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Alcohol prevention targeting licensed premises: a study of effects on violence.

https://arctichealth.org/en/permalink/ahliterature9739
Source
J Stud Alcohol. 2003 Mar;64(2):270-7
Publication Type
Article
Date
Mar-2003
Author
Eva Wallin
Thor Norström
Sven Andréasson
Author Affiliation
Department of Public Health, Karolinska Institutet, Stockholm, Sweden. eva.wallin@stad.org
Source
J Stud Alcohol. 2003 Mar;64(2):270-7
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Alcoholism - epidemiology - prevention & control
Community Mental Health Services - legislation & jurisprudence - organization & administration
Crime - statistics & numerical data
Humans
Incidence
Law Enforcement
Licensure - legislation & jurisprudence - statistics & numerical data
Program Evaluation
Research Support, Non-U.S. Gov't
Restaurants - legislation & jurisprudence
Seasons
Sweden - epidemiology
Violence - statistics & numerical data
Abstract
OBJECTIVE: This research studied the effects of a community alcohol prevention program on violent crimes. Starting in 1996, a 10-year multicomponent program based on community mobilization, training in responsible beverage service for servers and stricter enforcement of existing alcohol laws has been conducted in Stockholm, Sweden. The project has been led by an action group consisting of members from the hospitality industry and the authorities. METHOD: We used a time-series quasi-experimental design that included a control area. Data on police-reported violence during the period of January 1994 to September 2000 were analyzed through ARIMA modeling. RESULTS: During the intervention period, violent crimes decreased significantly by 29% in the intervention area, controlled for the development in the control area. CONCLUSIONS: The intervention seems to have been successful in reducing violent crimes. This effect is most likely due to a combination of various policy changes initiated by the project. The findings support the notion that community action projects working on a local basis can be effective in decreasing alcohol-related problems at licensed premises.
PubMed ID
12713202 View in PubMed
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Assessing the outcome of compulsory treatment orders on management of psychiatric patients at 2 McGill University-associated hospitals.

https://arctichealth.org/en/permalink/ahliterature123619
Source
Can J Psychiatry. 2012 Jun;57(6):359-65
Publication Type
Article
Date
Jun-2012
Author
Arash Nakhost
John Christopher Perry
Daniel Frank
Author Affiliation
McGill University, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada.
Source
Can J Psychiatry. 2012 Jun;57(6):359-65
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
Commitment of Mentally Ill - legislation & jurisprudence - statistics & numerical data
Community Mental Health Services - legislation & jurisprudence - statistics & numerical data
Delirium, Dementia, Amnestic, Cognitive Disorders - epidemiology - psychology - therapy
Female
Follow-Up Studies
Hospitals, University
Humans
Insanity Defense
Kaplan-Meier Estimate
Male
Mental Disorders - epidemiology - psychology - therapy
Middle Aged
Patient Readmission - statistics & numerical data
Personality Disorders - epidemiology - psychology - therapy
Prisoners - psychology
Psychiatric Department, Hospital
Psychotic Disorders - epidemiology - psychology - therapy
Quebec
Retrospective Studies
Schizophrenia - epidemiology - therapy
Treatment Outcome
Abstract
Some literature suggests that compulsory community treatment orders (CTOs) are effective in reducing hospitalizations in a subgroup of psychiatric patients with histories of repeated hospitalization, allowing them to be treated in the community under less restrictive measures. However, studies have yielded contradictory findings, in part because of methodological differences. Our study examines the effectiveness of CTOs in reducing hospitalizations and increasing community tenure of such patients.
The sample included all psychiatric patients who had been given a CTO during a 9-year period at 2 of McGill University's hospitals. This is a naturalistic, observational, retrospective, before-and-after study where patients acted as their own control subjects. We examined variables, including the number, duration, and time to psychiatric admissions, comparing 4 time periods: early, pre-index, index (when the first CTO was in force), and post-index periods. The total study duration per subject encompasses the longest period of observation within existing studies in Canada.
Psychiatric patients with histories of frequent readmissions demonstrated a significant reduction in their number of hospitalizations as well as an increase in the median time to re-hospitalization, during the period when they were treated under a CTO. This effect of CTO was sustained even after the CTO had expired.
Our study suggests that CTOs are effective in assisting psychiatric patients with histories of repeated hospitalizations to live and be treated in the community, diminishing the occurrence of frequent hospitalization.
PubMed ID
22682573 View in PubMed
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Beyond "bad manners": the power relations of "consumer participation" in Ontario's community mental health system.

