PB E-mail content delivery - eTOCs !
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals
QUICK SEARCH:   [advanced]


     

Psychiatric Bulletin (2003) 27: 367-370. doi: 10.1192/pb.27.10.367
© 2003 The Royal College of Psychiatrists
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mears, A.
Right arrow Articles by Lelliott, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Mears, A.
Right arrow Articles by Lelliott, P.
Psychiatric Bulletin (2003) 27: 367-370
© 2003 The Royal College of Psychiatrists

Consultant child and adolescent psychiatrists' knowledge of and attitude to the use of legislation concerning young people with psychiatric disorder{dagger}

Alex Mears, Research Fellow

College Research Unit, 83 Victoria Street, London SW1H 0HW

Richard White, Solicitor

White and Sherwin Solicitors, London

Paul Lelliott, Director

College Research Unit, London

Declaration of interest

Funded by the Department of Health as part of the National In-patient Child and Adolescent Psychiatry Study (NICAPS).

{dagger} The views expressed do not necessarily reflect those of the Royal College of Psychiatrists. Back


   Abstract
Top
 Abstract
Introduction
 Method
 Results
 Discussion
 References
 
AIMS AND METHOD

This study aimed to examine in-patient child and adolescent consultant psychiatrists' knowledge of and attitude to the Mental Health Act 1983 (MHA), the Children Act 1989 and issues around consent. A questionnaire form was sent to all in-patient consultants in England and Wales.

RESULTS

The consultants who responded (n=51, 67%) reported a desire for more training in legal issues. Knowledge of the MHA was better than for the Children Act 1989; those who used the MHA at least once every 6 months scored more correct answers to questions about the MHA than did those who used it less frequently or never.

CLINICAL IMPLICATIONS

Although the study indicates specific gaps in knowledge, the main message is that training should consider the legal framework as a whole, with an emphasis on practical issues about its application in the in-patient setting.


   Introduction
Top
 Abstract
 Introduction
Method
 Results
 Discussion
 References
 
A complex legal framework affects young people with mental health problems. The issues concerned have been the subject of legal dispute and, not surprisingly, some practitioners find them difficult to understand. This is particularly so for those who work with young people who are admitted to hospital against their will. In this context, practitioners work at an interface between the Children Act 1989, the Mental Health Act 1983, common law and judge-made precedent. Mears & Worrall (2001) reported that some in-patient child and adolescent psychiatrists are uncertain about when to use the Children Act 1989 as opposed to the Mental Health Act (MHA), and sometimes struggle with the issue of consent where common law and precedent have to be considered, as well as the person's status under the Children Act 1989 or MHA.

These findings suggest that some consultants would benefit from additional training about these issues. This paper reports a survey that we used to identify more precisely what these training needs are.


   Method
Top
 Abstract
 Introduction
 Method
Results
 Discussion
 References
 
The sample
A questionnaire was sent to the 76 consultant psychiatrists identified by the National In-patient Child and Adolescent Psychiatry Study (O'Herlihy et al, 2001) as working in an in-patient child and adolescent unit.

The questionnaire asked about the following:

  1. Training and activities related to the legal aspects of mental health care.
  2. Attitudes to legislation and other aspects of the legal framework. These were tested by presenting a series of statements and asking for a response on a five-point scale ranging from ‘strongly agree’ to ‘strongly disagree’.
  3. Knowledge about the Children Act 1989 and the Mental Health Act 1983. This section asked a series of questions; the permissible responses were ‘true’, ‘false’ or ‘I would have to look the answer up’. The latter response was to minimise the likelihood of the respondent consulting a text before responding to the question.

As well as piloting the questionnaire with a small group of consultant psychiatrists, the questions relating to legal matters were scrutinised by a solicitor with specialist knowledge in the law relating to young people (R.W.).


   Results
Top
 Abstract
 Introduction
 Method
 Results
Discussion
 References
 
Returns were received from 51 consultant psychiatrists, which is a 67% response rate.

Training and activity related to legal aspects of mental health care
Forty-one respondents (80%) were approved under Section 12 of the MHA. However, two-thirds (n=27) of those who were approved only engaged in the type of MHA work that required approval every 6 months or less frequently. Twenty-four (47% of all consultants) had participated in an MHA review tribunal in the past year; only one had ever acted as an MHA commissioner.

In terms of other law-related activity, 35 consultants (69%) had prepared at least one court report during the previous year and 20 (39%) had made at least one court appearance during the same period.

