Reforming mental health law in England and Wales.
Ontology highlight
ABSTRACT:
SUBMITTER: Eastman N
PROVIDER: S-EPMC1420714 | biostudies-literature | 2006 Apr
REPOSITORIES: biostudies-literature
Publications
Reforming mental health law in England and Wales.
BMJ (Clinical research ed.) 20060401 7544
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Project description:Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.
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Project description:PurposeThe Akrivia Health cohort was created to extract data from electronic health records in secondary mental health and dementia care services in England and Wales. The data are anonymised, structured and harmonised from the source electronic health records across a range of information technology systems, enabling for unified, privacy-preserving access for research purposes.ParticipantsThe cohort contains data from electronic health records for over 4.6 million patients in England and Wales, as of January 2024. The data are refreshed with regularity, and the dataset expands whenever a new healthcare provider joins the Akrivia network. 13% of the database are patients under 18 years old (n=590 160), 56% are adults 18-65 years old (n=2 631 690) and 31% are older people (n=1 422 609). About 11.5% are deceased (n=538 371).Findings to dateStructured data include patient demographics and service pathways. Akrivia Health also uses a bespoke natural language processing model to further extract the research-relevant information from free-text progress notes, including diagnoses, medications and clinical symptoms. This allows for an in-depth longitudinal description of patient journeys.Future plansThe anonymised data can be accessed in collaboration with Akrivia Health, following the National Health Service guidelines and without requiring a separate ethics application. There is no planned end date for data collection.
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Project description:Islam is the dominant religion in about 56 countries around the globe, and has more than 1.2 billion followers. Islam represents a holistic way of life, and according to a large proportion of its followers, the Islamic law or Shari'ah should prevail over secular law and should be implemented as state law. The etymological root of the word Shari'ah can be traced back to the harsh life in the desert and it means "pathway to be followed" or "path to the water hole," since the water was the basic element and preserver of life. At the dawn of its historical course and at its moral and ethical core, Islam introduced many interesting and innovative beliefs concerning the mentally ill. Islam underlines the moral necessity for the protection and care of the vulnerable individuals, as dictated by God himself. On the other hand, beliefs about "possession" and stigmatization influence the peoples' attitude against and apprehension of mental disorders. This strange admixture is reflected upon the status of the mental health services and corresponding legislation found in the different countries of the Islamic world.
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Project description:Adverse childhood experiences (ACEs) encompass various adversities, e.g., physical and/or emotional abuse. Understanding the effects of different ACE types on various health outcomes can guide targeted prevention and intervention. We estimated the association between three categories of ACEs in isolation and when they co-occurred. Specifically, the relationship between child maltreatment, witnessing violence, and household dysfunction and the risk of being involved in violence, engaging in health-harming behaviors, and experiencing mental ill-health. Data were from eight cross-sectional surveys conducted in England and Wales between 2012 and 2022. The sample included 21,716 adults aged 18-69 years; 56.6% were female. Exposure to child maltreatment and household dysfunction in isolation were strong predictors of variant outcomes, whereas witnessing violence was not. However, additive models showed that witnessing violence amplified the measured risk beyond expected levels for being a victim or perpetrator of violence. The multiplicative effect of all three ACE categories demonstrated the highest level of risk (RRs from 1.7 to 7.4). Given the increased risk associated with co-occurring ACEs, it is crucial to target individuals exposed to any ACE category to prevent their exposure to additional harm. Implementing universal interventions that safeguard children from physical, emotional, and sexual violence is likely to mitigate a range of subsequent issues, including future involvement in violence.
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| S-EPMC192853 | biostudies-literature
Project description:Despite close links with ethnic identity and other health-relevant identities, there is surprisingly little work on national identity in the context of population health. National identity is particularly important in multi-national states, where national identity is contested and where different nationalities often reflect both distinct ethnic groups and competing civic visions of national boundaries. The present study examines health disparities between national identity groups in Wales, a constituent nation of the UK. Using data from the National Survey for Wales (n = 23,303), latent class analysis was used to identify national identity groups in Wales. Generalised linear mixed-effects models were then fitted to the data to identity disparities between groups in terms of self-reported general and mental health, both unconditionally and conditionally on several socio-demographic and geographic variables. Analyses identified five groups: Anglophone Welsh, British, Cymry Cymraeg (Welsh-speaking Welsh), English and Ethnically Diverse. Striking health disparities were found, with the Cymry Cymraeg and Ethnically Diverse groups reporting better health than the other groups, especially the Anglophone Welsh and the English. These disparities could not be accounted for by differences in demographic, socio-economic or geographic factors.
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Project description:The new United Nations Convention on the Rights of Persons with Disabilities creates a new paradigm for mental health law, moving from a focus on institutional care to a focus on community-based services and treatment. This article considers implementation of this approach in Africa.
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Project description:Background: The Mental Capacity Act (2005) of England and Wales described in statute a test to determine whether a person lacked the "mental capacity" to make a particular decision. No large-scale survey has explored experiences of capacity assessment across professional groups. Methods: We administered an opportunistic self-report questionnaire survey of professionals who undertake capacity assessments in England and Wales (n= 611). Topics of interest included; how often and where capacity assessment took place, self-ratings of competency and challenges experienced in assessment, use of psychological testing and concerns about undue influence. We analysed the quantitative responses using a mixed-methods approach using regression methods for the quantitative ratings and a thematic analysis for qualitative data. Results: Our sample included 307/611 (50.2%), social workers, 89/611 (14.6%) psychiatrists, 62/611 (10.1%) nurses, 46/611 (7.5%) clinical psychologists, 30/611 (4.9%) doctors from other medical specialties, 12/611 (2.0%) speech and language therapists and 8/611 (1.3%) solicitors. 53% of these professionals undertook more than 25 capacity assessments per year, with psychiatrists, social workers and nurses undertaking them the most frequently. Most professionals reported high self-ratings of confidence in their assessment skills, although non-psychiatrist doctors rated themselves significantly lower than other groups (p< .005). Most professionals (77.1%) were at least moderately concerned about undue influence, with people with dementia and learning disabilities and older adults considered to be the most at risk. Qualitative themes for challenges in capacity assessment included inter-disciplinary working, complicated presentations and relational issues such as interpersonal influence. Requests for support mainly focused on practical issues. Conclusions: Most professionals feel confident in their ability to assess capacity but note substantial challenges around practical and relational issues. Undue influence is a particularly common concern amongst professionals when working with service users with dementia and learning disabilities which public services and policy makers need to be mindful of.
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