https://arctichealth.org/en/permalink/ahliterature209052
Source
Can J Commun Ment Health. 1996;15(2):27-44
Publication Type
Article
Date
1996
Author
K. Church
Author Affiliation
University of Toronto.
Source
Can J Commun Ment Health. 1996;15(2):27-44
Date
1996
Language
English
Publication Type
Article
Keywords
Community Mental Health Services - legislation & jurisprudence
Consumer Participation - legislation & jurisprudence
Humans
Mental Disorders - psychology - rehabilitation
Ontario
Patient Participation - legislation & jurisprudence
Patient satisfaction
Power (Psychology)
Abstract
This article describes the work of the legislation subcommittee of the steering committee responsible for the implementation of the Graham Report, Ontario's current blueprint for community mental health. It describes barriers to psychiatric survivor participation in the subcommittee's 1990 provincial consultation, including professional/bureaucratic characterization of survivor actions during the event as "bad manners." I argue that this naming is an act of power. Conflicts arose because the two groups operate from different behavioural codes in which the pivotal issue, acted out indirectly in all kinds of interactions, was whether and how deeply to include personal experience and emotions as forms of knowledge. The cultural dimensions of "consumer participation" must be more broadly recognized and more consciously considered if this policy is to remain viable, particularly in a time of major economic restructuring.
PubMed ID
10166895 View in PubMed
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Canadian compulsory community treatment laws: recent reforms.

https://arctichealth.org/en/permalink/ahliterature176185
Source
Int J Law Psychiatry. 2005 Jan-Feb;28(1):13-22
Publication Type
Article
Author
John E Gray
Richard L O'Reilly
Author Affiliation
Adult Mental Health Services, Ministry of Health Services, Victoria, British Columbia, Canada. jegray@shaw.ca
Source
Int J Law Psychiatry. 2005 Jan-Feb;28(1):13-22
Language
English
Publication Type
Article
Keywords
Canada
Commitment of Mentally Ill - legislation & jurisprudence
Community Mental Health Services - legislation & jurisprudence - organization & administration
Health Care Reform - legislation & jurisprudence
Hospitalization - legislation & jurisprudence
Humans
Informed consent
Mental Disorders - therapy
Patient Rights - legislation & jurisprudence
Recurrence - prevention & control
Abstract
This paper addresses the principles underlying compulsory community treatment (CCT) and discusses the different provisions in Canada's twelve jurisdictions. Comparisons with different models of CCT in other countries are also drawn. CCT is not only intended to reduce relapses it is also a "least restrictive" alternative to in-patient detention. Seven of the twelve Canadian mental health acts allow conditional leave from hospital. Two jurisdictions provide community treatment orders, but require two or three previous in-patient admissions. Criteria for CCT, in most jurisdictions, includes that there is a "likelihood of significant mental or physical deterioration". The requirement for previous hospitalization for CCT in Canada, unlike other countries, precludes CCT for use with first episode patients. Some jurisdictions require consent for CCT. Most jurisdictions explicitly state that the services necessary for the CCT conditions must be available.
PubMed ID
15710446 View in PubMed
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Can epidemiological studies assist in the evaluation of community treatment orders? - The experience of Western Australia and Nova Scotia.

https://arctichealth.org/en/permalink/ahliterature166867
Source
Int J Law Psychiatry. 2006 Nov-Dec;29(6):507-15
Publication Type
Article
Author
Stephen Kisely
Leslie Anne Campbell
Neil J Preston
Jianguo Xiao
Author Affiliation
Departments of Community Health and Epidemiology and Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. Stephen,Kisely@cdha.nshealth.ca
Source
Int J Law Psychiatry. 2006 Nov-Dec;29(6):507-15
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Coercion
Community Mental Health Services - legislation & jurisprudence - statistics & numerical data
Crime - statistics & numerical data
Humans
Mandatory Programs
Mental Disorders - epidemiology - therapy
Nova Scotia - epidemiology
Prevalence
Western Australia - epidemiology
Abstract
Epidemiological studies using administrative databases have several advantages over other methodologies in studying the effectiveness of compulsory community treatment such as community treatment orders (CTOs). We compared patients placed on CTOs in Western Australia with controls drawn from both within the jurisdiction and from another without this measure (Nova Scotia). Although in different countries, the mental health services in both jurisdictions share common characteristics. Notably, we were able to control for forensic history in our comparison within Western Australia. We analysed predictors of admission and number of bed-days using multiple, logistic or Cox regression as appropriate. Of the 274 subjects placed on a CTO, we were able to find controls for up to 96% (n=265). CTO placement was not associated with reduced admissions or mean bed-days, although there was a threshold effect with a reduced risk of inpatient stays exceeding 100 days. Outpatient contacts were significantly greater for the CTO group. However, we do not know whether the intensity of treatment, or its compulsory nature, effected outcome.
PubMed ID
17067675 View in PubMed
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Clinically significant differences among Canadian mental health acts.

