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The law of mental health authorizes involuntary detention in a psychiatric facility, in the absence of wrongdoing, of competent persons suffering from mental disorder likely to result in harm. Some jurisdictions are said to justify detention exclusively on the basis of danger prevention alone, thus predicating any ensuing treatment on the detainee's categorical dignitary right to refuse treatment even while detained. Other jurisdictions are said to justify detention also on the basis of the detainee's need of treatment, thus rendering the authorization to detain as a concomitant authorization to apply compulsory treatment. This article argues that 'dangerousness' is conceptually insufficient to justify detention in a psychiatric facility. If danger prevention per se were the only purpose of detention, then a psychiatric facility could perhaps be viewed as a permissible, but certainly not as the necessary, locus of authorized detention. Two propositions follow from this observation. The first is that need of treatment, in addition to danger prevention, must be a criterion of mental health law detention. The article formulates this proposition through a detailed reading of the detention provision in the Ontario (widely regarded as a 'dangerousness' jurisdiction) Mental Health Act and relevant case law. The second proposition is that, as much as the right to refuse treatment, regular and ongoing access to treatment is, therefore, a necessary condition of the justifiability, if any, of mental health law detention. The article develops this proposition through analysis of recent Ontario case law on the constitutionality of mental health law detention. The upshot is that failure to offer treatment is as inconsistent with constitutionally recognized liberty interests as the imposition of treatment in the absence of consent. By way of conclusion, the article focuses on what might be called the turn to criminal law to elaborate and affirm, by analogy, the rights of mental health law detainees. The article suggests that, while helpful, the turn to criminal law, because it brings into relief the dimension of danger to others, may also obscure the specific conceptual core of mental health law addressing danger to self. [ABSTRACT FROM AUTHOR]

The law of mental health authorizes involuntary detention in a psychiatric facility, in the absence of wrongdoing, of competent persons suffering from mental disorder likely to result in harm. Some jurisdictions are said to justify detention exclusively on the basis of danger prevention alone, thus predicating any ensuing treatment on the detainee's categorical dignitary right to refuse treatment even while detained. Other jurisdictions are said to justify detention also on the basis of the detainee's need of treatment, thus rendering the authorization to detain as a concomitant authorization to apply compulsory treatment. This article argues that 'dangerousness' is conceptually insufficient to justify detention in a psychiatric facility. If danger prevention per se were the only purpose of detention, then a psychiatric facility could perhaps be viewed as a permissible, but certainly not as the necessary, locus of authorized detention. Two propositions follow from this observation. The first is that need of treatment, in addition to danger prevention, must be a criterion of mental health law detention. The article formulates this proposition through a detailed reading of the detention provision in the Ontario (widely regarded as a 'dangerousness' jurisdiction) Mental Health Act and relevant case law. The second proposition is that, as much as the right to refuse treatment, regular and ongoing access to treatment is, therefore, a necessary condition of the justifiability, if any, of mental health law detention. The article develops this proposition through analysis of recent Ontario case law on the constitutionality of mental health law detention. The upshot is that failure to offer treatment is as inconsistent with constitutionally recognized liberty interests as the imposition of treatment in the absence of consent. By way of conclusion, the article focuses on what might be called the turn to criminal law to elaborate and affirm, by analogy, the rights of mental health law detainees. The article suggests that, while helpful, the turn to criminal law, because it brings into relief the dimension of danger to others, may also obscure the specific conceptual core of mental health law addressing danger to self. [ABSTRACT FROM AUTHOR]

Background Taking care of patients posing an imminent threat to themselves or others is not a routine task for most family physicians. There is widespread uncertainty on practically dealing with mental instability and deciding whether an involuntary admission to a psychiatric clinic is necessary. Search methodology This article is based on various psychiatric S3 guidelines (including "Schizophrenie", "Diagnostik und Therapie Bipolarer Störungen"), as well as the S2k guideline "Notfallpsychiatrie" and the guideline "Nationale VersorgungsLeitlinie Unipolare Depression". Furthermore, we used professional articles in the family medicine online manual Deximed. Key messages When assessing suicidality physicians should directly address suicidal ideation. If patients feel urged to commit suicide or have already made plans to do so, they must be admitted to a psychiatric clinic voluntarily or, if necessary, by force. If the person is putting themself or others in danger involuntary hospitalisation may also be necessary in the context of other psychiatric illnesses, such as acute exacerbation of psychosis. A thorough examination to assess the need for hospitalisation by psychiatric specialists is compulsory upon arrival in the clinic. The patient is then heard by a local judge. A justifiable necessity may be assumed in case of acute psychomotor agitation and may require compulsory medication treatment even before police and/or emergency physicians arrive. Conclusions There are set guidelines concerning the management of patients posing an imminent threat to themselves or others and the course of action regarding involuntary hospitalisations. The decision as to whether involuntary hospitalisation is inevitable is not made by the treating family doctor but by district judges supported by psychiatric specialists. It may be helpful to provide psychiatric patients with an emergency card for acute crises. [ABSTRACT FROM AUTHOR]

Psychiatrische Stationen sind ein wichtiges Element in der psychiatrischen Versorgung von Menschen mit akuter Eigen- oder Fremdgefährdung. Leider kommt es in diesem Rahmen immer wieder auch zu Aggression, Gewalt (Konflikten) sowie zur Anwendung von Zwang (Eindämmung). Als entscheidender Faktor für den sachgemäßen Umgang mit diesen Situationen wird sowohl die Quantität als auch die Qualität der Mitarbeitenden angesehen. Vor diesem Hintergrund beschäftigt sich die vorliegende Untersuchung mit der Versorgungssituation auf akutpsychiatrischen Stationen. Die Hypothese lautet, dass sowohl die Größe der akutpsychiatrischen Station als auch die Anzahl der Pflegenden einen Einfluss auf das Vorkommen konflikthafter Situationen haben. Hierfür sind Daten in 6 Kliniken auf insgesamt 12 psychiatrischen Stationen erfasst worden. Als Erfassungsinstrument diente die Patient Staff Conflict Checklist - Shift Report (PCC-SR). Insgesamt konnten 2026 Schichten (Früh‑, Spät- und Nachtschicht) erfasst und ausgewertet werden. Die personelle Besetzung der Stationen mit Pflegepersonal variierte erheblich. Die Ergebnisse zeigen, dass sowohl die Stationsgröße als auch die Anzahl der Pflegepersonen auf akutpsychiatrischen Stationen einen signifikanten Einfluss auf das Vorkommen von Konflikten haben. In den Ergebnissen zeigt sich weiterhin, dass sich die Inzidenz des konflikthaften Verhaltens von Patienten sowohl im Hinblick auf die untersuchten Stationen der beteiligten Krankenhäuser als auch im Hinblick auf die betrachteten Dienstzeittypen unterscheiden. Darüber hinaus zeigt sich, dass das Ausmaß der Schließung einer Akutstation und die Größe einer Station einen negativen Einfluss auf die Inzidenz von Konflikten im stationär akutpsychiatrischen Kontext haben. Das Auftreten konflikthaften Verhaltens kann zur Fremd- oder Selbstgefährdung und zu einer Vielzahl deeskalierender und eindämmender Maßnahmen führen. Hierfür sind entsprechende personelle Ressourcen erforderlich. [ABSTRACT FROM AUTHOR]

Os sujeitos infratores à lei, considerados portadores de doença mental e declarados legalmente inimputáveis, são objeto das denominadas medidas de segurança. Estas sanções legais dispõem, em alguns casos, a reclusão desta população em instituições específicas. Para definir essa condição de inimputável é necessária a realização de um laudo psiquiátrico que define também sua patologia e grau de periculosidade. Essa associação do discurso psiquiátrico com o jurídico e as práticas institucionais relacionadas leva à deterioração individual e social desta população e, com freqüência, à sua cronificação institucional. O propósito desta pesquisa é analisar as características destes discursos e sua funcionalidade institucional e social. Os laudos pertencentes aos sujeitos que cumprem medida de segurança na Ala de Tratamento Psiquiátrico do Presídio da Colméia de Brasília constituem a informação principal sobre a qual se baseia a análise. A Análise de Discurso e a Análise Institucional são as ferramentas metodológicas utilizadas para esse fim.Individuals who break the law, considered mentally ill and declared legally exempt from punishment are object to what is called security measures. These legal sanctions, in some cases, dispose of the incarceration of this population in specific institutions. To define the condition of exemption from punishment, it's necessary to carry out a psychiatric assessment that defines the pathology and level of danger to others. The association of psychiatric and judiciary discourse, and related institutional practices, conveys to individual e social deterioration and, frequently, to a chronic institutionalization. Analysis was based on the data taken from the medical records of subjects who are under security measures in the Psychiatric Treatment ward of the Presídio da Colméia in Brasília. Discourse analysis and Institutional analysis are methodological tools used for these objectives.

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Copyright of Der Nervenarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)