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Choosing methods in mental health research: mental health research from theory to practice
- Editors:
- SLADE Mike, PRIEBE Stefan, (eds.)
- Publisher:
- Routledge
- Publication year:
- 2006
- Pagination:
- 298p., bibliog.
- Place of publication:
- London
This book is concerned with how to choose the most appropriate mental health research method, not only to address a specific question, but to maximize the potential impact on shaping mental health care. The editors focus attention on the types of audience that the researcher is seeking to influence, the types of evidence each audience accepts as valid, and the relative strengths and limitations of each type of methodology. A range of research methodologies are described and critically appraised, and the use of evidence by different groups is discussed. This produces some important findings about the interplay between research production and consumption, and highlights directions for future mental health research theory and practice. The findings presented here will be relevant to mental health service users and professionals who use research evidence to inform decision-making.
Repatriating psychiatric patients
- Authors:
- GREEN Lucinda, NAYANI Tony
- Journal article citation:
- Psychiatric Bulletin, 24(11), November 2000, pp.405-408.
- Publisher:
- Royal College of Psychiatrists
In a psychiatric intensive care unit in central London 17 percent of consecutive admissions between 1 October 1997 and 1 October 1998 were foreign nationals from European Union (EU) countries. This paper discusses the experience of arranging repatriation and some of the relevant legal, ethical and clinical issues involved and reports the results of contacting all the EU embassies regarding the process of repatriating psychiatric patients to their respective countries.
Psychiatric issues in retrospective challenges of testamentary capacity
- Authors:
- SHULMAN Kenneth I., COHEN Carole A., HULL Ian
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(1), January 2005, pp.63-69.
- Publisher:
- Wiley
Challenges to Wills on the basis of lack of testamentary capacity are likely to increase due to a combination of economic factors, high prevalence of mental disorders in old age and the complexity of many modern families. Geriatric psychiatrists and other experts will be asked to provide expert assessment of the testamentary capacity of individuals whose Wills are being challenged retrospectively. The traditional criteria described in the Banks vs Goodfellow case have been held as the standard for testamentary capacity. However, these criteria may not be comprehensive enough for the coming generation of expert assessors. The literature and selected international case law relevant to testamentary capacity were reviewed. Particular focus is placed on the conceptual and empirical approaches to the assessment of complex capacities that may inform the development of specific legal standards. In addition, 25 consecutive medico-legal reports on retrospective testamentary capacity were analyzed according to co-morbid medical and psychiatric disorders as well as psychosocial and behavioural variables. Illustrative case vignettes are included. The typical profile for retrospective challenges to testamentary capacity included a radical change from a previous Will (72%), where undue influence was alleged (56%), in a testator with no biological children (52%), who executed the Will less than a year prior to death (48%). Co-morbid conditions were dementia (40%), alcohol abuse (28%) and other neurological/psychiatric conditions (28%). While Banks vs Goodfellow continues to provide a sound basis for assessing testamentary (task-specific) capacity, the complexity and subtlety of the issues reflected in these cases highlight the need to go beyond the traditional criteria and assess situation-specific factors. Expert assessors need to determine whether the testator appreciated the consequences of executing or changing a Will, especially when there has been a radical change in the context of a complex or conflictual family environment. Empirical studies addressing the cognitive functions relevant to testamentary capacity and the development of legal standards based on a competency construct may also help to inform retrospective capacity assessments.
Delivering children's mental health services: just who has the authority to make the decisions count?
- Author:
- SUTTON Adrian
- Journal article citation:
- Young Minds Magazine, 44, January 2000, pp.14-15.
- Publisher:
- YoungMinds
In an era of joined-up thinking the author a consultant child and adolescent psychiatrist uses examples from his own clinical experience to ask just how effective and substantive can be attempts to forge a more coordinated approach to the delivery of child and adolescent mental health service, until questions of authority and responsibility are thrashed out.
New mental health legislation. A lifesaver? Changing paradigm and practice
- Author:
- PLUMB Anne E.
- Journal article citation:
- Social Work Education (The International Journal), 18(4), November 1999, pp.459-478.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The British Government is making changes to its Mental Health Legislation. It intends to 'ensure compliance with appropriate treatment' and to introduce 'assertive outreach'. This article challenges Government claims that this will mean safe and effective care and a proper balance between the interests of the public and the rights of the individual (Department of Health, Press release, 29 July 1998). Since the Mental Health Act 1983, there have been significant developments in Mental Health Service User and Psychiatric System Survivor perspectives, organisation, and action. Changes, too, are emerging in Social Services paradigm and practice. Given these developments, the Government's changes could become, instead, the latest scandal in the history of psychiatric treatments. This article questions the premise on which medical treatment without consent is justified - that so-called mental illness prevents people from understanding what is 'best for them'. It asserts that treatment without consent is a violation of body and self, a trauma, and an abuse of power, and that the way should be paved not for increasing, but for removing treatment without consent and reliance on drug remedies.