https://arctichealth.org/en/permalink/ahliterature194470
Source
Can J Psychiatry. 2001 May;46(4):315-21
Publication Type
Article
Date
May-2001
Author
J E Gray
R L O'Reilly
Author Affiliation
Policy and Systems Development, Adult Mental Health Division, Ministry of Health, British Columbia. john.gray@moh.hnet.bc.ca
Source
Can J Psychiatry. 2001 May;46(4):315-21
Date
May-2001
Language
English
Publication Type
Article
Keywords
Canada
Commitment of Mentally Ill - legislation & jurisprudence
Community Mental Health Services - legislation & jurisprudence
Humans
Mental Disorders - therapy
Patient Advocacy - legislation & jurisprudence
Abstract
First, to highlight the major differences among mental health acts in different Canadian jurisdictions as they relate to involuntary admission criteria, treatment authorization, review and appeal procedures, and conditional leave and community treatment orders. Second, to analyze the impact of these differences on the care that individuals with mental illness receive.
We examined the mental health act provisions of all Canadian jurisdictions to determine how the clinical management of a typical case would differ among jurisdictions. We used a statement of principles for mental health legislation endorsed by the Canadian Psychiatric Association to guide the analysis. We confirmed interpretation of each act and its implementation through key informant contact in each province and territory.
We found clinically significant differences among the provinces and territories on all major components of their mental health acts.
Provisions that prevent patients receiving appropriate clinical care can be found in some Canadian mental health acts. Alternate provisions that support appropriate clinical care, that respect the human rights and personal dignity of patients, and that are consistent with the Canadian Charter of Rights and Freedoms can be found in the legislation of other jurisdictions.
PubMed ID
11387786 View in PubMed
Less detail

Community treatment orders and Nova Scotia--the least restrictive alternative?

