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Key Elements of Mental Health Law Reform:
          A Clinical Perspective



                 Brendan Kelly

       Mater Misericordiae University Hospital
             University College Dublin
Ireland meets 80 out of 166 standards (48.2%)



Chief deficits   Promoting rights
                 Rights of families and carers
                 Voluntary patients
                 Vulnerable groups
                 Economic and social rights

                 Capacity legislation
Arrangement-focussed
view of justice

Realization-focussed
view of justice
n = 81 recently detained individuals

Treatment was beneficial                         78%
Knew they had been detained                      86%
Tribunal made this easier to accept              46%
Negative impact on family relationships          28%
Negative impact on doctor-patient relationship   27%
n = 820 GPs

Not user-friendly    63%

Increased workload   27%
n = 321 psychiatrists

Training was satisfactory                     84%
Increased workload                            69%
Decreased time with service-users             27%
Changes in relationships with service-users   41%
….more legalistic, conflicted relationships
Re-define “voluntary patient”
Strengthen “best interests” dimension
Introduce cumulative tribunal “case-law”
Reduce legalism
Broaden criteria for Circuit Court appeal
  …“approved mental health professionals”?



Mental capacity legislation...
Best ways to increase observance of human
rights of the mentally ill:

         Social policy
         Mental health policy
         Mental health law
Kelly BD
Penrose’s Law in Ireland:
Ecological Analysis of
Psychiatric Inpatients and
Prisoners, 1963-2003.
Irish Medical Journal
2007; 100: 373-4
Best ways to increase observance of human
rights of the mentally ill:

    Social policy
    Mental health policy
    Mental health law
“Medicine is a social
science, and politics
nothing but medicine at a
larger scale”



Rudolf Virchow
(1821-1902)
Key Elements of Mental Health Law Reform:
          A Clinical Perspective



                 Brendan Kelly

       Mater Misericordiae University Hospital
             University College Dublin

             brendankelly35@gmail.com

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Key Elements of Mental Health Law Reform from a Clinical Perspective

  • 1. Key Elements of Mental Health Law Reform: A Clinical Perspective Brendan Kelly Mater Misericordiae University Hospital University College Dublin
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  • 4. Ireland meets 80 out of 166 standards (48.2%) Chief deficits Promoting rights Rights of families and carers Voluntary patients Vulnerable groups Economic and social rights Capacity legislation
  • 6. n = 81 recently detained individuals Treatment was beneficial 78% Knew they had been detained 86% Tribunal made this easier to accept 46% Negative impact on family relationships 28% Negative impact on doctor-patient relationship 27%
  • 7. n = 820 GPs Not user-friendly 63% Increased workload 27%
  • 8. n = 321 psychiatrists Training was satisfactory 84% Increased workload 69% Decreased time with service-users 27% Changes in relationships with service-users 41% ….more legalistic, conflicted relationships
  • 9. Re-define “voluntary patient” Strengthen “best interests” dimension Introduce cumulative tribunal “case-law” Reduce legalism Broaden criteria for Circuit Court appeal …“approved mental health professionals”? Mental capacity legislation...
  • 10. Best ways to increase observance of human rights of the mentally ill: Social policy Mental health policy Mental health law
  • 11. Kelly BD Penrose’s Law in Ireland: Ecological Analysis of Psychiatric Inpatients and Prisoners, 1963-2003. Irish Medical Journal 2007; 100: 373-4
  • 12.
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  • 14. Best ways to increase observance of human rights of the mentally ill: Social policy Mental health policy Mental health law
  • 15. “Medicine is a social science, and politics nothing but medicine at a larger scale” Rudolf Virchow (1821-1902)
  • 16.
  • 17. Key Elements of Mental Health Law Reform: A Clinical Perspective Brendan Kelly Mater Misericordiae University Hospital University College Dublin brendankelly35@gmail.com