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PubMed1994

Reform of "hogosha" system and psychiatric practice in Japan.

In this paper, the author examines the current working and drawbacks of the "hogosha" system as set out in the Mental Health Law of 1988, and goes on to suggest a plan for reform. Critics point to two main problems with the current system. One is that the hogosha's powers infringe on the patient's human rights. The other is that the system places too heavy a burden on hogoshas in its efforts to protect the community from the patient. The author argues that the hogosha should retain the power to consent for admission for medical care and custody, but other responsibilities should be reduced. The author stresses that local mayors must be prepared to take their responsibilities seriously when they assume the role of the hogosha.

Caregivers↗

PubMed2004

Evaluating stigma against mental disorder and related factors.

This study attempted to identify forms of stigma against individuals with mental disorders and related factors. The subjects comprised 2632 people living in the area covered by the K health center in N prefecture. Factor analysis of the Mental Disorder Prejudice Scale (1211 valid responses) identified three factors: 'rejection', 'peculiarity' and 'human rights alienation'. Regression analysis revealed that age, welfare activities, an active problem-solving attitude, lecture attendance, and previous contact, exerted independent effects with respect to 'rejection'. These results suggest the importance of disseminating accurate information and creating more opportunities for people to have meaningful interactions with people with mental disorders in order to dispell the stigma.

Adult↗

PubMed2006

A conversation: challenging the relevance and wisdom of separate mental health legislation.

This paper explores the dilemmas encountered by mental health nurses when working with mental health legislation. The concerns and considerations of an expert mental health nurse, complemented by the opinion of an expert in health-care and legal issues are presented. It is argued that there is currently a distorted perception with regard to the function and sentiment of mental health legislation, and this paper aims to restore balance in interpreting and working with such law. Viewing mental health legislation primarily as a mechanism for involuntary hospitalization effectively removes any power or recourse given to mental health consumers by the law. Principles of mental health care and legislation are examined as well as the relationship the law has with dangerousness to self or others and mental ill health. A dialogue is established between the two authors to assist the exploration of these legal and clinical issues. The continued relevance of specific mental health legislation is brought into question. It is proposed that the existence of such legislation constitutes discrimination and contributes to stigma associated with mental illness. An alternative legislation for all circumstances where an individual is deemed incompetent is proposed as the most significant step towards mainstreaming of mental health care and an end to discrimination.

Attitude of Health Personnel↗

PubMed2006

Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings.

The use of special observations in psychiatric practice may be employed as an alternative to more restrictive methods such as the use of seclusion and restraint. From the literature, special observations are used for a complex array of signs and symptoms (and risk behaviours) which include suicidal intent, self-injurious behaviour, hallucinatory experiences, and absconding. This paper reports on research into the use of special observations in both forensic and non-forensic psychiatric settings. A comparative approach was adopted to establish if the perceived risk factors leading to the adoption of special observations were similar in both settings. Three groups of nursing staff were requested to assess 30 patients who were placed on special observations. Before this, nurses were requested to rate the risk factors in terms of their severity on a 7-point Likert scale. The rank-ordering analysis revealed a similarity of identified risk factors and anova (one-way, unrelated) and the Jonckheere Trend Test revealed that there were significant differences between the scores in the forensic and the non-forensic settings. The statistical differences existed for risk factors relating to harm to self and others but not for psychiatric symptomatology.

Analysis of Variance↗

PubMed2005

Dangerous and severe personality disorder: an ethical concept?

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances.

Attitude of Health Personnel↗

PubMed1983

Risk taking as motivation for volunteering for a hazardous experiment.