https://arctichealth.org/en/permalink/ahliterature176970
Source
Health Law J. 2003;11:1-33
Publication Type
Article
Date
2003
Author
Shelley Trueman
Author Affiliation
Coady Filliter, Halifax, Nova Scotia.
Source
Health Law J. 2003;11:1-33
Date
2003
Language
English
Publication Type
Article
Keywords
Commitment of Mentally Ill - legislation & jurisprudence
Community Mental Health Services - legislation & jurisprudence
Humans
Mental Disorders - therapy
Nova Scotia
Patient Discharge
United States
Abstract
CTO/IOC legislation is a bewildering array of presumptions and inconsistencies. It is a reaction to the inherent difficulties of de-institutionalizing treatment into the community and has been based on heated arguments of misconceptions and misunderstandings of various proponents and opponents of CTOs/IOC. Legislators in the United Stated have implemented widely varying legislation over the past twenty-five years yet there is little common basis for states to proceed on or even to analyse when conceptualizing IOC legislation. It isn't surprising that Canada, after looking towards the United States as a leader in mental health legislation, is also encountering inconsistent and illogical legislation from province to province. To compound Canada's own inconsistencies, Canadian courts have not generally followed the lead of the United States of protecting fundamental rights within Canadian mental health legislation. As a result, Canadian provinces still rely on a broad parens patriae justification when infringing the rights of mental health patients and have not truly effected the narrower danger standard that is stated within its legislation. Provincial legislators should be very careful when proposing CTO legislation that will further erode patients' rights. Many provinces and states use the least restrictive alternative to justify the use of CTOs/IOC, either as a catch phrase or as a legitimate factor in considering options. Generally, though, the principle is used in terms of coerced treatment rather than a person's fundamental right to liberty or not to be arbitrarily detained. Legislators have translated the institutional model of medical treatment to the community by intrinsically linking treatment to committal. The most obvious contradictions of community treatment is the backwards slide of preventive commitment based on deterioration rather than purely danger. This includes the arbitrariness of releasing hospitalized patients on a continuing deterioration or even danger basis rather than fully discharging them. Another major problem is taking away a patient's inherent right, either by denying the patient's own decision-making if competent, or by ignoring prior wishes or substitute decision-making, to accept or refuse treatment. Legislators have succumbed to an artificial concept that mentally ill persons are dangerous or incompetent and do not have the ability to choose treatment when they are decompensating. Thus they have provided for patients' treatment in a confusing array of CTOs/IOC, all dependent on interference or restriction of a person's basic right to decide for himself. Very few studies have been able to isolate the key factors of what makes CTO/IOC work, although recent studies seem to suggest that CTOs/IOC won't work if there isn't the corresponding support/service system. At the same time, there have been studies of voluntary treatment plans that are succeeding, such as assertive community treatment, that do not rely on coerced treatment. Among these are PACT, case management, mobile crisis units and early intervention methods such as the delivery of emergency services (at a facility) when so requested. When considering CTOs as part of recommended amendments to the Hospitals Act, the Law Reform Commission certainly started on the right track by consulting a broad range of stakeholders and advisory groups within the Nova Scotia's mental health system. Unfortunately, the Commission derailed and did not fully develop its inquiry. Ideally, the Departments of Justice (or the Law Reform Commission), Community Services, and Health should have modelled a full-scale investigation after the RAND study developed for the California Senate. Consultation is definitely necessary, but it needs to be followed up with empirical evidence or at the very least other studies. Realistically, this may be beyond the financial means and resources of the Nova Scotia government. However, it is not beyond the reach of the Commission to explore such controversial issues further to see why certain legislation has been implemented in different provinces and whether it has proved effective or not. As New Brunswick is currently the only province that has considered and rejected CTOs, concentrating instead on community services and supports development, they deserve more than a cursory glance by the Commission and any inquiry performed by New Brunswick may contribute valuable insight as to why not legislate CTOs. This would be a more practical approach for the Commission to take rather than doing a survey of what other provinces are legislating and then accepting it blindly with or without the support of their stakeholders and advisory groups. The focus of the de-institutionalization movement was to revolutionalize how persons with mental illness are treated. A return to an institution mentality is not needed. Patience and the support of a new and better system that puts voluntariness and the mental health consumer in the centre of decision-making is the most promising way to effective mental health care.
PubMed ID
15600067 View in PubMed
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Community treatment orders: an essential therapeutic tool in the face of continuing deinstitutionalization.

https://arctichealth.org/en/permalink/ahliterature166395
Source
Can J Psychiatry. 2006 Oct;51(11):686-8; discussion 689-90
Publication Type
Article
Date
Oct-2006
Author
Richard L O'Reilly
Author Affiliation
Regional Mental Health Care, London, Ontario. Richard.O'Reilly@sjhc.london.on.ca
Source
Can J Psychiatry. 2006 Oct;51(11):686-8; discussion 689-90
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Canada
Coercion
Community Mental Health Services - legislation & jurisprudence - organization & administration - utilization
Deinstitutionalization - trends - utilization
Humans
Mental Disorders - therapy
Patient Compliance - psychology - statistics & numerical data
Randomized Controlled Trials as Topic - standards
Notes
Comment In: Can J Psychiatry. 2007 Apr;52(4):273-4; author reply 27417500310
Comment In: Can J Psychiatry. 2007 Aug;52(8):542; author reply 54217955918
Comment On: Can J Psychiatry. 2006 Oct;51(11):683-5; discussion 69117121165
PubMed ID
17121166 View in PubMed
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Community treatment orders: an uncertain step.

https://arctichealth.org/en/permalink/ahliterature177775
Source
Can J Psychiatry. 2004 Sep;49(9):577-8
Publication Type
Article
Date
Sep-2004
Author
Gary A Chaimowitz
Source
Can J Psychiatry. 2004 Sep;49(9):577-8
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Canada
Community Mental Health Services - legislation & jurisprudence - organization & administration
Community Psychiatry - legislation & jurisprudence - methods
Humans
Mental Disorders - drug therapy - therapy
Psychotropic Drugs - therapeutic use
Notes
Comment On: Can J Psychiatry. 2004 Sep;49(9):585-9115503729
Comment On: Can J Psychiatry. 2004 Sep;49(9):579-8415503728
PubMed ID
15503727 View in PubMed
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47 records – page 1 of 5.