What their words are telling us: ethical issues in nursing practice
- Authors:
- DAVIDSON Ben, CAMERON Sally
- Journal article citation:
- Mental Health Care, 1(6), February 1998, pp.199-202.
- Publisher:
- Pavilion
Nurses face difficult ethical decisions every day of their working lives. The greatest, perhaps, is to follow a model of care distinct from conventional psychiatry; one which validates the individual's unique experience of reality. The authors explain in the context of working with elderly people.
Impaired judgment: a useful symptom of dementia?
- Authors:
- HEAD L., BERRIOS G.E.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 11(9), September 1996, pp.779-785.
- Publisher:
- Wiley
'Impaired judgment' remains a diagnostic (and predictive) criterion for delirium, dementia and substance-related disorders, and yet its diagnosis and measurement are hampered by the absence of an operational definition. Most of the important research into judgment as a psychological function has been carried out in development and industrial psychology, in the experimental analysis of perception, medical diagnosis and legal decision-making. Models generated in these fields, although important, are only tangentially relevant to 'impaired judgment' as it is met with in clinical practice. This article explores some models of judgment and their application to dementia. It concludes that judgment is not a unitary function but a composite of subroutines. Hence, both low-and high-level analyses are required: the former to explore aetiology, differential diagnosis and treatment, the latter for the assessment of psychosocial competence. A model for the understanding of judgment is also suggested.
Intentions of first-degree relatives of patients with Alzheimer's disease to seek a cognitive status examination
- Authors:
- WERNER Peerla, HEINIK Jermia
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.479-486.
- Publisher:
- Wiley
The aim of the present study was to examine the factors influencing intentions to seek a cognitive status evaluation among first-degree relatives of persons with Alzheimer's disease. Phone interviews were conducted with 93 first-degree relatives of persons with Alzheimer's disease, recruited from a large memory clinic. Intentions to seek a cognitive status examination were examined by asking participants to rate their willingness to seek a cognitive status examination during the next year and during the next five years. Independent variables included participants' and patients' characteristics, caregiving characteristics, knowledge about AD, worries about memory problems, and perceptions of the benefits and barriers of seeking a cognitive status examination. Overall, first-degree relatives reported only moderate intentions to seek a cognitive status examination. Their willingness to seek an examination was related to the characteristics of the first-degree relative (income and subjective memory), the characteristics of the patients (behavioral problems), the caregiving characteristics (primary caregiver), and to the perceptions of barriers associated with the examination. These findings stress the complexity of the decision-making process confronting first-degree relatives regarding their intentions to seek a cognitive status examination, and suggest the need to provide information to reach an informed decision.
The Disability Discrimination Act 1995 and psychiatry: lessons from the first seven years
- Author:
- GLOZIER Nick
- Journal article citation:
- Psychiatric Bulletin, 28(4), April 2004, pp.126-129.
- Publisher:
- Royal College of Psychiatrists
The aim was to extract relevant information for clinicians from reported and/or accessible cases involving psychiatric illness brought under the Disability Discrimination Act 1995 (DDA). Institutional databases were searched for DDA cases and relevant guidance from case law extracted. Over half the cases reaching higher courts involve psychiatric illness. A number of decisions provide guidance for clinicians wishing to aid their own patients, and those involved as expert witnesses. These cover which conditions are included as impairments (almost everything in ICD-10), what associated effects are to be considered, and the relevance of comorbidity and treatment. Cases often involve recovery of clinical documents that reveal interesting variation in professional standards. Virtually all patients of psychiatrists in secondary care would be covered by the DDA. Knowledge of this Act could be used to enhance a patient’s access to employment and services, and potentially overcome some of the effects of stigmatisation.
Survey of expert second opinions in a tertiary psychiatric out-patient clinic in the Yorkshire region between 1988 and 2000
- Authors:
- NIRODI Pratibha, et al
- Journal article citation:
- Psychiatric Bulletin, 27(10), November 2003, pp.416-420.
- Publisher:
- Royal College of Psychiatrists
A medical second opinion is an expert clinical case evaluation requested by a colleague for a patient already under specialist care. There is no literature on the provision for second opinions in psychiatric practice other than those relating to the Mental Health Act 1983, and the availability of clinics offering second opinions varies greatly from one area to another. The authors undertook a survey of an expert second opinion service in Leeds over the period 1988-2000 and examined the case notes of 103 referred patients, of whom 71 were included in the analysis data. In the majority of cases diagnoses were not changed, but alternative treatment strategies were suggested. The exception was for patients with a diagnosis of personality disorder, in whom neither a new diagnosis nor alternative management was commonly suggested. Half of the assessments were completed in a single visit, but a substantial minority required further evaluation as outpatients, close follow-up or even hospital admission for detailed review. The authors believe that a second opinion service offers clinicians valuable support and expertise, especially in sector psychiatry. Evidence presented suggests that further therapeutic options are available for many patients regarded as 'difficult to treat'. In some cases this may involve a period of observation free of all psychotropic medication. As in other specialities, psychiatrists should be aware of the value of further advice for patients with particularly refractory or unusual disorders.