非临床和超法律因素对决定强制入院精神病院的影响。
Non-clinical and extra-legal influences on decisions about compulsory admission to psychiatric hospital.
机构信息
College Research Unit, Royal College of Psychiatrists, London, UK.
出版信息
J Ment Health. 2003;12(2):119-30. doi: 10.1080/0963823031000103434.
BACKGROUND
On the eve of reform of the 1983 Mental Health Act (MHA), little is known about how decisions to admit people under its powers are made.
AIMS
To describe non-clinical and extra-legal influences on professionals' decisions about compulsory admission to psychiatric hospital.
METHOD
Participant-observation of MHA assessments, including informal and depth interviews with the practitioners involved, and follow-up interviews with the people who had been assessed.
RESULTS
A candidate patient's chance of being sectioned is likely to increase when there are no realistic alternatives to in-patient care. This typically occurs when staff have insufficient time to set such alternatives in place and are unsupported by other professionals in doing this. Outcomes may also be affected by local operational norms and the level of professional accountability for specific MHA decisions.
CONCLUSION
Non-clinical and extra-legal factors explain some of the geographical variation in MHA admission rates. If compulsion is to be used only in the 'last resort', administrators and policy makers should look beyond legislative change to matters of resource allocation and service organisation.
背景
在 1983 年《精神卫生法》（MHA）改革前夕，人们对该法权力下的人员入院决策过程知之甚少。
目的
描述非临床和法律之外的因素对专业人员关于强制住院治疗的决定的影响。
方法
对 MHA 评估进行参与式观察，包括对相关从业者的非正式和深度访谈，以及对接受评估的人员进行后续访谈。
结果
当没有实际的住院替代方案时，候选患者被强制住院的可能性会增加。这种情况通常发生在工作人员没有足够的时间来制定替代方案，并且没有其他专业人员的支持时。结果也可能受到当地操作规范和对特定 MHA 决策的专业责任水平的影响。
结论
非临床和法律之外的因素解释了 MHA 入院率的一些地域差异。如果强制手段仅在“万不得已”时使用，管理人员和政策制定者应该超越立法变革，关注资源分配和服务组织等问题。
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