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Multiagency public protection arrangements (MAPPAs) were established in England and Wales 10 years ago to oversee statutory arrangements for public protection by the identification, assessment and management of high-risk offenders. This article reviews MAPPAs' relationship with mental health services over the past decade. Despite areas of progress in the management of mentally ill offenders, inconsistent practice persists regarding issues of confidentiality and information-sharing between agencies, which calls for clearer and more consistent guidance from the Royal College of Psychiatrists, the Ministry of Justice and the Department of Health.
Community compulsion via community compulsory treatment orders is used routinely in Scotland. We aimed to describe the common characteristics of individuals subject to community compulsion. We collected standardised information from a national database about individuals subject to community compulsion and compared them with people subject to hospital detention.
Analysis of 499 cases revealed that the majority of individuals subject to community compulsion had a psychotic illness, had a history of non-adherence to services and treatment, and were more likely than not to be in receipt of a long-acting injection of antipsychotic medication. Patients subject to community compulsion were clinically similar to patients subject to hospital-based treatment orders and usually were considered to pose a risk to other people.
Community compulsion has been widely adopted despite a relative lack of supporting scientific evidence. Our findings are similar to those of other related studies and highlight that individuals with a psychotic illness who are ambivalent about treatment and who pose a risk to self or others are likely to be considered for community compulsion.
The HEALTH Passport is a tool to help patients make lifestyle changes to reduce the future burden of chronic disease. This study assesses the potential of this behaviour change strategy in psychiatric patients. We introduced 50 psychiatric in-patients to the HEALTH Passport and asked them to complete a semi-qualitative questionnaire. Results were compared with those of 100 controls.
Psychiatric in-patients are exposed to almost twice as many modifiable risk factors of chronic disease compared with controls. Although psychiatric in-patients are less motivated to address their risk factors, the HEALTH Passport could almost halve the proportion of psychiatric patients at high risk of chronic disease.
The low level of health literacy among psychiatric patients must be addressed to reduce their risk exposure. Potentially, the HEALTH Passport provides a cost-effective tool for this purpose.
This study examined the frequency of seclusion intervention and factors associated with its use in the acute general adult psychiatric ward serving the Southland area of New Zealand. Details of the use of seclusion and relevant demographic data were collected over a 12-month period in 2007–2008.
During the study period there were 30 seclusion episodes involving 23 patients. The median duration of seclusion was 17 hours. The duration of seclusion was found to be inversely related to the treatment received during the period of isolation. Most patients under seclusion had a diagnosis of psychosis, and the nature of this was directly related to the Mental Health Act order applied.
The duration of seclusion in this study is long but compares with a similar study from elsewhere in New Zealand. The duration of treatment while in seclusion could be reduced if optimal treatment is given.
To evaluate the efficacy of naltrexone maintenance therapy in a community-based programme for opioid-dependent patients and to identify predictors for longer-term retention in treatment. A retrospective case-note study was conducted in 142 people dependent on opioids who had undergone detoxification and maintained adherence to naltrexone treatment for a minimum of 4 weeks. Social and clinical demographic factors during treatment were recorded using a standardised naltrexone monitoring scale. Efficacy was measured as retention in treatment, and potential predictors were examined using regression analysis.
Although there was overall low retention of patients in treatment, 55.6% of the patients remained in treatment for 4–8 weeks, and 29.6% of the patients remained in treatment for 17 weeks or more. Enhanced long-term retention in treatment was associated with Asian or other minority ethnic status, employment, parental supervision of naltrexone administration, less boredom, short duration of addiction, younger age, low alcohol intake and no cannabis use in univariate analyses. Short duration of opioid dependence syndrome (3 years) and low alcohol intake (<10 units/week) were significant independent predictors for longer-term retention in treatment in subsequent multivariate analysis.
Low alcohol intake and shorter duration of addiction were significant independent predictors for longer-term retention in treatment, but retention rates for naltrexone remain low overall. Additional psychosocial support may be needed to address these issues.
The engagement of psychiatry with religion is increasingly important for better understanding of the ways in which religious people find resources to cope with mental disorder. An example of how a more critical and constructive engagement might be achieved is found in the psychiatric literature on sacred texts. Articles which engage with the alleged psychopathology of the 6th-century BC Hebrew prophet Ezekiel are examined as an example of this and proposals are made for a more critical yet sensitive and constructive future debate.
Infant mental health is a growing research area, but findings have not generally translated into new service developments. Recognising mental health problems in young infants is relevant for clinicians in all mental health specialties, but it can be a particular challenge to make diagnoses in very young children. Mental health classification systems are fraught with the difficulties of standardising diagnoses for infants, while trying to provide a clinically useful and relevant framework. The diagnostic classification DC:0–3 appears to have strengths, for example, a clear space to consider relationship disorders, and therefore encouraging a broad assessment of the child and family. More information is beginning to gather regarding infant mental health services around the world and assessment of this patient group in clinical practice. This commentary aims to help inform clinicians about this developing field.