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PubMedDate not supplied

Ought we to sentence people to psychiatric treatment?

In principle, there seem to be three main ways in which society can react when people commit crimes under influence of mental illness. (1) The standard model. We excuse them. If they are dangerous they are detained in the interest of safety of the rest of the citizens. (2) The Swedish model. We hold them responsible for their criminal offence, we convict them, but we do not sentence them to jail. Instead, we sentence them to psychiatric treatment. (3) My model. We sentence them to jail, but offer them (voluntary) psychiatric treatment. The advantages of my model are obvious. We get a clear delineation of roles. We allow the psychiatrist to be just a doctor, not a warden. We liberate psychiatry of the objective of deciding whether people who were mentally ill when they committed criminal offences 'could have acted otherwise' -- a hopeless task. We allow that psychiatrists live up to their professional ethical code (The Hawaii Declaration). We treat psychically ill persons as 'normal', we allow them to repent their crimes, which renders easier their recovery. However, two objections to my model come to mind. First of all, is it not unfair to sentence people to jail who could not help doing what they did? And, secondly, the question of fairness set to one side, is it not inhumane to sentence mentally ill persons to jail? Is it not inhumane to the mentally ill persons themselves, and does it not mean that they will be a burden to other prisoners? In my paper I show that, if our system of criminal punishment takes a civilised form, neither of these objections carries any weight.

Child Abuse↗
PubMed1985

Overturning involuntary commitments at a psychiatric hospital in New York State: implications for the societal reaction model.

The revised commitment laws in the United States in general and in New York State in particular are reviewed to show that dangerousness is not the paramount criterion for commitment and that expanded discretion granted to admitting officials is the essence of the new laws. A qualitative portrait of psychiatric admission in the context of the new laws is offered followed by a discussion of implications for the societal reaction model.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Reducing DUI among US college students: results of an environmental prevention trial.

AIMS: Driving under the influence (DUI) of alcohol is among the most common and serious alcohol-related problems experienced by US college students. Community-based prevention trials using environmental approaches to DUI prevention have been effective in reducing DUI. Such interventions remain untested in college settings. This study is the first to test the efficacy of an environmental prevention campaign to reduce DUI among college students. DESIGN: We used a quasi-experimental non-equivalent comparison group design to test the efficacy of the DUI prevention intervention. Students at the experimental university were exposed to a DUI prevention intervention that included a social marketing campaign, a media advocacy campaign and increased law enforcement (DUI checkpoints and roving DUI patrols). SETTING: Students from two large public universities located along the US/Mexico border participated in the seven-semester study. PARTICIPANTS: In total, 4832 college students took part. MEASURES: Using telephone interviews of randomly selected students, we took pre- and postintervention measures of self-reported DUI. FINDINGS: Self-reported DUI (past year) decreased significantly from pre-test to post-test (odds ratio = 0.55) at the intervention school, whereas rates at the comparison campus remained stable. The campus-intervention interaction was statistically significant (P < 0.05), suggesting that the campaign led to the observed change in DUI. CONCLUSIONS: Environmental DUI campaigns similar to those validated in community prevention trials can be effective in college settings. Further research, however, is needed to determine the robustness of the changes associated with such campaigns.

Adult↗
PubMed1996

An investigation into nurses' perceptions of secluding patients on closed psychiatric wards.

Seclusion continues to be used in the care of acutely disturbed psychiatric patients despite often emotionally charged debate about its appropriateness within mental health services. Powerful legal and moral arguments about the use of seclusion emphasize an urgent need to critically examined its role into the care of mentally ill people. This paper examines the use of seclusion on closed psychiatric wards in the management of acutely disturbed patients. Seven psychiatric nurses working in two closed wards in an Australian teaching hospital were interviewed in relation to their perceptions of the role of seclusion. Data were analysed using grounded theory methodology revealing the core conceptual category 'controlling' and two sub-categories 'watching out for' and 'watching over'. Seclusion was found to be used as an adjunctive treatment in the care of individuals considered to be 'out of control'. Clinicians expressed comfort with the use of seclusion, citing a strict protocol that provided parameters for its use. Whilst expert therapeutic interventions were described by clinicians, they are contextualized within a framework of power and control - a framework that stands in stark contrast to contemporary philosophies of nursing care, providing impetus for a reconsideration of the use of constraining practices in the care of mentally ill people.