Army male enlisted personnel were tested in two experiments to assess the psychological correlates of volunteering for a hazardous combat simulation, (Experiment 1) and a riskless, psychological experiment (Experiment 2). Subjects were given a biographical and personal habit questionnaire, the IPAT Anxiety Scale, Rotter's Locus of Control Scale, and Torrance and Ziller's life experience inventory. Results from Experiment 1 indicated that volunteers were significantly less anxious, and more willing to take risks than were nonvolunteers. Noncommissioned officers, smokers, laterborn children, and children of lower socioeconomic class parents were significantly overrepresented among the volunteers for this hazardous experiment. In Experiment 2, which solicited volunteers for a routine, nonhazardous experiment, the only variable to discriminate the volunteers from the nonvolunteers was mothers' education level. Results are in agreement with findings, using college students, that volunteer samples differ significantly from nonvolunteer samples, and that the characteristics that discriminate these two groups vary as a function of situational factors.

Anxiety↗

PubMed2005

Weapon carrying in a sample of high school students in New Zealand.

OBJECTIVE: To examine self-report of carrying weapons and correlates in a sample of New Zealand high school students. METHOD: A sample of 652 Year 11 students from all Dunedin high schools completed a web-based version of the US Youth Risk Behaviour Survey. This included questions on weapon carrying, fighting, and feeling unsafe at school, as well as measures of family and peer/friend connectedness and perception of school climate. RESULTS: Reports of ever carrying a weapon and carrying one in the last 30 days were relatively common, being 27.5% and 19.3% respectively. Weapon carrying in the last 30 days was strongly associated with being male, fighting in the last year, missing school due to feeling unsafe, and a poorer perception of school climate. CONCLUSIONS: Many high school students report weapon carrying, which in turn was associated with other aspects of physical aggression. Further study of the lethality of weapons being carried and the context in which they might be used is clearly warranted.

Adolescent↗

PubMed1993

A proposal for the use of advance directives in the treatment of incompetent mentally ill persons.

[M]y question is how these patients while competent might be able to give their own informed consent to treatment, despite being both unwilling and incompetent to do so when treatment is to be begun, thereby reducing the need to relax the dangerousness criteria for involuntary commitment. It is uncontroversial that the dangerousness requirement would be too restrictive for all treatment of mental illness. When competent patients voluntarily seek and/or accept treatment for their mental illness, neither public policy nor medical practice restricts treatment to those patients judged to be dangerous. Instead, criteria should be and generally are comparable to those for the treatment of physical illness -- whether the patient is ill, in this case mentally ill, and likely to benefit from treatment. Through use of advance directives, it would be possible for mentally ill persons who are currently refusing treatment to give prior consent, while competent and with their disease in remission, to treatment at a later time when they are incompetent, have become noncompliant, and are refusing treatment. My proposal is certainly not entirely novel, since others have made similar proposals under the heading of Ulysses contracts and voluntary commitment contracts. Addressing briefly some of the criticisms of these earlier proposals will bring out one fundamental difference between them and my proposal here for a new use of advance directives -- whether the patient must then be incompetent when the contract or directive made earlier is later invoked -- a difference I shall argue strongly favors my proposal.

Advance Directives↗

PubMed1985

The subclassification of child firesetters.

The possibility that child firesetters are a heterogeneous group was investigated in a cross-sectional case note and item sheet study of all children referred to an Inner London clinic between 1973 and 1981. Firesetters were most usefully subdivided by age, and secondarily by reason for referral. There were no links between enuresis and dangerousness or cruelty to animals. Methodological issues and the implications of the findings are discussed, with particular reference both to the development of the disorder and to the subclassifications drawn for conduct disturbance.

Adolescent↗

PubMed1993

Seclusion on an adolescent unit.

We studied the seclusion records of an adolescent unit for a six-year period. Problems in the analysis of typical seclusion data are examined and statistical methods that overcame them are explained. Only a few relationships were found between the seclusion regime and available measures of patient and ward characteristics, though there was great variability in the frequency with which individuals were secluded and the duration of various episodes of seclusion. The average duration of seclusion (31 minutes) was much less than had been reported by other investigators. Furthermore, the durations became shorter over the period of study. The implications of these findings for further research and practice are discussed.

