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PubMed1983

Reasons for involuntary commitment in Manitoba and Ontario.

This paper concerns itself with the question of involuntary commitment of psychiatric patients in southwestern Manitoba. The purpose was to survey the reasons given for involuntary psychiatric hospitalization by a group of Manitoba physicians in 1979, and to compare these reasons with those given by their Ontario counterparts, as described in the Page and Yates (1) and Page and Firth (2) studies. Particularly, the aim was to compare the relative emphasis given to dangerousness/self-harm reasons, in view of the fact that Manitoba's Mental Health Act makes no explicit reference to the dangerousness criterion, while Ontario's legislation has increasingly specified this factor as a necessary condition for civil commitment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1983

Chronic psychiatric patients in the community.

A feasibility study is presented which describes a cohort of 102 chronic psychiatric patients. The cases were selected on the criterion of four or more new admissions to psychiatric services in the Hamilton-Wentworth region during the year 1977. The group was predominately in the age 20-39 year range and both sexes were represented about equally. The diagnostic labels were personality disorder, schizophrenia, depression and alcoholism in descending order of frequency. The large majority were socially isolated and had contact with social agencies and the police. Seven deaths occurred in the cohort during the year of study.

Adult↗
PubMed1983

ECT as a form of restraint.

ECT is controversial as a form of therapy, with lay and psychiatric objectors. Restraint is also controversial, though often necessary. The Ontario Mental Health Act of 1978 allows the psychiatrist to restrain patients without consent if there is risk of physical danger. The act mentions "chemical and mechanical" means. ECT is not dealt with as a form of restraint. A case is described of a manic male who during 2 episodes of psychosis presented a serious threat of assault to staff. The next of kin was reluctant to sign consent for "treatment" because of fear of the patient's later resentment. An application to the Review Board for permission to treat would have taken a week. On both occasions attempts to control the patient with chemotherapy were totally unsuccessful despite the use of rapid neuroleptization, paraldehyde, barbiturates and mechanical restraints. In both admissions 4 ECT given over 2 days produced rapid behavioural control. ECT was then discontinued because the patient declined to give consent for ECT as treatment and he no longer presented a threat. Medical and legal consultation were necessary and the consensus was that ECT as restraint may be justified on the basis of clinical judgment. In such cases ECT is safer, more reliable and more humane than chemotherapy or mechanical restraints. The authors discuss the current public and professional antipathy towards ECT. There is risk of death for the patient in circumstances where legal barriers prevent the appropriate use of electro-shock and a U.S. case is mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

How Alberta psychiatrists view commitment criteria and the problem of predicting dangerousness.

Mental health legislation has been under review in many jurisdictions throughout North America and Europe. The thorniest issue to review, practically everywhere, has been that of commitment. The Mental Health Act of Alberta, only 10 years old, is now too in the process of being changed. To help in this process, and on the belief that very seldom psychiatrists as a group are questioned about their opinions on these matters, and yet they are the ones who have to apply the legislation at the practical end, a questionnaire was circulated among Alberta psychiatrists. It aimed at obtaining the psychiatrists' views on general matters regarding commitment, such as criteria and the appropriate length of commitment, and the degree of legal involvement desired on a commitment decision. The questionnaire also touched on local issues pertaining to the delivery of psychiatric services such as the designation of "facilities", etc. This paper presents the results as compiled from the replies given by eighty psychiatrists, a 63 percent of those contacted.

Alberta↗
PubMed1984

Nine psychiatric inpatients who leaped from a height.

The authors describe nine psychiatric inpatients from the same hospital who leaped from a height. Common features included youth, social isolation, diagnosis of schizophrenia, and chronic psychosis despite neuroleptic therapy. All had prolonged hospitalizations and a history of assaults, suicide attempts, or both. The authors suggest that these characteristics in conjunction with a recent change in hospital treatment plan or loss of social supports may identify patients at high-risk for violent self-destructive acts.

Adult↗
PubMed1986

Legal issues in medical management of violent and threatening patients.

The responsibility of professionals in the medical management of violent and threatening patients is discussed using the Tarasoff case (American) and the Lawson case (Canadian) as landmark cases influencing subsequent jurisprudence. It is becoming increasingly important to be aware of the court's interpretations in such areas as confidentiality, predictions regarding dangerousness, the duty to warn, and the legal duty to strangers to the therapist/patient relationship. A number of other issues relating to the risks involved in management of patients potentially dangerous as a result of the use of drugs are also discussed.

Canada↗
PubMed1987

Persons discharged from warrants of the Lieutenant Governor.

The authors compiled demographic, psychiatric, and criminological information on persons who were held on warrants of the Lieutenant Governor in Ontario. These warrants were vacated between the period 1969-1982. Of the entire population of 296 such persons, 46% were held as being Unfit to Stand Trial, 51% were Not Guilty by Reason of Insanity, and the remainder were Mentally Ill prisoners. Separate analyses were conducted with the Unfit sample. The average length of confinement on a warrant was 7 years.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

Belegaled: mental health and the law in the United States, 1986.

Kenneth Gray, an attorney as well as a psychiatrist, was the leader in the development of law and psychiatry in Canada prior to his death in 1970. He lived during the post WWII years which saw a phenomenal growth of psychiatry as well as the beginnings of the modern era of a renewed concern for human rights. This later concern has caused the belegalment of many areas of psychiatric practice. Kenneth Gray would have to learn a new set of rules for commitment, the use of ECT and informed consent. He would discover that a patient has a right to treatment that must be buttressed by an individual treatment plan. He would discover that a committed patient has a right to refuse treatment and that some courts in the United States have said that anti-psychotic medications are mind-altering and thus an invasion of the patients 1st amendment rights. He would see untreated refusing patients languishing in the hospital or the homeless mentally ill on the streets because of restrictive commitment laws. As an attorney he would also be concerned about the proposed solution to the homeless, outpatient commitment. He certainly would have been impressed with some of the recent decisions in the United States on our duty to warn or protect known and unknown victims. Seeing patients' advocates on the hospital wards would be a real surprise to him. These controls on the practice of psychiatry for the protection of our patients cut both ways. Dr. Gray's medical/legal education would be tested to its full.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Longitudinal evolution of individuals having appealed their committal to the C.A.S.

