new paradigm of human rights, manifest in both the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the 2015 United Nations Sustainable Development Goals (SDGs) is explored, and the potential and limitations of the ECHR in advancing that new agenda considered.
Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning ... more Background: The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity e.g. through mania or severe depression. Aims: To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. Methods: National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. Results: 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. 199 (36.6%) participants knew about the MCA. 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney respectively. Barriers included not understanding its different forms, unrealistic expectations and advance plans ignored by services. Conclusion: In BD the demand for advance plans about welfare with loss of capacity was high but utilisation of the MCA was low with barriers at service user, clinician and organisation levels.
Please check your proof carefully and mark all corrections at the appropriate place in the proof ... more Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. Note: if you opt to annotate the file with software other than Adobe Reader then please also highlight the appropriate place in the PDF file. To ensure fast publication of your paper please return your corrections within 48 hours.
(GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood ... more (GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood at $251 per month in 19833 and is indexed to the cost of living. The GIS is available to persons receiving the OAS whose income is below a certain level, roughly $9,000 for singles and $15,000 for couples per annum including the OAS. In 1983, the GIS stood at a maximum $252 per month for singles and $194 each for spouses. 4 Once again, the GIS is indexed to the cost of living. These are the only universal retirement income programmes in Canada. The Canada Pension Plan and the Quebec Pension Plan (C/QPP) make up the second tier. These plans provide a retirement pension at age sixty-five equal to one quarter of average lifetime annual earnings, up to a maximum. In 1983, the maximum monthly C/QPP pension was $345.5 These pensions are also indexed to the cost of living and vest immediately. Survivor benefits are available to spouses to a maximum 60 percent of the deceased's C/QPP pension. Because the plans do not use gender-based actuarial tables and because they vest immediately, implicit and explicit gender distinctions are minimal.6 The third tier of the system consists of private pension plans, registered retirement savings plans (RRSPs), annuities, and other savings. Pension plans are usually terms of specific employment contracts. Presently, only 30.6 percent of the women and 44.8 percent of the men in the Canadian workforce are covered by these plans.7 This figure is, in fact, misleadingly 3 National Action Committee on the Status of Women, "Pension Reform" (Toronto: NAC, 1983) at 3. 4 Ibid. at 4. 5 Ibid. 6 The National Action Committee on the Status of Women has pointed out that women remaining at home to raise children are likely to receive lower CPP benefits. In these years, their income is likely to be negligible. This lowers the average annual earnings of these women, reducing their CPP entitlement: see NAC, "Women and Pensions" (Toronto: NAC, 1982). This is remedied in the QPP by a "child-care drop-out" provision, whereby time spent at home with young children is excluded from calculation of lifetime average earnings. A similar issue exists in private pensions, where women raising children have smaller lifetime contributions to a money-purchase plan and smaller amounts of service under defined benefit plans, thereby entitling them to smaller pensions upon retirement. The drop-out provisions are justified under the QPP as a matter of social policy. The issue is how widely the financial burden of raising children ought to be spread. There is a strong social argument that women should not suffer in their old age because they raised children at home. It is not a problem with which private insurance and pension plans can deal, however. The principles of insurance law applicable to private pensions are based on expected returns to specific contributions. Movements away from this principle may be justified in some cases, but the drop-out provision would be a large departure from the standard practice. In addition, the advantage to women would be limited, as it may be likely that they will return to the same pension plan when they return to the workforce. 7 Statistics Canada, Pension Plans in Canada, 1982, (Ottawa: Ministry of Supply and Services, 1984) at 13. Participation in Ontario is roughly 1.7 percent higher than the national average overall (ibid. at 18). No sexual breakdown is available for the Ontario figures.
International Journal of Offender Therapy and Comparative Criminology, Jan 24, 2020
Where safe, forensic mental health systems should provide care in the least restrictive environme... more Where safe, forensic mental health systems should provide care in the least restrictive environment possible. Doing so can maximize patient autonomy and empowerment whilst minimizing unnecessary social disconnection and stigmatization. This study investigated whether patients' perceptions of restrictiveness were associated with demographic, clinical and legal characteristics. The Forensic Restrictiveness Questionnaire (FRQ) was used to measure perceptions of restrictiveness in 235 patients in low, medium and high secure settings in England. The results showed that restrictiveness scores were significantly higher for patients that experienced an adverse event in the past week or were diagnosed with a personality disorder compared to those with a mental illness. A regression analysis suggested that only diagnosis was predictive of FRQ scores when controlling for perceptions of ward atmosphere and quality of life. Age, length of stay, ethnicity, level of security, legal section and offence type were not associated with FRQ scores. Future research should investigate the roles that individual symptoms, insight into illness, mood, personality and expectations of care have in influencing perceptions of restrictiveness.
