Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland.
Ir J Med Sci. 2020 Aug;189(3):1127-1134. doi: 10.1007/s11845-019-02163-9. Epub 2019 Dec 13.
This Doolin Memorial Lecture presents six suggestions for positive change in Ireland's mental health services, focused on legislation and rights: (a) revision of the Mental Health Act 2001 in line with existing recommendations, to better protect and promote a broad range of rights, including rights to treatment and liberty (which are related); (b) enhanced forensic mental health care to better protect and promote both treatment and liberty in this population; (c) prompt full implementation of the Public Health (Alcohol) Act 2018 to reduce alcohol-related harm and the opportunity cost of alcohol problems in the health service; (d) implementation of the Assisted Decision-Making (Capacity) Act 2015 to provide decision-making supports to the 29.4% of medical/surgical inpatients and 52.6% of psychiatry inpatients who lack full decision-making capacity for treatment decisions; (e) judicious medicalisation of our response to individual cannabis use (although legalisation is not advised); and (f) enhanced recognition of the social rights of the mentally ill, especially the right to housing. Attention to these areas would improve the quality of life and quality of liberty of people with mental illness and their families. Progress in these areas needs to be underpinned by enhanced involvement of service-users in planning and provision of care, increased funding of mental health services and particular attention to groups who are currently underserved, including children and adolescents. Enhanced attention to these areas would also help advance Ireland's national mental health policy, "A Vision for Change", which has yet to be implemented in full. That, too, would help.
这篇杜林纪念演讲提出了爱尔兰精神健康服务的六项积极变革建议，重点关注立法和权利：(a) 根据现有建议修订 2001 年《精神健康法》，以更好地保护和促进广泛的权利，包括治疗权和自由权（两者相互关联）；(b) 加强法医精神保健，以更好地保护和促进这一人群的治疗和自由；(c) 迅速全面实施 2018 年《公共卫生（酒精）法》，以减少酒精相关伤害和酒精问题在卫生服务中的机会成本；(d) 实施 2015 年《辅助决策（能力）法》，为 29.4%的内科/外科住院患者和 52.6%的精神科住院患者提供决策支持，这些患者在治疗决策方面缺乏完全的决策能力；(e) 明智地将我们对个人使用大麻的反应医疗化（尽管不建议合法化）；(f) 更加强调精神病患者的社会权利，特别是住房权利。关注这些领域将提高精神病患者及其家属的生活质量和自由质量。要在这些领域取得进展，需要服务使用者更多地参与规划和提供护理，增加精神健康服务的资金，并特别关注目前服务不足的群体，包括儿童和青少年。更多地关注这些领域也将有助于推进爱尔兰的国家心理健康政策《变革愿景》，该政策尚未全面实施。这也将有所帮助。
