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The U.S. mental health service delivery system consists of a broad array of inpatient and ambulatory services operated under governmental, corporate, nonprofit, and entrepreneurial auspices. Granted this complex mixture of control patterns, a primary question to be addressed by this paper is the degree to which this set of services can be conceptualized as a system at any level of social organization beyond a single control point for a subset of services. This paper will also explore the utility of systems formulations, including cybernetic processes, for addressing the question of whether mental health services can be controlled and directed to such a degree that they act in concert across different control points. Reference will be made to exogenous systems, such as public and private reimbursement programs, that may influence control processes. Some directions for future research will also be explored.

The purpose of this paper is to measure any impact that IMHA support had on patient’s self-determination.

The study used a questionnaire design, co-produced with patients to ensure question relevance, accessibility and ease of use. The theoretical framework used by the study was Deci & Ryan’s empirically validated self-determination theory (SDT) as it is predictive, across cultures and domains (including healthcare), of psychological well-being and self-determined action following the satisfaction of three fundamental human needs for autonomy, competence and relatedness.

Following advocacy support, increased self-determination, was found in 70 percent of the patients surveyed. In this study, increased self-determination was inferred by patients’ subjective responses to survey questions which measured satisfaction with contextual aspects of autonomy, competence and relatedness. The extensive SDT research has identified that the satisfaction of these needs is essential for psychological well-being and a prerequisite for self-determined and motivated action. Research has also linked psychological needs fulfilment to the personal recovery journey for those diagnosed with a mental illness.

Although limited, qualitative research evidence has identified that IMHA support helps to empower their partners (referred to in the text as patients or patient partners) to be more self-determined. This is an important finding, particularly for those patient partners detained under the Mental Health Act, given the often disempowering and autonomy reducing nature of mental illness and the characteristics of detained environments. However, a gap in the literature exists for quantitative outcome data identifying the specific impact that IMHA support has for patients. Obtaining measurable outcome data which seek to understand how and why Independent Mental Health Advocacy support impacts its patient partners is essential for developing and validating outcome measures that can lead to best practice improvements in IMHA service delivery. Furthermore, this knowledge is pivotal in optimizing IMHA services’ potential for empowering patients and providing commissioners with the much-needed evidence for effective commissioning of such services.

The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.

A Delphi method was used to elicit views from Irish forensic psychiatrists, a legal expert and an expert in ethics using a structured questionnaire. Themes were extracted from the results of the questionnaire to propose a management algorithm. A consensus was reached on management considerations.

Five consultant forensic psychiatrists, a legal expert and an expert on psychiatric ethics (n=7) consented to participation, with a subsequent response rate of 71.4 per cent. Consensus was achieved on a proposed management algorithm. Assessment for mental disorder, capacity to refuse food and motivation for food refusal are seen as key psychiatric tasks. The need to work closely with the prison general practitioner and the value of multidisciplinary working and legal advice are described. Relevant aspects of law included mental health, criminal law (insanity) and capacity legislation.

This study outlines a management algorithm for the psychiatric assessment and management of prisoners on a hunger strike, a subject about which there is limited guidance to date. Although written from an Irish perspective, this study outlines key considerations for psychiatrists in keeping with international guidance and therefore may be generalisable to other jurisdictions.

The purpose of this study is to draw on multiple streams analysis (MSA) and to investigate how policy change emerged from two inquiries into allegations of abusive hospital care in National Health Service (NHS) hospitals in the United Kingdom (UK) in the 1960s.

The methodology of this study is regarding a historical case study of two inquiries.

The Sans Everything and Ely inquiries had the same legal standing and terms of reference, but the second put psychiatric hospital reform on the agenda, while the first did not. The main factor making Ely rather than Sans Everything the turning point seems to have been concerned with “agency”, linked with a few key individuals.

A study of 1960s event necessarily relies heavily on documentary and archival sources, and cannot draw on interviews which are an important ingredient of many case studies.

The originality of the study is to examines inquiries, which have been largely neglected in MSA, despite their obvious potential role in placing issues on the agenda. Previous studies of MSA have devoted little attention to the ability of the media to provide the focus on “focusing events”.

