Three samples of supporters of elderly infirm dependents who were either attending or about to attend day hospitals were given the 30-item General Health Questionnaire (GHQ) to complete. Prevalence levels of disturbance varied from 57% to 73%; female supporters (the majority) reported higher levels of distress. High scores were related to a diagnosable psychiatric condition, and were significantly associated with a combination of poor self-health ratings in the supporters, more frequent behaviour problems in the dependents and a more negative view of the premorbid relationship between supporter and dependent. Reported amount of contact time and levels of formal and informal outside support were not related to GHQ scores.
Fifty-three elderly women attending a day centre were interviewed and observed to examine hypotheses about depressive symptoms and behaviour. Observers were blind to interview findings. The Geriatric Mental Status Schedule (GMS) and Multiple Affect Adjective Checklist (MAACL) provided information on current symptoms and mood. Time-sampling was used to assess clients' level and type of engagement. No significant relation was found between 'disengagement' (absence of engaged activity) and symptom level. Those clients reaching the Feighner criteria for depression did not differ from other clients either in level of 'disengagement' or in type of engaged activity. Within the whole sample 'disengagement' was related to age and to self-reports of good health. 'Onlooking' was correlated with 'recent loss of interest' and self-blame'. Results are discussed in relation to behavioural formulations of depression and studies of engagement.
<p>The proposal by Szmukler and others for a law that fuses mental health law and mental capacity law in England and Wales, both in the context of civil admissions to hospital based on the mental disorder of the patient and the making of orders by the criminal courts, can be summarised in the following quotes from their paper. They suggest:</p><p>“a legal regime that … relies squarely on the incapacity of the person to make necessary treatment decisions as the primary justification for intervention in their life.”</p><p>By intervention is meant both detention and treatment under compulsion: so, rather than separate criteria for detention (based on the risk of harm) and treatment (based on capacity, at least in part), there would be a single incapacity test “that specifies the conditions for both treatment under compulsion and treatment under circumstances amounting to a ‘deprivation of liberty’.”</p><p>What is meant by ‘incapacity’? It is an “inability to understand, recall, process, use or weigh relevant information; inability to communicate a decision; or inability to reach a decision that is sufficiently stable for it to be followed.”</p><p>There would be a requirement that there be no less restrictive option available than intervention; for emergency situations, there would also be a safeguard for intervention based on a reasonable belief as to a lack of capacity.</p>
The question of how courts assess expert evidence-especially when mental disability is an issue-raises the corollary question of whether courts adequately
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