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PubMed2004

Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial.

OBJECTIVE: To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment. DESIGN: Single blind randomised controlled trial, with randomisation of individual patients. The investigator was blind to allocation. SETTING: Eight community mental health teams in southern England. PARTICIPANTS: 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years. INTERVENTION: The joint crisis plan was formulated by the patient, care coordinator, psychiatrist, and project worker and contained contact information, details of mental and physical illnesses, treatments, indicators for relapse, and advance statements of preferences for care in the event of future relapse. MAIN OUTCOME MEASURES: Admission to hospital, bed days, and use of the Mental Health Act over 15 month follow up. RESULTS: Use of the Mental Health Act was significantly reduced for the intervention group, 13% (10/80) of whom experienced compulsory admission or treatment compared with 27% (21/80) of the control group (risk ratio 0.48, 95% confidence interval 0.24 to 0.95, P = 0.028). As a consequence, the mean number of days of detention (days spent as an inpatient while under a section of the Mental Health Act) for the whole intervention group was 14 compared with 31 for the control group (difference 16, 0 to 36, P = 0.04). For those admitted under a section of the Mental Health Act, the number of days of detention was similar in the two groups (means 114 and 117, difference 3, -61 to 67, P = 0.98). The intervention group had fewer admissions (risk ratio 0.69, 0.45 to 1.04, P = 0.07). There was no evidence for differences in bed days (total number of days spent as an inpatient) (means 32 and 36, difference 4, -18 to 26, P = 0.15 for the whole sample; means 107 and 83, difference -24, -72 to 24, P = 0.39 for those admitted). CONCLUSIONS: Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness. The reduction in overall admission was less. This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services.

Adult↗
PubMed1977

A question of zeal.

Explore the source record for details and available documents.

Bipolar Disorder↗
PubMed1985

Clinical characteristics of hospitalized psychotic patients who refuse antipsychotic drug therapy.

Thirty psychotic patients who refused antipsychotic medication were compared with 30 patients matched for age, sex, treatment ward, commitment status, and diagnosis who consented to drug treatment. Refusers were no more assaultive or combative than consenters; they were less often diagnosed as having schizophrenia and more often diagnosed as having bipolar or schizoaffective illness. A comparison between 17 of the least symptomatic refusers and 17 of the most persistent refusers showed that persistent refusers were more likely to have a diagnosis of schizophrenia; least symptomatic refusers were more often diagnosed as having affective disorders or schizoaffective disorders.

Adult↗
PubMed2004

Forensic assertive community treatment: preventing incarceration of adults with severe mental illness.

OBJECTIVE: Persons with severe mental illness are overrepresented in jails and prisons in the United States. A national survey was conducted to identify assertive community treatment programs that have been modified to prevent arrest and incarceration of adults with severe mental illness who have been involved with the criminal justice system. METHODS: Members of the National Association of County Behavioral Health Directors (NACBHD) were surveyed to identify assertive community treatment programs serving persons with criminal justice histories and working closely with criminal justice agencies. Programs were identified that met three study criteria: all enrollees had a history of involvement with the criminal justice system, a criminal justice agency was the primary referral source, and a close partnership existed with a criminal justice agency to perform jail diversion. Senior representatives of each program were subsequently contacted, and a telephone survey was administered to gather information about the design and operation of the programs. RESULTS: A total of 291 of 314 NACBHD members (93 percent) responded to the survey. Sixteen programs that met the study criteria were identified in nine states. The primary referral sources for 13 of these programs (81 percent) were local jails. Eleven programs (69 percent) incorporated probation officers as members of their assertive community treatment teams. Eight programs (50 percent) had a supervised residential component, with five providing residentially based addiction treatment. Eleven of the 16 programs have begun operating since 1999. Only three programs have published outcome data on program effectiveness. CONCLUSIONS: Forensic assertive community treatment is an emerging model for preventing arrest and incarceration of adults with severe mental illness who have substantial histories of involvement with the criminal justice system. Further research is needed to establish the structure, function, and effectiveness of this developing model of service delivery.

Adult↗
PubMed1986

Law versus clinical treatment: the case of L.C..

This paper defines certain conflicts between the clinical treatment process of borderline pathology in severely disturbed adolescents and the legal "patients rights" issues. It shows how these conflicts become part of the externalization of the internal splitting process in hospitalized borderline patients. It also demonstrates the sabotaging aspects of legal interventions in a treatment program that is structured for a locked inpatient unit. One case example is used to explicate these points.

Adolescent↗
PubMed1980

Strategic interventions with involuntary patients.

For successful treatment of involuntary patients who resist change, therapists from all schools of thought use numerous interventions. A variety of interventions, from the general strategic therapy approach to tactics for dealing with specific behavioral symptoms, are described. Strong emphasis in applying interventions is placed on the therapist's controlling the therapeutic relationship and establishing the patient's responsibility for his behaviors. Guidelines are also given for the effective use of interventions and the precautions in applying them.

Anger↗
PubMed1991

Effect of evaluations of competency to stand trial on the state hospital in an era of increased community services.

The authors studied court-ordered inpatient evaluations of competency to stand trial at two Massachusetts state hospitals for the period from 1972 to 1987, with particular attention to the effects of a 1978 federal court consent decree that created an extensive system of community-based services in the catchment area of one of the hospitals. The authors found that the broad array of community services developed under the consent decree did not reduce commitments to the state hospital for evaluation of competency to stand trial at the same rate as it reduced civil commitments, with the result that the composition of the patient population changed to include a significantly larger proportion of patients referred by the criminal justice system. This proportion was as high as 17.8 percent in 1985. These patients used a disproportionate share of the hospital's resources, staying in the hospital for a median of 28 days, compared with 12 days for all other patients.

Antisocial Personality Disorder↗
PubMed1992

Who commits matricide?

The authors studied sixteen men who committed matricide. Fifteen out of sixteen cases had a diagnosis of schizophrenia and the remaining patient had a diagnosis of schizophrenia with personality disorder. All were single at the time of the matricide. Data indicate an intense conflict-laden and ambivalent relationship between the majority of patients with their mothers. Thirteen out of sixteen cases described their mothers as quite domineering and demanding but the EMBU inventory revealed that the Matricidal group differed from the Control group in how tolerant they saw their parents. The sample as a whole saw mothers were more over-involved, overprotective, tolerant, affectionate, stimulating, performance-orientated and shaming. The matricidal group differed from the control group in the way they viewed the difference between mother and father on various scales, like over-involved, tolerant, affectionate and performance-orientated. The matricidal groups' mothers were found to be more over-involved, tolerant, affectionate, and fathers more abusive. Mothers in the control group were more performance-orientated.

Adult↗
PubMed1999

The Bournewood judgment: a way forward?

In this article we provide a commentary on the various reasonings behind the Law Lords' unanimous judgements in their recent decision (25 June 1998) in Regina v. Bournewood Community and Mental Health NHS Trust, Ex parte L. After summarizing the judgment and commenting on its important implications, we suggest a way forward. The 1995 Law Commission incapacity proposals, on which the 1997 consultation paper Who Decides? was based, do afford a mechanism which could resolve much of the practical difficulty which practitioners feared from the Appeal Court decision, whilst at the same time affording the sorts of rights which the House of Lords decision denies.

Adult↗
PubMed1990

Resistant bipolar disorder.

A 66-year-old farmer's wife had been admitted 31 times over eight years, suffering from manic depression. A variety of treatments for depressive episodes led to hypomania, and a case conference was held to discuss treatment.

Aged↗