• A bail and probation hostel for mentally disordered defendants

      Geelan, Steve (2000)
      Elliott House is the only specialized approved bail and probation hostel for mentally disordered men in the UK. It was established as a partnership between the West Midlands probation service and the forensic psychiatry services based at the Reaside Clinic. We report on the evaluation of this facility. Comprehensive social and psychiatric data were collected on all those residents between August 1994 and April 1996. The reason for leaving the hostel was also recorded. During the study period, 83 men completed a period of residence. Of these men, 47% had a psychotic illness. Deliberate self-harm was a significant problem in 13%. Only 4% reoffended whilst resident at the hostel. The condition of residency was breached by 41%. Departure was a result of a normal bail variation for 22% and of admission to hospital for 11%. Elliott House is a successful national resource, attracting residents with major mental disorders. A key principle of the recent White Paper is that the NHS will work in partnership with other agencies to put the needs of patients at the centre of the care process. The hostel demonstrates that a close partnership between separately managed agencies can successfully deliver care to a previously deprived group.
    • A mental disorder of a kind or degree warranting confinement: Examining justifications for psychiatric detention

      Bartlett, Peter (2012)
      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. © 2012 Taylor & Francis.
    • 'Appropriate' medical treatment: What's in a word?

      Phull, Jaspreet S.; Bartlett, Peter (2012)
      Following the amendments in the 2007 Act, there were several revisions made focusing largely on community treatment orders and deprivation of liberty of persons lacking capacity. One of the amendments included a requirement that 'appropriate treatment' be 'available' for compulsion to be imposed in a variety of contexts, most notably admission for treatment under section 3. The definition of appropriate medical treatment within the Act appears largely circular, and therefore of little assistance. The Code of Practice provides some guidance but does little to add to the statutory language. In terms of jurisprudence, there are three reported cases concerning the provision. These cases are analysed and their significance is discussed in an attempt to formulate a clearer definition for appropriate medical treatment.;
    • Are psychiatrists affecting the legal process by answering legal questions?

      Hardie, Timothy; Elcock, Sue (2008)
      Background: Psychiatrists are often asked to answer legal questions. The extent to which they answer strictly legal rather than medical matters is not known.; Aim: To investigate how strongly psychiatrists in England and Wales express opinions on one legal question - that of diminished responsibility in respect of a murder charge, and how this is related to outcome in court. METHOD Our data were extracted from psychiatric reports and case files supplied by the then Department of Constitutional Affairs (now the Ministry of Justice) on cases heard in the Crown Courts between 1 January 1997 and 31 December 2001 in which the defence of diminished responsibility had been raised. The cases had been selected by the Law Commission in their earlier review of partial defences to murder. We devised a reliable system of rating the presence/absence and strength of expression of a legal opinion in the medical reports. We tested the data for relationship between nature and strength of opinion and progression to trial and verdict. RESULTS Psychiatric reports were available on 143 of 156 cases in which diminished responsibility was considered. They yielded 338 opinions on at least one aspect of diminished responsibility. In 110 (93%) of the 118 cases in which there was a diminished verdict, this was made without trial and, therefore, without reference to a jury. In only eight (27%) out of the 30 cases that went to trial, was a diminished responsibility verdict made. Half of the reports (169) gave a clear opinion on diminished responsibility, a third (121) invited the court to draw a particular conclusion and only 11% (36) provided relevant evidence without answering the legal questions. When there was an opinion or an invitation to make a finding on the legal question, a trial was less likely. A trial was also less likely if reports agreed on what the verdict should be. CONCLUSIONS Psychiatrists frequently answer the legal question of diminished responsibility. The judiciary and medical experts should join in research to examine the consequences of different styles or approaches in presentation of essentially similar evidence in court.;
    • Articulating future directions of law reform for compulsory mental health admission and treatment in Hong Kong

      Bartlett, Peter (2020)
      This article explores and outlines four possible pathways for law reform in the area of compulsory mental health admission and treatment in Hong Kong: the (i) abolition, (ii) risk of harm, (iii) mental capacity and (iv) consensus pathways. The discussion of each pathway takes into account local challenges in implementation, as well as Hong Kong's international commitments for the protection of rights. In outlining these pathways for reform, the authors intend to also provide a blueprint for regulatory change in other jurisdictions that are in the process of reforming their mental health laws. © 2019 Elsevier Ltd
    • At the interface between paradigms: English mental capacity law and the CRPD