Adolescent↗

PubMed1997

Epilepsy in Pakistan: stigma and psychosocial problems. A population-based epidemiologic study.

PURPOSE: To assess the stigmatization and psychosocial problems of persons with epilepsy in Pakistan. METHODS: A population-based, cross-sectional epidemiologic study of 241 persons with epilepsy identified from an at-risk population of 24,130 individuals (64.7% from urban and 35.3% from rural areas). Of these patients, 77% suffered from recurrent non-febrile generalized convulsions. We evaluated degree of stigmatizations (i.e., avoidance by friends, neighbors, and others), and the effect of epilepsy on other psychosocial aspects (e.g., marriage), and also the relationships between gender and level of education of the patients, and stigmatization. RESULTS: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grades are affected by the disorder. They have difficulty performing activities of daily living and find it hard to make decisions about whether to marry or to have children. Women believed that they were more dangerous to others, received less help from their families, and, more frequently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men-a fact influenced by social and cultural pressures, including pressure from family, because it is nearly always the responsibility of the parents to arrange the marriage of a daughter. Influence of education indicates that people with epilepsy who have higher education, as compared with those with less education, had fewer children, were less often avoided by their classmates and neighbors, had fewer problems with plans for education, less frequently encouraged others to avoid them, were more frequently married, and believed that they were more dangerous to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes. CONCLUSIONS: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the observations are statistically significant as per P-value.

Attitude to Health↗

PubMed1985

Mentally retarded admitted to psychiatric hospitals in Denmark.

Computerized register linkage and a questionnaire survey showed that the number of mentally retarded admitted to psychiatric hospitals in Denmark is rapidly increasing. This development is highly deplorable. Diagnosis and treatment are frequently complicated by the nature of the mental handicap and, especially, the often diverging clinical appearance of the psychiatric disorders in these persons. Mentally retarded with a psychiatric disorder should, in general, be treated in special institutions or outpatient clinics, by specially trained social psychiatrists and staffs.

Adolescent↗

PubMed1985

Patients admitted for compulsory treatment to selected psychiatric units in Italy and in Sweden.

Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatment to either an Italian or a Swedish psychiatric unit in selected areas of the two countries have participated in an exploratory study aimed at assessing the main characteristics of compulsory admitted patients, and in particular, the immediate reason for admission. The two series proved to be quite similar as concerns most sociodemographic variables, and as concerns clinical diagnosis and severity of the morbid condition at admission as measured by means of a rating scale. More Swedish than Italian patients lived alone when admitted to hospital, and for more of them the request for admission was made by other people than relatives, and a larger proportion of them was accompanied to the hospital by medical or social welfare personnel. In both series the largest proportion had a low educational level and belonged to the lower social groups. The same proportion in the two series had previous admissions. The most common reason for admission was "odd or improper behaviour" for the Swedish patients, and "feared or manifest dangerousness" for the Italian patients. The Italian patients remained at hospital on average half the time than the Swedish patients.

Adolescent↗

PubMed1991

A prospective study of patient assaults on nurses in a provincial psychiatric hospital in Canada.

A 27-month prospective study was conducted of patient assaults on nurses in a Canadian psychiatric hospital. Rates were low (4% of the patients committing an assault) and the injuries mostly trivial. Schizophrenics accounted for 43% of attacks, but when allowance was made for the disproportionate number of patients in the hospital with this diagnosis, individuals with mental retardation or dementia were approximately twice as likely to be assaultive as schizophrenics. Repeat assaulters (greater than 4 attacks) were more likely to be suffering from paranoid schizophrenia.

Adolescent↗

PubMed1996

Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment.

Few empirical studies have examined the attitudes and ethical beliefs of psychiatrists. In this study, 328 members of the Swedish Psychiatric Association were randomly selected to respond to a questionnaire containing three clinical vignettes examining involuntary hospitalization, other compulsory interventions, and restraint. The questionnaire also contained 16 controversial statements and items on the abuse of psychiatry. A 60% response rate was obtained. Psychiatrists' responses were influenced not only by the severity of and risks associated with the patient's disorder, but also by family pressure which affected the decision-making process. Female psychiatrists less often suggested the use of physical restraints and the compulsory use of ECT. Sexual misconduct, and also the inadequate treatment of refugees, were the most frequently reported forms of abuse of psychiatry.