International Journal of Forensic Mental Health, Jul 17, 2019
Forensic care settings are often isolated spaces with high levels of security. Where these settin... more Forensic care settings are often isolated spaces with high levels of security. Where these settings are overly restrictive, this can affect recovery, autonomy and the therapeutic milieu. It is not clear what phenomena patients themselves identify as restrictive and how, subjectively, they experience these. Semi-structured interviews were conducted with 18 patients in secure hospitals in England. Respondents included male and female patients with mental illness or personality disorders on both civil and criminal detentions. The results suggest a model of restrictiveness consisting of five themes: 1) the antecedent conditions to restrictive phenomena; 2) restrictive phenomena themselves; 3) how these are enacted, 4) how these phenomena were subjectively experienced by patients; and 5) the consequences of these phenomena as expressed by patients. Restrictiveness understood in this way is broader than 'least restrictive practices' typically understood as restraint, seclusion and forced medication. Respondents' comments encourage us to rethink the unintended effects of placing individuals within secure hospitals.
system. At the basic level is Old Age Security (OAS) and the Guaranteed Income Supplement (GIS). ... more system. At the basic level is Old Age Security (OAS) and the Guaranteed Income Supplement (GIS). The OAS is payable to all Canadian citizens over the age of sixty-five. The pension stood at $251 per month in 19833 and is indexed to the cost of living. The GIS is available to persons receiving the OAS whose income is below a certain level, roughly $9,000 for singles and $15,000 for couples per annum including the OAS. In 1983, the GIS stood at a maximum $252 per month for singles and $194 each for spouses. 4 Once again, the GIS is indexed to the cost of living. These are the only universal retirement income programmes in Canada. The Canada Pension Plan and the Quebec Pension Plan (C/QPP) make up the second tier. These plans provide a retirement pension at age sixty-five equal to one quarter of average lifetime annual earnings, up to a maximum. In 1983, the maximum monthly C/QPP pension was $345.5 These pensions are also indexed to the cost of living and vest immediately. Survivor benefits are available to spouses to a maximum 60 percent of the deceased's C/QPP pension. Because the plans do not use gender-based actuarial tables and because they vest immediately, implicit and explicit gender distinctions are minimal.6 The third tier of the system consists of private pension plans, registered retirement savings plans (RRSPs), annuities, and other savings. Pension plans are usually terms of specific employment contracts. Presently, only 30.6 percent of the women and 44.8 percent of the men in the Canadian workforce are covered by these plans.7 This figure is, in fact, misleadingly 3 National Action Committee on the Status of Women, "Pension Reform" (Toronto: NAC, 1983) at 3. 4 Ibid. at 4. 5 Ibid. 6 The National Action Committee on the Status of Women has pointed out that women remaining at home to raise children are likely to receive lower CPP benefits. In these years, their income is likely to be negligible. This lowers the average annual earnings of these women, reducing their CPP entitlement: see NAC, "Women and Pensions" (Toronto: NAC, 1982). This is remedied in the QPP by a "child-care drop-out" provision, whereby time spent at home with young children is excluded from calculation of lifetime average earnings. A similar issue exists in private pensions, where women raising children have smaller lifetime contributions to a money-purchase plan and smaller amounts of service under defined benefit plans, thereby entitling them to smaller pensions upon retirement. The drop-out provisions are justified under the QPP as a matter of social policy. The issue is how widely the financial burden of raising children ought to be spread. There is a strong social argument that women should not suffer in their old age because they raised children at home. It is not a problem with which private insurance and pension plans can deal, however. The principles of insurance law applicable to private pensions are based on expected returns to specific contributions. Movements away from this principle may be justified in some cases, but the drop-out provision would be a large departure from the standard practice. In addition, the advantage to women would be limited, as it may be likely that they will return to the same pension plan when they return to the workforce. 7 Statistics Canada, Pension Plans in Canada, 1982, (Ottawa: Ministry of Supply and Services, 1984) at 13. Participation in Ontario is roughly 1.7 percent higher than the national average overall (ibid. at 18). No sexual breakdown is available for the Ontario figures.
The new United Nations Convention on the Rights of Persons with Disabilities creates a new paradi... more 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.
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is rightly seen a... more The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is rightly seen as a break from the past in mental capacity law. At the same time, implementation will occur in the specific existing legal and administrative contexts of each State. This article uses English mental capacity law to explore these issues. The English Mental Capacity Act 2005 (MCA) can be considered the best of the "old" paradigm. The article argues that there are continuities between it and a CRPD-compliant approach. These continuities should be built upon. Further, the implementation of the MCA is still in recent memory. The lessons of that implementation will have considerable application to moves toward CRPD compliance. CRPD compliance is not just about specialist stator guardianship reǵimes. It is also about a myriad of law, currently capacity based, located in specific legal areas such as contract, wills and succession, and criminal law. Reform in these areas will involve not just disability law, but successful integration into those other legal areas, a matter requiring the involvement of those knowledgeable in those other areas. Since change in these areas will involve the removal of disability as a gateway criterion, they will affect the public as a whole, and the thus, determination of the degree and sort of intervention that the broader public will consider appropriate.
Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly r... more Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = −0.72) and ward climate (Spearman's ρ = −0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery ... more BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, p...
Aims and method To determine features associated with better perceived quality of training for ps... more Aims and method To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act 2005 (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder. An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed. Results Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation. Good or better quality and two or more sessions of MCA training were associated with more positive attitudes and reported use of ADRTs, although many psychiatrists would never discuss them clinically with people with bipolar disorder. Clinical implications Consistent delivery of better-quality training is required for all psychiatrists to increase use of ADRTs in...
Journal of mental health (Abingdon, England), Jan 23, 2017
The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both hea... more The Mental Capacity Act (2005) (MCA) provides a legal framework for advance planning for both health and welfare in England and Wales for people if they lose mental capacity, for example, through mania or severe depression. To determine the proportion of people with bipolar disorder (BD) who utilise advance planning, their experience of using it and barriers to its implementation. National survey of people with clinical diagnosis of BD of their knowledge, use and experience of the MCA. Thematically analysed qualitative interviews with maximum variance sample of people with BD. A total of 544 respondents with BD participated in the survey; 18 in the qualitative study. 403 (74.1%) believed making plans about their personal welfare if they lost capacity to be very important. A total of 199 (36.6%) participants knew about the MCA. A total 54 (10%), 62 (11%) and 21 (4%) participants made advanced decisions to refuse treatment, advance statements and lasting power of attorney, respectivel...
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
ABSTRACT In lieu of an abstract, here is a brief excerpt of the content: Bulletin of the History ... more ABSTRACT In lieu of an abstract, here is a brief excerpt of the content: Bulletin of the History of Medicine 79.1 (2005) 147-148 Steven Cherry. Mental Health Care in Modern England: The Norfolk Lunatic Asylum/ St Andrew's Hospital, 1810-1998. Woodbridge, U.K.: Boydell Press, 2003. xi + 335 pp. Ill. $75.00; £45.00 (0-85115-920-6). As the title suggests, this is an institutional history of the Norfolk Lunatic Asylum from its opening in 1810 to its eventual closure in 1998. This was one of the first English county asylums; its history therefore allows an overview of the full chronology of the institutional care of the insane—from Poor Law and other local roots, to large-scale asylum, through eugenics and two world wars, to its eventual erosion in the era of community care. This is not a book that introduces grand new theories about asylumdom; its strength is instead in its assembly of detail. Steven Cherry bases his study primarily on the records of the asylum itself, particularly its annual reports, account books, and minutes of its governors' meetings. Case notes and other primary sources are referred to, but less extensively. In the course of more than three hundred pages, Cherry charts the changes in asylum administrative structure, changes to the asylum building, the staffing conditions, the treatments offered and their effectiveness, and the patient population. While he approaches his subject and his protagonists with a generosity of spirit, this is not a new Whiggish account. The historical context of change is acknowledged, and Cherry is careful and perceptive in acknowledging benefits, weaknesses, successes, and failures of provision. The book is particularly interesting in its account of the changes in administrative structures, and the expectations placed on nursing staff. There is also a good account of the development of the asylum farm, both as a source of occupation for the patients and as a practical benefit to the asylum diet and economy. Particular mention is warranted of the discussion of the asylum during the war years, most notably the Great War. Other asylum histories tend to gloss over these years; Cherry instead provides a good account of the administration of the asylum during the war, and the ways in which the asylum coped with its occupation by the war effort as a military hospital. The institutional history is a frustrating discursive form, for the coverage of two centuries of care inevitably turns the project into something of a historical survey, precluding detailed discussion of particular points. Inevitably, therefore, there were a number of tantalizing points that I felt were incompletely covered, perhaps because of space constraints. For example: (1) Cherry argues that the original design of the asylum can be understood as part of a spirit of moralization (p. 34). Such "moral architecture" is generally a later trend; its appearance in the second decade of the nineteenth century is therefore interesting, and it is unfortunate that it is not discussed at greater length. (2) Norfolk introduced a medical superintendent only in 1861, and the run-up to this appointment was controversial in its alleged neglect of medical viewpoints. This represented a complex transition for the asylum, and more detailed discussion would have furthered a variety of historical arguments regarding the role of the Poor Law and local administration in asylum management, the efficacy of the Lunacy Commission, and the professional status of asylum doctors in the period. (3) Cherry notes that medical personnel appear to have been dissuaded from pursuing their more radical ideas while at Norfolk. He points out that it was only after leaving Norfolk in 1863 that MacKenzie Bacon put his ideas regarding the importance of curbing masturbation into practice, and similarly that David Thomson (superintendent, 1887-1922) did not pursue his interest in sterilization at Norfolk (p. 307). While these may in hindsight have been fortunate outcomes, it suggests a dynamic of dissuading medical innovation in the asylum that is never fully explained. These examples are not given in the spirit of criticism; rather, I am pointing out some research and analysis that Cherry may yet wish to pursue. Peter Bartlett University of Nottingham ...
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