key elements of mental health law reform: a clinical perspective brendan kelly mater misericordiae...

Key Elements of Mental Health Law Reform: A Clinical Perspective

Brendan Kelly

Mater Misericordiae University HospitalUniversity College Dublin

Ireland meets 80 out of 166 standards (48.2%)

Chief deficits Promoting rightsRights of families and carersVoluntary patientsVulnerable groupsEconomic and social rights

Capacity legislation

Arrangement-focussed view of justice

Realization-focussed view of justice

n = 81 recently detained individuals

Treatment was beneficial 78%Knew they had been detained 86%Tribunal made this easier to accept 46%Negative impact on family relationships 28%Negative impact on doctor-patient relationship 27%

n = 820 GPs

Not user-friendly 63%

Increased workload 27%

n = 321 psychiatrists

Training was satisfactory 84%Increased workload 69%Decreased time with service-users 27%Changes in relationships with service-users 41%….more legalistic, conflicted relationships

Re-define “voluntary patient”Strengthen “best interests” dimensionIntroduce cumulative tribunal “case-law”Reduce legalismBroaden criteria for Circuit Court appeal …“approved mental health professionals”?

Mental capacity legislation...

Best ways to increase observance of human rights of the mentally ill:

Social policyMental health policyMental health law

Kelly BDPenrose’s Law in Ireland: Ecological Analysis of Psychiatric Inpatients and Prisoners, 1963-2003. Irish Medical Journal 2007; 100: 373-4

Best ways to increase observance of human rights of the mentally ill:

Social policyMental health policyMental health law

“Medicine is a social science, and politics nothing but medicine at a larger scale”

Rudolf Virchow(1821-1902)

Key Elements of Mental Health Law Reform: A Clinical Perspective

Brendan Kelly

Mater Misericordiae University HospitalUniversity College Dublin

brendankelly35@gmail.com