Adult↗

PubMed1998

Factors predictive of referral to psychiatric hospital among general hospital psychiatric consultations.

The aim of this paper was to explore the factors necessitating psychiatric hospital care in a Finnish multi-centre study of general hospital in-patients referred for psychiatric consultation. The study group consisted of 1251 patients referred to psychiatric hospital (n = 181) and a comparison group (n = 1070) consisting of subjects who were not referred. Differences between groups were studied by univariate analysis. Logistic regression analysis was used both to assess the factors contributing to referral to psychiatric hospital and to create predictive models. The validity of the models was analysed by means of receiver operating characteristic (ROC) curves in an independent sample. Psychiatric hospital care during the previous 5 years was associated with a 3.7-fold (odds ratio) increased risk of hospitalization. A diagnosis of psychosis was associated with a 2.9-fold increased risk, and attempted suicide as a reason for consultation was associated with a 2.1-fold increased risk. Not being married doubled the risk, and the odds ratio was also high in cases of poor psychosocial functioning (as assessed by Global Assessment of Functioning (GAF) score). The predictive model differentiated reasonably well between those patients who were hospitalized and the other patients. In conclusion, this multi-centre study of factors predictive of referral to psychiatric hospital among general hospital patients revealed that the most important determinants were previous psychiatric care, diagnosis of psychosis or severe depression, attempted suicide, being unmarried, and poor psychosocial functioning as assessed by GAF score.

Adult↗

PubMed2006

Do mental health professionals stigmatize their patients?

OBJECTIVE: Assessing stereotypes towards people with mental illness among mental health professionals, comparing their view to the Swiss general population and analysing the influence of demographic factors, profession and work place variables (type of ward, employment time and professional experience). METHOD: Conducting a representative telephone survey (n = 1073). Factor analysis was used to achieve one-dimensional scales, which were analysed by regression analysis. RESULTS: Most positive depictions were regarded as less characterizing people with mental illness, whereas most negative descriptions were viewed as more typing these people. Compared with the Swiss general population, mental health professionals have not consistently less negative or more positive stereotypes against mentally ill people. Of the 22 stereotypes five factors were detected: 'social disturbance', 'dangerousness', 'normal healthy', 'skills' and 'sympathy'. Stereotypes about people with mental illness are influenced by the professional background and if at all only slightly affected by gender, age, ward type, participation rate of the hospital, weekly working hours or years of professional experience. CONCLUSION: Mental health professionals must improve their attitudes towards people with mental illness. Different ways, e.g. improving their professional education or their quality of professional contacts by regular supervision to prevent burn-out, are discussed.

Activities of Daily Living↗

PubMed2007

Violence from young women involuntarily admitted for severe drug abuse.

OBJECTIVE: To simultaneously evaluate actuarial and dynamic predictors of severe in-patient violence among women involuntarily admitted for severe drug abuse. METHOD: All patients admitted to special facilities for involuntary treatment of absconding-prone, previously violent, drug abusing women in Sweden were assessed with the Staff Observation Aggression Scale, revised. Actuarial data on risk factors for violence were collected and considered in an extended Cox proportional hazards model with multiple events and daily assessments of the Broset Violence Checklist as time-dependent covariates. RESULTS: Low-grade violence and being influenced by illicit drugs were the best predictors of severe violence within 24 h. Significant differences in risk for violence between different institutions were also found. CONCLUSION: In-patient violence risk is rapidly varying over time with being influenced by illicit drugs and exhibiting low-grade violence being significant dynamic predictors. Differences in violence between patients could not be explained by patient characteristics.

Actuarial Analysis↗