Australia↗
PubMed1990

Rating management difficulty: a study into the prevalence and severity of difficult behaviour displayed by residents in a large residential hospital for the mentally handicapped.

This survey assessed the prevalence and severity of difficult behaviour displayed by residents in a residential hospital for the mentally handicapped as reported by the direct-care staff. Of the hospital residents, 30.2% were reported as having at least one problematic behaviour. The men were generally more difficult than the women and those on the disturbed wards more difficult than those on residential wards. Men and women exhibited the same types of behaviours in both disturbed and residential wards. However, withdrawn/uncooperative behaviour, stealing and inappropriate sexual behaviour were more prevalent on disturbed wards; withdrawn and inappropriate sexual behaviour being exhibited by more men than women on disturbed wards. The factors most likely associated with being on a disturbed ward were sex and age; young men presenting with most management difficulty. Approximately 12% of the hospital population were defined as presenting with a 'severe' management difficulty. Difficult behaviour is the main reason for admission to and remaining in hospital. The concept of management difficulty and the implications on service provision are discussed.

Adolescent↗
PubMed1990

Frequency and type of incidents occurring in urban-based group homes.

A total of 770 persons with mental retardation were evaluated to determine the frequency and types of incidents occurring in urban-based group homes. All persons resided in group homes located in a large city. Over an 18-month period, a total of 3075 incidents in 14 categories, were documented. Two categories, behavioural incidents and medication errors, comprised 61% of all incidents recorded. Further, a small number of clients accounted for a disproportionately high number of behavioural incidents. Results point to the need to apportion resources based on frequency and types of incidents occurring in group homes.

Adolescent↗
PubMed1993

The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district.

This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370,000. At the time of the survey, the Mental Handicap Register for the district recorded 1,362 people as having a learning difficulty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7%) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difficulties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reported behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self-injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difficulties from the district were reported to be currently presenting such a risk. Similarly, only 2% of the base population (n = 18) were reported to be extremely difficult to manage. The implications of the findings are discussed.

Adolescent↗
PubMed2006

Psychiatric inpatient units for children and adolescents with intellectual disability.

BACKGROUND: Inpatient beds for the psychiatric assessment and treatment of young people (under the age of 18 years) with intellectual disability have become scarce although there is pressure to redevelop them. In the UK, 63% of the NHS beds are at Prudhoe Hospital. This study examines their rôle and utility in relation to community services, both local and national. METHOD: A case note study of the 96 young people admitted over three years was supplemented by a standardised interview canvassing the opinion of the staff involved, both within the units and in the community. RESULTS: Two groups emerged: those with more severe disability who were admitted for neuropsychiatric management (63%) and those, predominantly adolescent, whose problems were closer to mainstream psychiatry but whose intellectual disability prevented their needs being met adequately by mainstream services (37%). Admissions were equally divided between those from the immediate vicinity and nationally. For 43% the primary aim was to disentangle the extent of the environmental effect on the individual: the remainder were admitted for various reasons including, for example, the need to protect the individual from harming themselves or others, unusually complex or hazardous treatment or the carers inability to cope with the treatment plan. All admissions were thought appropriate but, had the community resources been better, 18% were avoidable. CONCLUSIONS: Admission is necessary for a small number of young people who are not readily managed within mainstream units. While the number may be reduced by better community provision, this is likely to partially offset by better case finding. Inpatient facilities should be closely linked with community services; a point reinforced by the prolongation of admissions because a shortfall in community resources.

Adolescent↗
PubMed1996

Therapeutic interventions associated with seclusion of acutely disturbed individuals.

The use of seclusion--i.e. placing an individual in a specially designed room with a locked door--continues to be an option in the management of mentally ill individuals whose behaviour is acutely disturbed, and who pose a personal and/or environmental threat. In a grounded theory study of psychiatric nurses' use of seclusion in two closed wards in a metropolitan teaching hospital in Australia, 'intervening' and 'mainstreaming' are the categories that describe nursing interventions developed from constant comparison of the data collected. Details of these interventions are presented, with reference to the skills that participants describe as necessary in the care of a mentally ill patient being secluded and then being re-integrated into ward life. Considerations for further study on the topic of seclusion are presented.

Dangerous Behavior↗
PubMed2004

Patient and nurse accounts of violent incidents in a medium secure unit.