      Bartlett, Peter (2020)
      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 régimes. 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.
    • Best practices for reducing the use of coercive measures

      Ewington, Jacqueline (2016)
      Coercive measures in forensic metal health settings are utilised in the management of disturbed, aggressive or violent behaviour and there are always moral issues, even when these types of intervention are legitimised. Although coercive measures are routinely utilised when all other intervention options fail, it is important to acknowledge that occasionally patients with predisposing factors for violence do not always respond positively to de-escalation attempts, and the violence that nurses and other professionals face is sometimes instantaneous, extreme and intense; so it is unrealistic to believe that coercive measures are totally unnecessary or uncalled for. Therefore, while we strive to reduce their use to a minimum, they will continue to be considered as planned or unplanned intervention options. In 2014, the United Kingdom Government guidance 'Positive and Proactive Care; reducing the need for restrictive interventions' (Department of Health (DH). Positive and Proactive Care: Reducing the need for restrictive interventions. http://www.tinyurl.com/o2h8rxs, 2014) was published to ensure that care providers implemented least restrictive practices in their services. This initiative was further supported by the Mental Health Act (Code of Practice. TSO, Norwich, 2015) and the National Institute for Clinical Excellence [NICE] (Violence and aggression: Short-term management in mental health, health and community settings. http://www.nice.org.uk/guidance/ng10, 2015). These drivers inspire positive changes as all NHS Trusts must evidence a Restrictive Intervention Reduction Programme. Prevention and early intervention strategies rely on promoting least restrictive ways of managing a patient's behaviour by reducing risk factors for violence and aggression. To achieve this and reduce the use of coercive measures, protective factors that promote the safety and well-being of patients must be implemented, and individuals should be treated with understanding and acceptance. To begin to reduce coercive measures such as physical restraint, seclusion and chemical restraint, and identify and introduce best practice initiatives, healthcare professionals should gain insight into the theories around causes of violence and aggression and understand factors that may pre-empt or exacerbate violent episodes. A review of the background of violence and aggression management and staff training in forensic mental health settings clearly shows how practices have evolved and developed so far. An evaluation of staff training and practice models gives insight into progress and development. Change management models and methods are identified to help leaders drive best practice changes. Current drivers and guidance for healthcare providers within the NHS and the Private Sector are highlighted with best practices and innovative projects aimed at reducing the use of coercive measures in response to the guidance. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • Can we harmonise forensic psychiatry across Europe?

      Khalifa, Najat; Taylor, Mark H. (2008)
      Comments on an article by H. Gordon and P. Lindqvist (see record 2007-17844-006). The authors refer to harmonisation of forensic psychiatry in Europe. We agree with the authors that, although laudable in principle, such undertaking is difficult, if not impossible, to achieve. However, it is possible to share experiences and learn from each other. In the section on ethics in forensic psychiatry the authors call attention to reports of differences in the canons of ethics pertaining to US and British forensic psychiatrists. The fact is that one or two prominent US forensic psychiatrists visiting the UK have misinformed our British colleagues that forensic psychiatrists in the USA follow principles of ethics that are different from the code of medical ethics applicable to psychiatrists everywhere. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Capacity, consent and the law

      Waite, Jonathan (2019)
      As health care professionals we owe a duty of care to our patients. Our patients have a right to autonomy – to make their own decisions. If we impose treatment on them against their wishes, when they have capacity to make a decision to refuse treatment, then we may be committing the tort of battery; if we fail to treat them when they lack capacity to make treatment decisions we may be found to be negligent.
    • Changes to (un)fitness to plead and insanity proceedings

      Morris, Adrian; Elcock, Sue; Hardie, Timothy (2006)
      Significant changes to both unfitness to plead and the defence of insanity are hidden away in the Domestic Violence, Crime, and Victims Act 2004. These changes, which could easily be overlooked, are the subject of discussion in this paper. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Conclusion

      Vollm, Birgit A. (2014)
      Deinstitutionalization, the closure of mental hospital beds and changes to commitment laws were highly touted initiatives that provided the backbone of mental health reform policies implemented in many countries in the second half of the last century. These initiatives, however, have often been given as reasons for the increasing demands for forensic psychiatric services and an increase in the number of mental patients in prison. The net result of these developments is that patients who receive a label of “forensic” enter into a mental health ghetto with little connectivity or integration with the general mental health system (Arboleda-Florez 2003).
    • Consent, capacity and the law

      Waite, Jonathan (2013)
    • Criminal law and mentally ill offenders in comparative perspective

