一项对1983年《精神健康法案》2007年修正案后英格兰精神健康法案评估的前瞻性定量研究：这些变化是否兑现了承诺？

A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?

作者信息

Singh Swaran P, Paul Moli, Parsons Helen, Burns Tom, Tyrer Peter, Fazel Seena, Deb Shoumitro, Islam Zoebia, Rugkåsa Jorun, Gajwani Ruchika, Thana Lavanya, Crawford Michael J

机构信息

Mental Health and Wellbeing, Warwick Medical School, Coventry, UK.

Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford-upon-Avon, UK.

出版信息

BMC Psychiatry. 2017 Jul 10;17(1):246. doi: 10.1186/s12888-017-1391-2.

DOI:10.1186/s12888-017-1391-2

PMID:28693512

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5504787/

Abstract

BACKGROUND

In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007.

METHOD

A prospective, quantitative study of MHA assessments undertaken between July-October 2008-11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases.

RESULTS

The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher's exact Χ p = 0.735). Only patients with LD and 'any other disorder or disability of the mind' were significantly more likely to be assessed under the MHA post implementation (Χ = 5.485, P = 0.018; Χ = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients.

CONCLUSIONS

In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.

摘要

背景

2008年，英格兰和威尔士实施了2007年《精神健康法》（MHA）对1983年《精神健康法》的修订案。这些修订旨在消除在拘留患有人格障碍（PDs）、性偏差和学习障碍（LDs）的高风险患者时所察觉到的障碍。AMEND研究旨在检验以下假设：这些变革的实施将导致根据2007年《精神健康法》接受评估和拘留的患有这些病症的患者数量或比例增加。

方法

对2008 - 2011年7月至10月期间在英国三个地点进行的《精神健康法》评估进行一项前瞻性定量研究。数据从用于《精神健康法》评估文件的本地表格和患者电子数据库中收集。

结果

在每个为期四个月的数据收集期间，评估的总数各不相同：2008年为1034次，2009年为1042次，2010年为1242次，2011年为1010次（n = 4415）。在这些评估中，2008年有65.6%的评估结果导致拘留，2009年为71.3%，2010年为64.7%，2011年为63.5%。将2008年的评估与2009年、2010年和2011年的综合数据进行比较时，拘留的优势比没有显著变化（OR = 1.025，费舍尔精确检验Χ p = 0.735）。只有患有学习障碍和“任何其他精神障碍或残疾”的患者在实施《精神健康法》后接受评估的可能性显著更高（分别为Χ = 5.485，P = 0.018；Χ = 24.962，P > 0.001）。在被拘留患者的诊断类别方面，实施后没有显著变化。