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Civil detentions of older adults under successive Scottish mental health legislation: a comparative analysis

Published online by Cambridge University Press:  01 March 2011

Gary S. Stevenson
Gary S. Stevenson*
Affiliation:
Department of Psychiatry (Older Adults) NHS Fife, Stratheden Hospital, Cupar, Fife, UK
*
Correspondence should be addressed to: Dr Gary S Stevenson, Medical Offices, Stratheden Hospital, Cupar, Fife KY15 5RR, UK. Phone: +44 1334 696368; Fax: +44 1334 696042. Email: gstevenson@nhs.net.
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Abstract

Background: Many countries have adopted new mental health legislation, with the detention of adults for treatment of mental disorders remaining an integral part of such policies. However, there are relatively few publications on the use of mental health legislation in the detention of older adults. This paper examines the civil detention of older adults in one Scottish region under successive mental health legislation.

Method: This prospective study collected data primarily by clinician-based interviews on all emergency detentions under the Mental Health (Scotland) Act 1984 of older adults in 1994 and compared these with all emergency and initial short-term detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 of older adults during 2008 in the same Scottish region.

Results: There were a total of 124 detentions, with an initial rate of 68 increasing to 141 detentions per 100,000 of the respective over-65 year age populations, a two-fold increase. Compared to the 1994 patient cohort, the 2008 cohort had higher rates of over 85-year-olds (18.4% v 5.4%) and organic mental disorders (74.7% v 56.8%) and were significantly more likely to be detained by consultant psychiatrists (73.6% v 18.9%) during working hours (87.4% v 48.6%) and proceed to six-month detention orders (31% v 10.8%).

Conclusion: The observed higher rates and longer periods of detention in the 2008 cohort may reflect changes in clinical attitudes and legal requirements from a previous reliance on the common law doctrine of necessity to the requirements of a more legalistic framework, and may signal future clinical requirements, given the aging population, pointing towards the need for earlier recognition and management of clinical issues in an attempt to minimize the “necessity” of clinico-legal intervention.

Keywords

Mental Health (Care and Treatment) (Scotland) Act 2003emergency ordergeriatricdementiacommon lawconsultant psychiatrist
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1344 - 1353
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Akuffo, K. (2004). The involuntary detention of persons with mental disorder in England and Wales: a human rights critique. International Journal of Law and Psychiatry, 27, 109–133.CrossRefGoogle Scholar
Aitkinson, J. and Patterson, L. (2001). Review of Literature Relating to the Mental Health Legislation. Edinburgh: Scottish Executive Research Unit.Google Scholar
Aitkinson, J. M., Lorgelly, P., Reilly, J. and Stewart, A. (2007). The Early Impact of the Administration of New Compulsory Powers under the Mental Health (Care and Treatment) (Scotland) Act 2003. Available at: http://www.scotland.gov.uk/Publications/2007/08/27160321/0.Google Scholar
Audini, B. and Lelliot, P. (2002). Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. British Journal of Psychiatry, 180, 222–226.CrossRefGoogle ScholarPubMed
Baig, B. J., Walker, J., Crowe, E. S., MacHale, S. M., Aditya, H. and Potts, S. G. (2008). Knowledge about the Scottish Mental Health Act in a general hospital setting. Scottish Medical Journal, 53 (2), 15–17.CrossRefGoogle Scholar
Begum, M., Helliwell, R. and MacKay, A. (2004). Difficulties with use of the Mental Health (Scotland) Act 1984 by general practitioners in rural Scotland. Psychiatric Bulletin, 28, 248–250.CrossRefGoogle Scholar
Blank, K., Vingiano, W. and Schwartz, H. I. (1989). Psychiatric commitment of the elderly. Journal of Geriatric Psychiatry and Neurology, 2, 140–144.CrossRefGoogle ScholarPubMed
Carney, T. (2007). Mental health legislation in the Commonwealth. Current Opinion in Psychiatry, 20, 482–485.CrossRefGoogle ScholarPubMed
Department of Health (1999). Inpatients Formally Detained in Hospitals under the Mental Health Act 1983 and other Legislation, England 1988–89 to 1998–99. London: Government Statistical Service.Google Scholar
Deshpande, N., Morton, T., Haque, S. and Oyebode, F. (2007). Appeals to the Mental Health Review Tribunal in an ageing population. Medicine, Science and the Law, 48, 246–250.CrossRefGoogle Scholar
Feehan, C. J. (1994). Audit of the use of the Mental Health Act in a psychogeriatric hospital. International Journal of Geriatric Psychiatry, 9, 563–565.CrossRefGoogle Scholar
General Register Office for Scotland (2010). Mid-2009 Population Estimates, Scotland. Available at: www.gro-scotland.gov.uk/statistics/publications-and-data/population-estimates/mid-year/Google Scholar
Gilmore, C., Wood, G. C. and Rigby, J. C. (1994). Elderly patients and the Mental Health Act 1983. International Journal of Geriatric Psychiatry, 9, 809–818.CrossRefGoogle Scholar
Hatfield, B., Huxley, P. and Mohamad, H. (1997). Social factors and compulsory detention of psychiatric patients in the UK. International Journal of Law and Psychiatry, 20, 389–397.CrossRefGoogle Scholar
HL v UK (2004). European Court of Human Rights (app. No. 45508/99). Judgment Strasbourg, 5 October.Google Scholar
Jacob, C. and Freer, T. (2005). Cross-sectional survey of the use of Section 5(2), Mental Health Act 1983, within a psychiatric hospital. Medicine, Science and the Law, 45, 129–134.CrossRefGoogle ScholarPubMed
Jacoby, R. (2002). Old age psychiatry and the law. British Journal of Psychiatry, 180, 116–119.CrossRefGoogle ScholarPubMed
Kallert, T. W., Glockner, M. and Schutzwohl, M. (2008). Involuntary vs. voluntary hospital admission: a systematic literature review on outcome diversity. European Archives of Psychiatry and Clinical Neurosciences, 258, 195–209.CrossRefGoogle ScholarPubMed
Katsakou, C. and Priebe, S. (2006). Outcomes of involuntary hospital admission – a review. Acta Psychiatrica Scandinavica, 114, 232–241.CrossRefGoogle ScholarPubMed
Kearney, N. and Treloar, A. (2000). In the light of Bournewood: changes in the management of elderly incapacitated patients. Psychiatric Bulletin, 24, 52–54.CrossRefGoogle Scholar
Keown, P., Mercer, G. and Scott, J. (2008). Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996–2006. BMJ, 337, a1837.CrossRefGoogle ScholarPubMed
Lelliott, P. and Audini, B. (2003). Trends in the use of Part II of the Mental Health Act 1983 in seven English local authority areas. British Journal of Psychiatry, 182, 68–70.CrossRefGoogle ScholarPubMed
Lyons, D. (2008). New mental health legislation in Scotland. Advances in Psychiatric Treatment, 14, 89–97.CrossRefGoogle Scholar
Maxmin, K., Cooper, C., Potter, L. and Livingston, G. (2009). Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients. International Journal of Geriatric Psychiatry, 24, 1367–1375.CrossRefGoogle ScholarPubMed
McPherson, A. and Jones, R. G. (2003). The use of Sections 2 and 3 of the Mental Health Act (1983) with older people: a prospective study. Aging and Mental Health, 7, 153–157.CrossRefGoogle ScholarPubMed
Mental Health Tribunal for Scotland (2010). Annual Report 2010. Edinburgh: Mental Health Tribunal for Scotland. Available at: http://www.mhtscotland.gov.uk/mhts/files/members_area_files/AnnualReport2010.pdfGoogle Scholar
Mental Welfare Commission for Scotland (2007). Annual Report 2006–7. Edinburgh: Mental Welfare Commission for Scotland.Google Scholar
Mental Welfare Commission for Scotland (2008). Annual Report 2007–8. Edinburgh: Mental Welfare Commission for Scotland.Google Scholar
Morris, C. and Anderson, I. M. (1994). The use of the Mental Health Act in elderly patients in one health district. Psychiatric Bulletin, 18, 459–461.CrossRefGoogle Scholar
Mukherjee, S. and Shah, A. (2001). The prevalence and correlates of capacity to consent to a geriatric psychiatry admission. Aging and Mental Health, 5, 335–339.CrossRefGoogle ScholarPubMed
Mulder, C. L. et al. (2008). Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000–2004. International Journal of Law and Psychiatry, 31, 331–336.CrossRefGoogle ScholarPubMed
Neville, P., Boyle, A. and Baillon, S. (1999). A descriptive survey of acute bed usage for dementia care in old age psychiatry. International Journal of Geriatric Psychiatry, 34, 348–354.3.0.CO;2-B>CrossRefGoogle Scholar
Niveau, G. and Materi, J. (2007). Psychiatric commitment: over 50 years of case law from the European Court of Human Rights. European Psychiatry, 22, 59–67.CrossRefGoogle ScholarPubMed
Rimmer, M.A., O'Connor, S. and Anderson, D. (2002). Appeal against detention under the Mental Health Act 1983: relationship to age and incapacity. International Journal of Geriatric Psychiatry, 17, 884–885.CrossRefGoogle ScholarPubMed
Salib, E., Tadros, G., Ambrose, A. and Allington, M. (2000). Detention of elderly psychiatric inpatients under Section 5(2) of the Mental Health Act 1983. Medicine, Science and the Law, 40, 158–163.CrossRefGoogle ScholarPubMed
Scottish Government (2010). Adults with Incapacity (Scotland) Act 2000. Code of Practice (Third Edition): For Practitioners Authorised to Carry Out Medical Treatment or Research Under Part 5 of the Act. http://www.scotland.gov.uk/Publications/2010/10/20153801/0Google Scholar
Shah, A. and Heginbotham, C. (2008). What factors are associated with the presence of mental health legislation? A cross-national study. International Psychiatry, 5 (3), 69–71.CrossRefGoogle ScholarPubMed
Shah, A. and Joels, S. (2006). Appeals by the elderly against compulsory detention under the Mental Health Act 1983. International Journal of Geriatric Psychiatry, 21, 1213–1214.CrossRefGoogle ScholarPubMed
Smith, H. and White, T. (2007). Before and after: introduction of the Mental Health (Care and Treatment)(Scotland) Act 2003. Psychiatric Bulletin, 31, 374–377.CrossRefGoogle Scholar
Stevenson, G. S. (1999). Emergency psychiatric detentions: inter-regional comparison of Sections 24 and 25 of the Mental Health (Scotland) Act 1984. Scottish Medical Journal, 44, 111–113.CrossRefGoogle ScholarPubMed
Stevenson, G. S. (2003). Emergency psychiatric detentions in a Scottish health region: the use of Sections 24 and 25 of the Mental Health (Scotland) Act 1984. International Journal of Law and Psychiatry, 26, 257–267.CrossRefGoogle Scholar
Stevenson, G. S. (in press). Detentions of older adults under the Mental Health (Care and Treatment) (Scotland) Act 2003. Medicine, Science and the LawGoogle Scholar
Stevenson, G. S., Ryan, T. and Anderson, S. (2009). Principles, patient welfare and the Adults with Incapacity (Scotland) Act 2000. International Journal of Law and Psychiatry, 32, 120–126.CrossRefGoogle ScholarPubMed
Taylor, J. and Idris, K. (2003). Use of the Mental Health (Scotland) Act (1984) in south Glasgow. Psychiatric Bulletin, 27, 141–144.CrossRefGoogle Scholar
World Health Organization (1992). The ICD 10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.Google Scholar
World Health Organization (2008). Policies and Practices for Mental Health in Europe: Meeting the Challenges. Geneva: WHO.Google Scholar
Zinkler, M. and Priebe, S. (2002). Detention of the mentally ill in Europe – a review. Acta Psychiatrica Scandinavica, 106, 3–8.CrossRefGoogle ScholarPubMed