In a series of three studies, the present authors and others in this research group have examined the Review Panel process: (a) before the hearing (which patients apply for a hearing?); (b) at the hearing (how do the patients released by the Panel differ from those retained by the Panel and; (c) after the hearing, how are the Panel-released patients faring one and two years after being released by the Panel, compared to patients released by the attending psychiatrist?) In the present paper, the findings of these three studies are summarized and an attempt is made to explain the findings, some of which are surprising (for example, the 35% disagreement between Panel and attending physician with respect to suitability for discharge and the finding that Panel-released patients survive as long in the community as do physician-discharged patients). Based on the findings and the interpretation placed on them, the authors make a series of recommendations with respect to the operation of Panels, the management of defiant involuntary patients and future research in this area.
This study surveyed the content of committal forms completed at two B.C. hospitals. A profile of 50 patients at a provincial mental hospital and 50 patients on the ward of a general hospital was obtained by comparing the two groups on a number of demographic and psychiatric history variables. The medical certificates of the patients were then assessed for the inclusion of information required by the B.C. Mental Health Act. Of the 198 forms rated (two per patient), 137 (69.2%) were in compliance with the requirements of the B.C. Mental Health Act. Although a larger number of valid forms was scored for the psychiatric hospital, this difference was not significant. A total of 50 patients had a legally valid combination of medical certificates. Much of the problem associated with the invalid forms was related to the vague and confused wording of the Mental Health Act. It is suggested that a clearer definition of committal criteria and a rewording of the medical certificate may aid physicians in completing commitment documentation.
This paper critically examines the code of ethics that applies to practising psychiatrists. The code performs the functions for which it was designed admirably well. It does not, however, resolve moral dilemmas (i.e., complex situations in which any course of action compromises certain ethical principles). In these cases, the psychiatrist must turn to wider moral theory (i.e., psychiatric ethics) for guidance.
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