Vontade e juízo na avaliação psiquiátrica das internações involuntárias

O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica.

Major new mental health law long awaited

Opinion and Analysis: Major new mental health law long awaited

A Comparative Analysis of Regulations on Involuntary Loss of Nationality in the European Union. CEPS Liberty and Security in Europe, 75/December 2014

This study examines the workings of the Common European Asylum System (CEAS), in order to assess the need and potential for new approaches to ensure access to protection for people seeking it in the EU, including joint processing and distribution of asylum seekers. Rather than advocating the addition of further complexity and coercion to the CEAS, the study proposes a focus on front-line reception and streamlined refugee status determination, in order to mitigate the asylum challenges facing Member States, and vindicate the rights of asylum seekers and refugees according to the EU acquis and international legal standards. Joint processing could contribute to front-line reception and processing capacity, but is no substitute for proper investment in national systems. The Dublin system as currently configured leads inexorably to increasing coercion and detention, and must thus be reconfigured to remove coercion as a principle and ensure consistency with human rights and other fundamental values of the EU.

Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Abstract Objective Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation. Method We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation. Results One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria. Conclusions The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T. Keywords: Involuntary commitment; Mental health legislation; Dangerousness; Australia

Submission to National Inquiry into Children in Immigration Detention from The Australian Psychological Society

Executive Summary The Australian Psychological Society categorically condemns the practice of detaining child asylum seekers and their families, on the grounds that it is not commensurate with psychological best practice concerning children’s development and mental health and wellbeing. Detention of children in this fashion is also arguably a violation of the UN Convention on the Rights of the Child. A thorough review of relevant psychological theory and available research findings from international research has led the Australian Psychological Society to conclude that: • Detention is a negative socialisation experience. • Detention is accentuates developmental risks. • Detention threatens the bonds between children and significant caregivers. • Detention limits educational opportunities. • Detention has traumatic impacts on children of asylum seekers. • Detention reduces children’s potential to recover from trauma. • Detention exacerbates the impacts of other traumas. • Detention of children from these families in many respects is worse for them than being imprisoned. In the absence of any indication from the Australian Government that it intends in the near future to alter the practice of holding children in immigration detention, the Australian Psychological Society’s intermediate position is that the facilitation of short-term and long-term psychological development and wellbeing of children is the basic tenet upon which detention centres should be audited and judged. Based on that position, the Society has identified a series of questions and concerns that arise directly from the various psychological perspectives that have been brought to bear on estimating the effects of detention on child asylum seekers. The Society argues that, because these questions and concerns relate specifically to improvement and maintenance of child detainees’ educational, social and psychological wellbeing, they are legitimate matters for the Inquiry to consider and investigate. • What steps are currently being taken to monitor the psyc hological welfare of the children in detention? In particular, what steps are being taken to monitor the psychological wellbeing of children arriving from war-torn countries? • What qualifications and training do staff who care for children and their families in detention centres have? What knowledge do they have of psychological issues faced by people who have been subjected to traumatic experiences and are suffering high degrees of anxiety, stress and uncertainty? • What provisions have been made for psycho-educational assessment of children’s specific learning needs prior to their attending formal educational programmes? • who are suffering chronic and/or vicarious trauma as a result of witnessing threatening behaviour whilst in detention? • What provisions have been made for families who have been seriously affected by displacement to participate in family therapy? • What critical incident debriefing procedures are in place for children who have witnessed their parents, other family members, or social acquaintances engaging in acts of self-harm or being harmed while in detention? What psychotherapeutic support is in place for children who themselves have been harmed or have engaged in self- harmful acts while in detention? • What provisions are in place for parenting programmes that provide support for parents of children under extremely difficult psychological and physical circumstances? • What efforts are being made to provide parents with the opportunity to model traditional family roles for children, such as working to earn an income, meal preparation, other household duties, etc.? • What opportunities are in place for the assessment of safety issues such as bullying, and sexual or physical abuse of children or their mothers in detention centres? • How are resources distributed to children and families in detention centres? • What socialization opportunities are available either within detention centres or in the wider community for children to develop skills and independence, engage in social activities, participate in cultural traditions, and communicate and interaction with same-age peers and adults from similar ethnic and religious backgrounds? • What access do children and families have to videos, music and entertainment from their cultures of origin? • What provisions are in place to ensure the maintenance of privacy in a manner commensurate with usual cultural practice? • What is the Government’s rationale for continuing to implement a policy of mandatory detention of child asylum seekers that on the face of it is likely to have a pernicious impact on these children’s mental health? • In view of the evidence on the potential long-term impact of mandatory detention on children, what processes may be followed by Government to avoid such a practice and, more importantly, to develop policies and practices that will have a positive impact on these children’s psychological development and mental health?