The longitudinal evolution of 66 patients admitted between 1976 and 1986 at the Centre Hospitalier Robert-Giffard, and who have appealed their case before the Commission des Affaires Sociales (C.A.S.) was studied. After a review of the literature, the authors compare the evolution of the patients whose appeal was accepted and who left the hospital against medical advice to those individuals whose appeal was rejected. The authors wanted to see if the first group of patients had a less favourable short-term and medium term evolution. From a study of the files and of the case notes prepared by the physicians for the C.A.S. hearings, the authors draw a profile of the typical individual of this group and they study the influence of 16 factors of dangerousness on the Commission's decisions. The results show that the short and medium term evolution of the patients who have appealed their case before the Commission does not differ significantly in the area of dangerousness, whether their appeal was accepted or rejected. However, the length of stay of those patients who had to remain in hospital was significantly longer and that may be the reason why the period of time between their discharge and their re-hospitalization was afterwards much longer. In light of these results, the authors comment on the importance given by the Commission to the legalistic rather than therapeutic aspects of cases.

Adult↗
PubMed1989

Assaultive behaviour: before it happens....

This paper reviews risk factors associated with assaultive behaviour. The author will look at specific risk factors to evaluate when assessing patients with an aggressive potential and he will examine patient-staff relationships that might trigger assaultive behaviour. The author believes that a better knowledge of risk factors allows us to develop preventive attitudes, and these will be discussed in the latter part of this paper.

Aggression↗
PubMed1990

The validity of commitment certificates in British Columbia.

This study surveyed the content of committal forms completed at two B.C. hospitals. A profile of 50 patients at a provincial mental hospital and 50 patients on the ward of a general hospital was obtained by comparing the two groups on a number of demographic and psychiatric history variables. The medical certificates of the patients were then assessed for the inclusion of information required by the B.C. Mental Health Act. Of the 198 forms rated (two per patient), 137 (69.2%) were in compliance with the requirements of the B.C. Mental Health Act. Although a larger number of valid forms was scored for the psychiatric hospital, this difference was not significant. A total of 50 patients had a legally valid combination of medical certificates. Much of the problem associated with the invalid forms was related to the vague and confused wording of the Mental Health Act. It is suggested that a clearer definition of committal criteria and a rewording of the medical certificate may aid physicians in completing commitment documentation.

Adult↗
PubMed1991

Anatomy of a second generation Tarasoff case.

Few medicolegal doctrines have spread so widely and wildly as the Tarasoff duty of professionals to protect potential victims of violence perpetrated by psychiatric patients. Post-Tarasoff decisions have not been limited to identifiable third parties in danger, but in some circumstances have been extended to the community at large. Lipari v. Sears, Roebuck and U.S. is the first of such court rulings to invoke the concept of strict liability for the violent acts of a patient who, in the case presented, randomly fired at club patrons, killing one and wounding many others. A detailed examination of this pivotal and troubling case will facilitate recognition of the inherent complexity associated with subjecting human problems to the legal process.

Adult↗
PubMed1991

The role of Canadian psychiatry in dangerous offender testimony.

Psychiatrists and psychologists who participate in dangerous offender hearings are accorded "expert status" by the courts for the long term prediction of violent recidivism. The clinical and judicial bases for such involvement are reviewed and critiqued. Given the frailties of our predictive abilities, the most prudent course would be for mental health experts to eschew dangerous offender determinations. Since this alternative appears unlikely, tentative guidelines are offered to reduce grave errors in testimony given at dangerous offender hearings.

Commitment of Persons with Psychiatric Disorders↗
PubMed1991

Patient assaults on psychiatric residents: the Canadian experience.

There have been fairly limited reports in the literature of assaults on residents in psychiatric facilities. Assaults on residents and staff tend to be underreported and, for a variety of reasons, not adequately dealt with by the administration. For this reason, security in psychiatric facilities may be lacking in many instances. In order to prepare a position paper of guidelines specifying minimum security requirements for psychiatric facilities in Canada, the Residents' Section of the Canadian Psychiatric Association gathered data on this issue from psychiatric residents. We present the results of a questionnaire sent to all psychiatric residents who are members of the Canadian Psychiatric Association. Results indicate that 40.2% of residents have been assaulted at least once. We present some interesting findings that relate to the residents' perception of their training and the appropriateness of the facilities for assessing patients. Requests for improved security were made by 36.9% of the residents, but only 22.9% of this group found the response by acceptable. Some of the residents' explanations for the assaults suggest interesting dynamics. These and other findings suggest an urgent need to address this issue.

Adult↗
PubMed1991

HIV transmission: ethical and legal considerations in psychotherapy.

Psychiatrists, particularly psychotherapists, have access to the most intimate details of patients' lives. As a result, psychiatrists may face a number of ethical dilemmas, particularly when the issue of potential human immunovirus (HIV) transmission is involved. This paper examines the principle and the limits of confidentiality, and outlines various ways to resolve situations in which there is a conflict between the risk of HIV being transmitted to the unsuspecting public and the principle of confidentiality. Psychiatrists should not assume that patients engaged in high risk behaviour that may be self-destructive fully understand the risks involved. An educational approach may be warranted with these patients, even though such an approach would not be consistent with non directive therapy.

Canada↗