The purpose of this paper is to explore newly graduated nurses’ experiences of their preparation for psychiatric nursing practice in Malawi. Knowledge of how basic or undergraduate nursing training programs prepare nurses for mental health services will inform educators to maximize the teaching and learning processes. Students are a key stakeholder in professional training hence an understanding of their experiences of training programs is critical.

A qualitative exploratory study was undertaken. In total, 16 newly graduated nurses with six months work experience at three psychiatric hospitals in Malawi were purposively sampled and recruited into the study. One to one interviews which lasted almost 45 minutes were conducted. Data were analyzed using content analysis.

Findings show that training programs fall short in preparing students for psychiatric nursing practice. Participants reported little attention to the specialty as compared to other specialties by educators. Inadequate academic support during practice sessions was highlighted by the majority of participants.

The study needed to compare the findings with experiences of students who have been allocated to other nursing specialties.

Psychiatric nursing specialty remains the least preferred career choice for many nursing students. However, preservice nursing education programs are expected to socialize, motivate and prepare students for psychiatric practice as well. It is therefore critical to understand gaps that exist in student preparation for psychiatric nursing services in order to improve mental health training.

The purpose of this paper is to present an argument for taking the long view of the retention and preservation of inactive medical records.

Using the theoretical framework of Actor-Network Theory, the author examines medical records, and especially mental health records, as actants that participate in the classification and treatment of patients, and in the development of psychiatry and mental hospitals as social institutions.

The varied and profound roles of medical records demonstrate the ability for records to have multiple “lives” that can touch many individuals beyond a single human lifetime.

As the current and future custodians of historical medical record collections, information professionals are in a position to be greater advocates for the increased preservation of and mindful access to these materials.

Medical records have potential to be cultural heritage documents, especially for emergent communities.

This paper articulates the ways in which medical records are an embedded part of many societies, and affect the ways in which illness is defined and treated. It thus suggests that while laws regarding the retention and destruction of and access to medical records continue to be deliberated upon around the world, such records can have enduring value as information artifacts.

The targeting of scarce mental health resources is currently organised around three broad areas: treating severe mental illness; reducing suicide; and obviating risk to the wider community. High priority clients are those who present with either psychotic symptoms, or who are perceived to be high risk to self or others. This study examined records of emergency assessments at a mental health trust in the south‐east of England over a three‐month period (n = 336) to see whether clients with these characteristics are more likely than others to be offered hospital admission or treatment. It was found that clients presenting with psychosis are much more likely to be offered admission than those assessed as non‐psychotic, that those assessed as a suicide risk are also significantly more likely to be offered admission, and that those assessed as presenting a risk to the public at large are no more likely to be admitted than those presenting no risk. This investigation indicates that the emergency service of the trust studied is addressing the first two target areas, but may be under‐performing in the third.

Human right is a phenomenon universal to all but greatly significant for disadvantaged groups like people with mental illness who due to the limitations of their illness cannot assert their rights. This study aims to assess the knowledge and attitude of nursing students regarding the human rights of people with mental illness.

A descriptive study was conducted among 72 nursing students purposively selected from two nursing schools in Enugu, Nigeria. Data were collected using a 38 item literature-based questionnaire developed by the researchers. The reliability of the instrument was established using Cronbach’s alpha model with 0.812 coefficients.

Participants 32 (44.4%) demonstrated moderate knowledge regarding the human rights of people with mental illness. The attitude of nursing students towards the right of people with mental illness was positive (2.81). There is no significant difference in knowledge between students of the two schools, p = 0.199 (>0.05). However, the study showed that students from basic nursing school had a more favourable attitude towards the rights of people with mental illness compared to the post-basic nursing students, p = 0.050 (<0.05).

The rising incidence of human right violation in mental health practice indicates the need to assess the knowledge and attitude of the future workforce who play a critical role in the care and management of people with mental illness. The nursing curriculum should provide nursing students in their various institutions of training, sufficient information on the human rights of people with mental illness. Also, a legal structure in Nigeria for people with mental illness is imperative to protect them from gross human rights violations.