RESUMEN
BACKGROUND: For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents. METHODS: This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation. RESULTS: After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention. CONCLUSION: Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.
Asunto(s)
Internamiento Involuntario , Trastornos Mentales , Salud Mental , Adolescente , Niño , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Salud Mental/legislación & jurisprudencia , Grupos Minoritarios , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: GPs are often faced with deciding whether or not a patient may require detention for assessment in hospital under mental health legislation. This can be a complex and daunting process. Despite this, GPs and most other professionals receive limited formal training. AIM: To map and review the current literature on training in mental health detention processes. These insights are vital to inform the further development of meaningful educational approaches. DESIGN & SETTING: A systematic scoping literature review was conducted to identify what is known about how best to develop training in this area. METHOD: Arksey and O'Malley's framework was used to select, chart, and analyse articles from across six electronic databases. A total of 1136 articles were included in the initial screening phase and 183 articles were included in the full-text screening phase. Key themes were derived using an iterative and thematic approach. A personal and public involvement (PPI) group was set up for this project and other stakeholders in the mental health detention process were consulted about the findings. RESULTS: Fifty-two articles were included in the final review. Professionals consistently highlighted unmet training needs and difficulties with the process. There were identified needs for practical, interdisciplinary training, including discussion of complex cases, and opportunities to learn from those with direct experience. CONCLUSION: This work is foundational for the development of meaningful educational approaches around mental health detention processes. A strong research base will inform and strengthen training with the ultimate aim of improving patient care.
RESUMEN
The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.