Thirty-two respondents (63%) reported having received one day's training, or less, in mental health law during the previous 2 years. Consistent with this, only 19 consultants (37%) rated themselves as being fully up-to-date with changes in the law that affected young people; a further 29 (57%) thought that they were partly up to date. Ninety per cent (n=46) rated their access to legal advice as adequate or better.

Attitudes to legislation and related issues
The consultants' responses to the attitudinal statements are shown in Table 1. For some statements there was a fairly even spread of responses, indicating a range of views; for others, there was more concordance. The latter include a strong endorsement for a multi-disciplinary approach to mental health care, the need for guidance in clarifying when to use the MHA and when to use the Children Act 1989, the need for more training about legal issues and the importance of child and adolescent psychiatrists being approved under the MHA.


View this table:
[in this window]
[in a new window]
  		Table 1. Consultants' attitudes to legislation use (percentage of sample)
 

Knowledge about the Mental Health Act 1983 and the Children Act 1989
Tables 2 and 3 show the consultants' responses to the questions about knowledge of the MHA and Children Act 1989, respectively. The mean correct response rate for questions about the MHA was 2.7/4 (68%), with a standard deviation of 1.0. For the Children Act 1989, the mean correct response rate was 4/9 (45%), with a standard deviation of 2.0. The most striking difference was that a much higher proportion indicated that they would have to look up the answers for questions relating to the Children Act 1989 (a mean of 49% for each question), compared with those relating to the MHA (9%).


View this table:
[in this window]
[in a new window]
  		Table 2. Consultants' knowledge of the Mental Health Act 1983
 

View this table:
[in this window]
[in a new window]
  		Table 3. Consultants' knowledge of the Children Act 1989
 

Responses to the questions about consent are shown in Table 4. The mean correct response rate was 2.8/5 (77%), with a standard deviation of 0.9.


View this table:
[in this window]
[in a new window]
  		Table 4. Consultants' knowledge of consent
 

Relationship between use of the Mental Health Act 1983 and knowledge
Those who used the MHA at least once every 6 months (n=21) scored more correct responses to questions about the MHA than those who used it less frequently or never: 3.1 (s.d.=0.9) v. 2.4 (s.d.=1.0) (t-test: t=2.6, d.f.=49, P<0.05). The difference remained significant when the consultants who were not approved under Section 12 of the MHA (n=10) were excluded.


   Discussion
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
References
 
It is likely that knowledge, as tested by this questionnaire, does not accurately reflect how a psychiatrist would actually apply the legislation or the principles of consent. In clinical practice, these types of decisions are not taken in isolation. This is supported by the responses to the attitude questionnaire, which suggest that this group of psychiatrists is committed to multi-disciplinary teamwork that, presumably, would include social workers. Also, it is likely that in complex cases they would seek advice from the Code of Practice or from their organisations' legal advisers - most seemed satisfied with their access to legal advice.

Despite this, the results do suggest that there are significant deficits in the knowledge about legislation and legal issues concerning consent. This is acknowledged by the psychiatrists themselves, who are strongly in favour of more training. In particular, many consultants either do not understand or report uncertainty about key aspects of the Children Act 1989. It is likely that there is a cycle at play whereby lack of knowledge causes psychiatrists to favour the MHA over the Children Act 1989, and a lack of exposure to the Children Act 1989 increases unfamiliarity with it.

There are significant differences in knowledge between those who use the MHA relatively frequently compared with those who use it rarely or never. This might suggest that psychiatrists should either use the MHA frequently or not at all. Alternatively, training should be targeted particularly at those who use the MHA infrequently, to help them overcome deficits associated with lack of practice.

The survey highlights specific areas of strength and weakness in consultants' knowledge of the legal framework. However, perhaps the main conclusion is that training should consider the legal framework as a whole and practical issues about its application in child and adolescent mental health services.


   References
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 References
 
MEARS, A. & WORRALL, A. (2001) A survey of psychiatrists' views of the use of the Children Act and the Mental Health Act in children and adolescents with mental health problems. Psychiatric Bulletin, 25, 304.[Abstract/Free Full Text]

O'HERLIHY, A., WORRALL, A., BANERJEE, S., et al (2001) National In-patient Child and Adolescent Psychiatry Study. London: Department of Health.





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Mears, A.
Right arrow Articles by Lelliott, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Mears, A.
Right arrow Articles by Lelliott, P.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals