Articles for tag: assessment, breach, conundrum, law, legal, psychiatry, regulation, rights, standards, statute, statutory

Section 136: A Framework in Crisis

February 15, 2025February 12, 2025 by TheEditor

From 2017 changes to the MHA 1983 reduced the period of detention under 136 from 72 hours to 24 hours, with a provision to extend to 36 hours. Mental Health Services had struggled to deliver when the timeframe was 72 hours. Now they struggle even more, leading to unquantified instances nationally where Trusts have had …

Section 62(1): the hard boundary between law and ethics

February 17, 2025February 1, 2025 by TheEditor

In a previous post I unpacked some of the key issues in Section 62(1). Appropriate study of this article will necessitate digestion of Fathoming Section 62 of the MHA 1983 – Investigative Psychiatry (April 2024). Understanding of this article depends on having a foundational understanding of Statute Law, what it means and the power of …

Is Diagnosis in Psychiatry More Art Than Science?

March 16, 2025January 25, 2025 by TheEditor

The claim that psychiatric diagnosis is “an art, not a science” is a dangerous myth, often perpetuated to the detriment of those struggling with mental illness. This misconception implies a reliance on subjective guesswork rather than the rigorous application of scientific principles that underpin other medical fields. While psychiatric diagnosis certainly presents unique complexities, it …

Mental Health Tribunals

February 5, 2025January 18, 2025 by TheEditor

This article provides a detailed explanation of Mental Health Tribunals (MHTs) within the context of the Mental Health Act (MHA) 1983 in England and Wales. The MHA 1983 (Amended 2007) provides the legal framework for the compulsory admission to hospital for treatment or assessment of individuals experiencing mental disorders that may pose a risk to …

The Role and Duties of Expert Witnesses in the UK Legal System

February 5, 2025December 24, 2024 by TheEditor

The role of the expert witness is frequently misunderstood. Contrary to certain portrayals in American media, which often depict expert witnesses as partisan advocates, expert witnesses within the UK legal system bear an overriding duty to the court itself. This fundamental distinction is crucial for a comprehensive understanding of the function and obligations of expert …

We Need to do Something about Smoking and Mental Health

March 14, 2025November 9, 2024 by TheEditor

This article is brazenly one-sided because it is about an addictive killing substance sold legally. The author is unapologetically anti-smoking because tobacco is the only killing substance sold legally for consumer use. Smoking (of tobacco) is normally seen as a physical health problem. This article will show it is a serious mental health problem as …

The Importance of the Nearest Relative in Mental Health Law

February 5, 2025May 25, 2024 by TheEditor

In mental health care (in England & Wales), the legal concept of the ‘nearest relative‘ (NR) holds significant weight. This pivotal role, enshrined in the Mental Health Act 1983, serves as a vital safeguard for patients who find themselves navigating the complexities of mental health treatment. The term should not simply be equated with ‘next …

Paragraph 98 and remote consultations

February 5, 2025March 1, 2024 by TheEditor

This blog has considered a number of issues relevant to prescribing of medications. Paragraph 98 is one of the most powerful. It is squarely designed to protect patients. You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign …

Understanding Your Rights: What Doctors Need to Know About the NHS Complaints Processes

October 30, 2024January 29, 2024 by TheEditor

Complaints – the very word can strike a chord in many of us, especially doctors working within the NHS, a system deeply rooted in service to the public. We understand that patients or their loved ones expressing dissatisfaction are ultimately highlighting opportunities for improvement. It is crucial that these concerns are met with a robust …

Asylums

April 12, 2024January 14, 2024 by TheEditor

“Asylums: Essays on the Social Situation of Mental Patients and Other Inmates,” written by sociologist Erving Goffman and published in 1961, is a seminal work in the field of sociology and particularly in the study of social institutions and mental health care. The book offers a profound analysis of life in “total institutions,” particularly focusing …

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Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences