Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
Int J Law Psychiatry. 2020 May-Jun;70:101564. doi: 10.1016/j.ijlp.2020.101564. Epub 2020 Apr 22.
Many countries have enacted, or are in the process of enacting, emergency mental health legislation in response to the global pandemic of Covid-19 (coronavirus). In Ireland, the Emergency Measures in the Public Interest (Covid-19) Act, 2020 amends the Mental Health Act 2001 to permit the Mental Health Commission to request an independent psychiatric report about an involuntary patient from any consultant psychiatrist who is not treating the patient (and not just those on its designated panel). This independent examination may occur 'in person', 'by other appropriate means', or even, 'due to the exigencies of the public health emergency', not occur at all, once this is explained in the resultant report. The 2020 Act acknowledges that 'the exigencies of the public health emergency' might hamper the independent psychiatrist's work and requires a written report from the patient's treating psychiatrist 'no earlier than the day before' the tribunal, in lieu of the psychiatrist physically attending a tribunal hearing, although, if possible, they will attend (i.e. phone in to) a tribunal held by conference call. The 2020 Act permits the Mental Health Commission to, if necessary, appoint tribunals 'consisting of one member who shall be a practising barrister or solicitor'. Such a tribunal shall, if possible, consult with a consultant psychiatrist if the reports from the independent psychiatrist and treating psychiatrist conflict or if it is otherwise 'necessary in the interest of the patient'. A tribunal can extend an involuntary order by a second period of 14 days 'of its own motion if the tribunal, having due regard to the interest of the patient, is satisfied that it is necessary'. Tribunals for current involuntary patients will be prioritised over retrospective tribunals for discharged patients; a tribunal can direct a witness to provide 'a written statement' rather than attending; and the patient can make written representation to the tribunal instead of physically attending a tribunal hearing, although they may attend (i.e. phone in to) a tribunal held by conference call. Psycho-surgery for involuntary patients is banned. While it is clear that revisions are urgent and necessary in light of Covid-19, the proportionality of these changes will depend on how, and the extent to which, they are used in practice. With good communication, efficient team-working and close adherence to professional codes of practice and ethics, it is hoped that these amendments will result in a review system that is as reasonable, robust and reassuring as the current, highly unusual circumstances permit.
许多国家已经颁布或正在颁布应对新冠疫情的紧急心理健康法规。在爱尔兰，2020 年的《公共利益紧急措施（新冠病毒）法》修订了 2001 年的《精神卫生法》，允许精神健康委员会向任何未治疗患者的顾问精神病医生请求关于非自愿患者的独立精神病报告（而不仅仅是那些在其指定小组中的医生）。这种独立检查可以“亲自进行”，“通过其他适当的方式”，甚至“由于公共卫生紧急情况的需要”，根本不进行，一旦在结果报告中进行了解释。2020 年的法案承认，“公共卫生紧急情况的需要”可能会妨碍独立精神病医生的工作，并要求患者的主治精神病医生在法庭前“不早于前一天”提交书面报告，代替精神病医生亲自出席法庭听证，尽管如果可能的话，他们将通过电话会议参加法庭听证。2020 年的法案允许精神健康委员会在必要时任命“由一名执业大律师或律师组成的法庭”。如果独立精神病医生和主治精神病医生的报告存在冲突，或者出于“患者利益的需要”，则这样的法庭应尽可能与顾问精神病医生协商。法庭可以自行将非自愿令延长 14 天，如果法庭在适当考虑患者利益的情况下，认为有必要延长。对于当前的非自愿患者的法庭将优先于已出院患者的回溯法庭；法庭可以指示证人提供“书面陈述”而不是出庭；患者可以向法庭提出书面陈述，而不是亲自出席法庭听证，但他们可以通过电话会议参加法庭听证。对非自愿患者进行精神外科手术被禁止。虽然鉴于新冠疫情，修订是紧急和必要的，但这些变化的相称性将取决于它们在实践中的使用方式和程度。通过良好的沟通、高效的团队合作以及密切遵守专业行为准则和道德规范，希望这些修正案将导致一个审查系统，在当前高度特殊的情况下尽可能合理、稳健和令人放心。