Most studies examining violence in a forensic setting have adopted a statistical approach to associate relevant predictors and the likelihood of violence. Views of patients and nurses have been a relatively neglected research area. This study explored patients' and nurses' accounts of violent incidents, considering similarities and differences in their narratives. Permission was obtained from the local National Health Service Research Ethics Board and the Research Ethics Committee of University of East London. Anonymized transcripts were produced from semi-structured interviews conducted in a Medium Secure Unit with four nurses and four patients, who consented to talk at length with the first author about violent events they had witnessed on the Unit. Grounded theory analysis of the data generated a core category, 'control', and five constituent themes: the construction of identity of the perpetrator of violence; nurses' dual role of caring and controlling; aspects of parentalism involved in control; following set policies and procedures; and segregation from mainstream society. Because of widespread social interest and media coverage in the topic, discursive examination was made of aspects of social context arising within the data. This study was small scale and exploratory, and further confirmatory research is needed. Nevertheless, clear contrasts between the nurse and patient accounts indicated tentative suggestions for training (including user involvement) and intervention in managing violent behaviour.

Adult↗
PubMed2005

Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing.

The purpose of acute inpatient psychiatric care, and nurses' role within that, are in need of clarification and restatement in order to provide a framework for practice, education, research and development. Inpatient psychiatry has suffered from a paucity of research in recent years. In addition, being a complex system, involving multiple professions with differing ideologies, means that widely accepted succinct descriptions of its purpose are hard to achieve. Yet such a framework is essential to support positive attitudes to patients and for good staff-management relationships. Using an oblique strategy, this paper defines the function of acute inpatient psychiatry, and the role of psychiatric nurses, via a structured examination of the literature on reasons for admission to acute inpatient psychiatric wards. Seven such reasons were discovered and are described: dangerousness, assessment, medical treatment, severe mental disorder, self-care deficits, respite for carers, and respite for the patient. Acute inpatient psychiatric nurses are therefore: providing safety for the patient and others; collecting and communicating information about patients, giving and monitoring treatment; tolerating and managing disturbed behaviour; providing personal care; and managing an environment where patients can comfortably stay. The implications for psychiatric nursing are discussed.

Acute Disease↗
PubMed1994

Failure of the revised pre-donation guidelines to prevent people with a history of high-risk behaviour from donating blood.

We have evaluated the effectiveness of the alteration in the literature aimed at the self-exclusion of blood donors with a history of high-risk behaviour. Since the introduction of anti-HCV screening on 1 September 1991 all HCV-positive donors in the Trent Region have been invited for interview by Blood Transfusion medical staff to ascertain risk factors for HCV infection. We have compared the 5-month periods before (1 September, 1992 to 31 January, 1993) and after (1 February, 1993 to 30 June, 1993) the introduction of the amended literature on 1 February, 1993. No differences between the two time periods were noted for the prevalence rate of HCV infection amongst new or repeat donors, or history of risk factors or specific exclusion criteria. The new literature is failing to exclude people with a history of high-risk behaviour from donating blood and further study of this problem is urgently required.

Adult↗
PubMed1991

Recurrent neuroleptic malignant syndrome associated with inv dup(15) and mental retardation.

Neuroleptic malignant syndrome (NMS) is an uncommon but serious adverse reaction to neuroleptic drugs. Clinically, it resembles malignant hyperthermia, a pharmacogenetic disorder of anesthesiology. Inv dup(15) is a rare but underrecognized cause of mental retardation among institutionalized patients. NMS and inv dup(15) have not been previously reported together. Their association should encourage clinicians to search for genetic markers for NMS.

Adult↗
PubMed1994

Treating the mentally disordered criminal offender in a hospital setting.

The author outlines the legislation and treatment system for mentally disordered criminal offenders in Japan, and reviews the recent studies on the treatment of refractory patients in mental hospitals. Involuntary admission of patients referred by a public prosecutor or by a head of a correctional institution is problematic regarding the judgment criteria for admission and discharge, and imposes a burden on practitioners. The author outlines the main problems of the treatment of criminal offenders in a hospital setting: reaction to the hospital environment, lack of motivation for treatment, therapists' reluctance to treat these patients, absence of support for rehabilitation and uncertainty about future risk. Suggested measures for the solution of these difficulties include the role of the Psychiatric Review Board, the psychiatric evaluation system, and therapeutic skills pertaining to dangerous patients.

Antisocial Personality Disorder↗