Oates Jennifer, Brandon Toby, Burrell Carole, Ebrahim Selma, Taylor John, Veitch Paul
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Northumbria University, Newcastle-upon-Tyne, UK.
Int J Law Psychiatry. 2018 Sep-Oct;60:51-56. doi: 10.1016/j.ijlp.2018.07.005. Epub 2018 Jul 27.
The 2007 amendments to the Mental Health Act, 1983 in England and Wales enabled non-medics to take on the role of legally 'responsible clinician' for the overall care and treatment of service users detained under the Act, where previously this was the sole domain of the psychiatrist as Responsible Medical Officer. Following state sanction as an 'Approved Clinician', certain psychologists, nurses, social workers or occupational therapists may be allocated as a Responsible Clinician for specific service users. Between 2007 and 2017 only 56 non-medics had become Approved Clinicians. This study reports on a first national survey of 39 non-medical Approved Clinicians. Descriptive statistics and thematic analysis of free text answers are presented here. The survey results show the limited uptake of the role, save for in the North Eastern region of England. Non-medical Approved Clinicians were motivated by a combination of altruistic intents (namely a belief that they could offer more psychologically-informed, recovery-oriented care) and desire for professional development in a role fitting their expertise and experience. Barriers and facilitators to wider uptake of the role appear to be: organisational support, attitudes of psychiatrist colleagues and a potentially lengthy and laborious approvals application process. The survey is a starting point to further research on the interpretation and implementation of the range of statutory roles and responsibilities under English and Welsh mental health law.
2007年，英格兰和威尔士对1983年的《精神健康法》进行了修订，使非医学专业人员能够承担起对依据该法案被拘留的服务使用者进行全面护理和治疗的法定“责任临床医生”角色，而在此之前，这一角色完全由作为责任医疗官的精神科医生担任。在获得国家认可成为“认可临床医生”后，某些心理学家、护士、社会工作者或职业治疗师可能会被指定为特定服务使用者的责任临床医生。在2007年至2017年期间，只有56名非医学专业人员成为认可临床医生。本研究报告了对39名非医学认可临床医生进行的首次全国性调查情况。这里呈现了对自由文本回答的描述性统计和主题分析。调查结果显示，除了在英格兰东北部地区外，该角色的接受程度有限。非医学认可临床医生的动机是利他意图（即相信他们能够提供更具心理导向、以康复为导向的护理）以及渴望在适合其专业知识和经验的角色中实现职业发展这两者的结合。该角色更广泛应用的障碍和促进因素似乎包括：组织支持、精神科同事的态度以及可能漫长而繁琐的认可申请过程。这项调查是进一步研究英格兰和威尔士精神健康法规定的一系列法定角色和责任的解释与实施情况的起点。