Juveniles in detention in Australia, 1981-2008

The Australian Institute of Criminology’s (AIC’s) national Juveniles in Detention Monitoring Program was established to contribute to the evidence base on juvenile detention in Australia, with a particular focus on Indigenous juveniles. Findings date back to 1981 and have been reported annually. This report provides an overview of the numbers and rates of juveniles in detention in Australia since 1981 and juveniles in detention for the financial year 2007–08. As with the AIC’s previous report on juveniles in detention (Taylor 2009), it also provides contextual information on young people sentenced in the children’s courts. The collation of data for these reports is supported by statutory juvenile justice agencies in each of Australia’s jurisdictions, as well as the NSW Department of Corrective Services. As described in more detail in this report, the Australian Institute of Health and Welfare (AIHW) administers the Juvenile Justice National Minimum Data Set and also reports annually on juveniles in detention. Given this development, the AIC is conducting a review of the Juveniles in Detention Monitoring Report in 2010–11, to ensure that AIC’s research and monitoring does not duplicate the AIHW’s work and that it makes a useful contribution to the field and enables more in-depth analysis of key issues.

Trends in juvenile detention in Australia

This paper provides an overview of key trends in juvenile detention in Australia, based on data contained in the Australian Institute of Criminology’s (AIC’s) Juveniles in Detention in Australia Monitoring Program database and then provides a discussion of two key trends in juvenile detention—the national increase in the proportion of juvenile detainees that is remanded (rather than sentenced) and the increase in the over-representation of Indigenous juveniles in detention.

The challenge of normative influences for program design for youth in detention

Young people in detention are at greater risk of death and disability from injury sustained while not in custody. Injury prevention and mental health programs have been designed for this group but their theoretical basis is rarely discussed. The present study investigates whether the conceptual basis of the Theory of Planned Behavior (TPB) is relevant to youth in a detention center. Focus group and observational data were collected. A thematic analysis supported central theoretical constructs and emphasized “Subjective Norms.” The challenge of normative influences must be actively addressed in the design of health interventions for youth in detention.

The doctrine of necessity and the detention and restraint of people with intellectual impairment: Is there any justification?

In Australia, the legal basis for the detention and restraint of people with intellectual impairment is ad hoc and unclear. There is no comprehensive legal framework that authorises and regulates the detention of, for example, older people with dementia in locked wards or in residential aged care, people with disability in residential services or people with acquired brain injury in hospital and rehabilitation services. This paper focuses on whether the common law doctrine of necessity (or its statutory equivalents) should have a role in permitting the detention and restraint of people with disabilities. Traditionally, the defence of necessity has been recognised as an excuse, where the defendant, faced by a situation of imminent peril, is excused from the criminal or civil liability because of the extraordinary circumstances they find themselves in. In the United Kingdom, however, in In re F (Mental Patient: Sterilisation) and R v Bournewood Community and Mental Health NHS Trust, ex parte L, the House of Lords broadened the defence so that it operated as a justification for treatment, detention and restraint outside of the emergency context. This paper outlines the distinction between necessity as an excuse and as a defence, and identifies a number of concerns with the latter formulation: problems of democracy, integrity, obedience, objectivity and safeguards. Australian courts are urged to reject the United Kingdom approach and retain an excuse-based defence, as the risks of permitting the essentially utilitarian model of necessity as a justification are too great.

Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study

Background: This study aimed to examine factors associated with treatment adherence in first-episode psychosis (FEP) patients followed up over 8 years, especially involuntary first admission and stopping cannabis use. Methods: This prospective, longitudinal study of FEP patients collected data on symptoms, adherence, functioning,and substance use. Adherence to treatment was the main outcome variable and was categorized as ‘good’ or ‘bad’. Cannabis use during follow-up was stratified as continued use, stopped use, and never used. Bivariate and logistic regression models identified factors significantly associated with adherence and changes in adherence over the 8-year follow-up period. Results: Of the 98 FEP patients analyzed at baseline, 57.1% had involuntary first admission, 74.4% bad adherence,and 52% cannabis use. Good adherence at baseline was associated with Global Assessment of Functioning score (p = 0.019), Hamilton Depression Rating Scale score (p = 0.017) and voluntary admission (p < 0.001). Adherence patterns over 8 years included: 43.4% patients always bad, 26.1% always good, 25% improved from bad to good. Among the improved adherence group, 95.7% had involuntary first admission and 38.9% stopped cannabis use. In the subgroup of patients with bad adherence at baseline, involuntary first admission and quitting cannabis use during follow up were associated with improved adherence. Conclusions: The long-term association between treatment adherence and type of first admission and cannabis use in FEP patients suggest targets for intervention to improve clinical outcomes.