PubMed Health⌕ Search

Biomedical subjects

Richard Mullen

Publications and source records attributed to Richard Mullen.

5 recordsLinked to original sources
PubMed2006

Dilemmas for clinicians in use of Community Treatment Orders.

Clinicians who treat patients using Community Treatment Orders (CTOs) face many potential dilemmas in their relations with involuntary outpatients and the exercise of their powers. We compare the dilemmas identified in the literature with those reported by responsible clinicians in New Zealand (NZ). These clinicians experienced a number of well-known dilemmas, such as determining the right moment for a person's discharge from a CTO, but they seemed less troubled by some other difficulties than might be expected, usually because they considered involuntary outpatient treatment the best option for the patient or the best way to manage the risks involved. Further dilemmas were identified by the NZ clinicians that have not been widely discussed, concerning the proper scope of clinical authority over patients under CTOs and the decision to revoke involuntary outpatient status. In conclusion, some suggestions are made as to how clinicians might best manage the dilemmas involved.

Adult↗
PubMed2004

Maori experience of community treatment orders in Otago, New Zealand.

OBJECTIVE: To consider the impact of community treatment orders (CommTOs) on Maori patients and their whanau (extended family) and the associated views of mental health professionals. METHOD: As a distinct aspect of a larger study of CommTOs, eight Maori patients under compulsory community care were interviewed and, where possible, members of their whanau. Associated interviews were held with their psychiatrists, key workers and other carers: 39 interviews in total. RESULTS: Both benefits and drawbacks of CommTOs for Maori were identified by patients and whanau. CommTOs were considered helpful in increasing patient safety and whanau security and in promoting access to services. They were favoured over hospital care, forensic care and homelessness. The drawbacks included the sense of external control imposed on both Maori patients and staff, particularly concerning medication and restrictions on choices. CONCLUSIONS: This was a small study of a limited number of Maori patients under CommTOs. Their views may not be fully representative. There was a general consensus among those interviewed that the timely use of CommTOs can enhance the mental wellbeing and social relationships of Maori patients. Continuing efforts are needed by health professionals to communicate effectively with whanau and to understand the conflicts experienced by Maori in reconciling their traditional beliefs with the medical model of mental illness.

Adult↗
PubMed2004

How mental health clinicians view community treatment orders: a national New Zealand survey.

OBJECTIVE: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships. METHOD: A national survey of New Zealand psychiatrists and a regional survey of non-psychiatric community mental health professionals for comparison. RESULTS: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use. CONCLUSIONS: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.

Adult↗
PubMed2003

Delusions: the continuum versus category debate.

OBJECTIVE: In this paper I critically review the recently developed idea that delusions are best considered as part of a continuum along with more ordinary human beliefs. METHOD: A literature review of the area was guided by a Medline search, and supplemented with material already known to the author. Claims that recent research supports the continuum hypothesis is critiqued. RESULTS: The argument and evidence advanced for the continuum approach to delusions depends largely on: (i) inadequacies of prevailing definitions of delusion, particularly in the light of evidence that delusional conviction is often not absolute; and (ii) the high prevalence of unusual beliefs in community populations. To the extent that the delusion construct contains much in addition to conviction and unusual or false belief content, the continuity approach is weak. The category of delusions continues to have some validity. CONCLUSION: Both categorical and continuous approaches to delusions have validity that depends at any time on our immediate clinical or scientific needs. No definitive resolution of the category versus continuum debate is likely to emerge.

Culture↗