Background The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. Aims To explore changes in the use of the Act since its introduction. Method The Department of Health and the Home Off...
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Background The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. Aims To explore changes in the use of the Act since its introduction. Method The Department of Health and the Home Off ice routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures. by year. for the total numbers admitted under each section of the Act;We used the total psychiatric hospital admissions and total prison populations as denominator data. Results Formal admissions rose from 16 044 in 1984 to 26 308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of ail admissions. The increase is mainly accounted for by changes in the use of Part ii of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s. Conclusions Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion. Declaration of interest Funded by the Department of Health.
Background Persons of African-Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour. Aims To estima...
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Background Persons of African-Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour. Aims To estimate population-based prevalence rates of treated mental disorder in different ethnic groups compulsorily admitted to secure forensic psychiatry services. Method A survey was recorded of 3155 first admissions, from 1988 to 1994, from half of England and Wales, with 1991 census data as the denominator adjusted for under-enumeration. Results Compulsory admissions for Black males were 5.6 (Cl 5.1-6.3) times as high as, and for Asian males were half, those for White males;for Black females, 2.9 (Cl 2.4-4.6) times as high and for Asian females one-third of those for White females. Admissions of non-Whites rose over the study period. Patterns of offending and diagnoses differed between ethnic groups. Conclusions Variations in compulsory hospitalisation cannot be entirely attributed to racial bias. Community-based services may be less effective in preventing escalating criminal and dangerous behaviour associated with mental illness in African-Caribbeans. Declaration of interest None. Funding was provided by the Department of Health.
The need to better understand and manage risk of violent behavior among persons with severe mental illness (SMI) in community care is increasingly being recognized. Of particular concern is a subset of the SMI populat...
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The need to better understand and manage risk of violent behavior among persons with severe mental illness (SMI) in community care is increasingly being recognized. Of particular concern is a subset of the SMI population characterized by a "revolving door" pattern of institutional recidivism and poor adherence to outpatient treatment Little empirical research exists which examines the specific dimensions of violent incidents and their surrounding context in this population. The present paper describes characteristics of violent behavioral events in a sample of 331 people with psychotic or major mood disorders who were placed on involuntary outpatient commitment in North Carolina. By pooling baseline data from respondents' self-report, collateral informant interviews, and hospital records, the study found violent behavior to be a problem affecting over half the sample in a 4-month period preceding hospitalization. The study also found considerable variability in the frequency of violent events, severity weapon use, subjective state when incidents occurred initiation of fights, settings, relationship to others involved, and associated threat of victimization. Multivariable analyses showed that cooccurring substance abuse problems, history of criminal victimization, and age (being younger) were significantly associated with violent behavior when all sources of data were taken into account. Clinical diagnosis and symptom variables were not related to violence in this sample. Implications of these findings for service delivery priorities and future research are discussed.
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