      Koenraadt, Frans (2000)
      In this article we compare legal arrangements dealing with mentally disordered offenders in the criminal law systems of Belgium, Canada, Germany, the Netherlands, Norway, Sweden, and the United Kingdom. To describe relevant differences and similarities in the arrangements, we used a checklist containing central aspects of adjudication, assessment and treatment of mentally ill offenders. These aspects concern: (1) the legal classifications of mental illnesses that can lead to exclusion of criminal responsibility; (2) the acceptance of diminished capacity as a partial excuse; (3) the possibilities for imposing security measures of compulsory treatment instead of or next to criminal punishment; (4) the conditions for their imposition in terms of seriousness of crimes committed and dangerousness of offenders; (5) the available hospitals or special clinics for executing security measures; (6) the role and task of forensic mental health professionals in assessing the offender's state of mind and in advising compulsory treatment; (7) the rules for duration, prolongation and termination of the measures. The findings of this comparative analysis are evaluated in light of legal protection for mentally disordered offenders.
    • Current ethical challenges in prison psychiatry in England and Wales

      Kaul, Adarsh; Vollm, Birgit A. (2013)
      This chapter describes the legal context of psychiatric care for mentally disordered offenders in England and Wales, the different settings in which such care is provided, the organization of the prison system and of healthcare provision within prisons as well as the main ethical challenges mental health care practitioners working in prisons face. We will consider ethical challenges encountered through recent legal and policy developments, those related to working in a custodial setting, challenges associated with providing healthcare to mentally disordered prisoners and specific ethical issues such as food refusal. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
    • Editor's introduction to the special issue

      Hollin, Clive R. (2004)
      In this Special Issue, Professor Ward and Eccleston have assembled a formidable cast of contributors who can take the hard questions full on, asking a few of their own as they go. It is my view that the level of debate set up by this collection of papers is absolutely critical to the further development of the field. I took a great deal from reading these papers and I am confident that others will too. The work that goes into editing a collection of papers such as this should not be underestimated and we owe a debt of gratitude to the Guest Editors for all the work they have done in bringing together this edition. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Editorial: Introduction to special edition on law and rights, International Journal of Law and Psychiatry

      Bartlett, Peter (2005)
      This editorial presents an introduction to the special edition on law and rights. Much of the legal debate and development regarding mental health and rights in the last 15 years or so has sprung from international human rights instruments. Whether this involves instruments directed specifically at mental disorder, or the application of more general human rights instruments, national compliance with international obligations has acquired a central place in legal debates surrounding mental health law. It is a theme which permeates the papers in this volume. At its most theoretically simple level, discussions of this compliance must be based on some systematic assessment of whether the state in question is in compliance with its obligations: a rights audit is required. One of the papers in this volume provides a framework for such an audit, based on the obligations contained in the United Nations Principles. The majority of the papers note the increasing importance of capacity in modern understanding of mental health law, but there is no express reference to this concept in the key general international human rights documents. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Ethical issues

      Robertson, John P. (2001)
    • Ethical issues in forensic and prison psychiatry

      Vollm, Birgit A. (2010)
      Forensic psychiatry is a subspecialty of clinical psychiatry which requires special legal and criminological knowledge and experience in the treatment of mentally disordered offenders. Forensic psychiatrists should have solid psychiatric training as well as practical experience in dealing with mentally disordered offenders. The double knowledge in psychiatry and law defines the subspeciality of forensic psychiatry and provides the ethical foundations for its practitioners (Arboleda-Florez 2006). 'In psychiatric ethics, the dual-role dilemma refers to the tension between psychiatrists' obligations of beneficence towards their patients, and conflicting obligations to the community, third parties, other health-care workers, or the pursuit of knowledge in the field. These conflicting obligations present a conflict of interest in that the expectations of the psychiatrist, other than those related to patients' best interests, are so compelling. This tension illustrates how the discourse in psychiatric ethics is embedded in the social and cultural context of the situations encountered. It appears that as society changes in its approach to the value of liberal autonomy and the "collective good", psychiatrists may also need to change' (Robertson and Walter 2008). This quote reminds us that social and political factors are important drivers of decision making, particularly as in-depth analysis of specific ethical problems in forensic psychiatry are only beginning to emerge. This chapter discusses the role of a forensic psychiatrist, and ethical issues involved in risk assessment, treatment, consent, and compulsory treatment of mentally disordered prisoners. (PsycINFO Database Record (c) 2016 APA, all rights reserved)