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There is an increasing trend for patients detained in medium secure units (MSUs) to stay for longer than 2 years. Little information is currently available on factors which determine prolonged stay. The study aimed to identify characteristics associated with prolonged length of stay in a MSU in East London. Stay for more than 2 years was associated with diagnosis of psychotic disorder, multiple previous admissions, detention under a hospital order, being on a restriction order, and a history of moderately violent offending. Factors indicating risk of future violence were not found to be associated with length of admission. Beds in this MSU were blocked by a cohort of patients with specific clinical characteristics and needs, indicating that reconfiguration of services is required to provide rehabilitation at lower levels of security. [ABSTRACT FROM AUTHOR]

Defendants with mental health problems find themselves caught between the healthcare system and the criminal justice system, with the inevitable debate in relation to care versus control in society. Cases taken to the European Court of Human Rights by mentally disordered offenders demonstrate the inherent challenges in ensuring appropriate care to individuals whilst safeguarding the public. The Department of Health/Home Office Circular 66/90 advised that no person detainable under the Mental Health Act 1983 should be detained in prison, although in practice, this seemingly sensible principle remains extremely difficult to achieve, almost two decades later.1 This article will examine the human rights of defendants, the incorporation of the European Convention of Human Rights into UK legislation, the effect that this has had on the care and diversion of mentally disordered defendants from the criminal justice system, and finally the limitations to the Human Rights Act 1998. [ABSTRACT FROM AUTHOR]

Mentally incapacitated individuals represent a vulnerable section of our society. The law has been involved in making decisions for adults lacking capacity for several centuries. While children lacking capacity usually have the safeguard of parents who can make decisions on their behalf, adults incapacitated, often due to mental disorder or physical illness, have been left largely in the hands of professionals. The concept of treating an incapacitated adult in their 'best interests' has arisen in the Courts and statute relatively recently. This article will explore the introduction of the concept of best interests, how this concept has been developed primarily through case law, and the more recent impact of Parliamentary statute in helping define this term. [ABSTRACT FROM AUTHOR]

The Mental Health Act 1983 (UK), which governs the compulsory detention of psychiatric patients in England and Wales, includes a number of statutory safeguards to ensure that the patient's continued detention is not unlawful. One of these safeguards is the Mental Health Review Tribunal (MHRT). The primary role of MHRTs is to review the legality of a patient's detention in hospital and to direct discharge of those to whom the criteria for detention do not apply. Their powers, duties and procedures are contained within the Mental Health Act 1983 (UK) and the Tribunal Procedure (First-tier tribunal) Rules 2008. To hear individual cases, tribunals sit as a panel of three: a psychiatrist, a lay person and a legal chairperson. Article 5 of the European Convention of Human Rights (ECHR) enshrines the individual's right to liberty and security, but also includes a provision permitting the detention of persons of unsound mind. The ECHR also includes the right for an individual to have a periodic review of his or her detention and the lawfulness of it, a function that is fulfilled by the MHRT system. Currently approximately 40 000 patients per year are detained under the Mental Health Act, and almost 22 000 appeals are made to the MHRT, of which 12 000 are heard, in over 600 locations. The aim of this article is to examine the evidence as to whether MHRTs are inherently unfair to patients and biased towards overcautious professionals, and consider this in the light of various changes to the MHRT system proposed and adopted over recent years. [ABSTRACT FROM AUTHOR]

The Mental Health Act 2007 (UK) (MHA 2007) received Royal Assent in July 2007 and has now reached the statute books after 8 years of controversy and debate. The MHA 2007 makes amendments to several pieces of existing legislation, but the main changes it makes are to the Mental Health Act 1983 (MHA 1983) and the introduction of “Deprivation of liberty safeguards” into the Mental Capacity Act 2005 (UK). Much of the concern about more patients being subject to detention is a perception of the new legislation, tempered by the antecedents to the MHA 2007 (which included an expert report, a Green paper, a White Paper and two draft Bills') as well as Government propaganda. The purpose of the present article was to highlight how the Government's approach and propaganda has fuelled these concerns, to scrutinize the amendments contained in the MHA 2007, and to consider whether these may result in more patients being subject to compulsion. [ABSTRACT FROM AUTHOR]

India has been implementing active case-finding (ACF) for TB among marginalised and vulnerable (high-risk) populations since 2017. The effectiveness of ACF cycle(s) is dependent on the use of appropriate screening and diagnostic tools and meeting quality indicators. To determine the number of ACF cycles implemented in 2021 at national, state (n = 36) and district (n = 768) level and quality indicators for the first ACF cycle. In this descriptive study, aggregate TB program data for each ACF activity that was extracted was further aggregated against each ACF cycle at the district level in 2021. One ACF cycle was the period identified to cover all the high-risk populations in the district. Three TB ACF quality indicators were calculated: percentage population screened (≥10%), percentage tested among screened (≥4.8%) and percentage diagnosed among tested (≥5%). We also calculated the number needed to screen (NNS) for diagnosing one person with TB (≤1538). Of 768 TB districts, ACF data for 111 were not available. Of the remaining 657 districts, 642 (98%) implemented one, and 15 implemented two to three ACF cycles. None of the districts or states met all three TB ACF quality indicators' cut-offs. At the national level, for the first ACF cycle, 9.3% of the population were screened, 1% of the screened were tested and 3.7% of the tested were diagnosed. The NNS was 2824: acceptable (≤1538) in institutional facilities and poor for population-based groups. Data were not consistently available to calculate the percentage of i) high-risk population covered, ii) presumptive TB among screened and iii) tested among presumptive. In 2021, India implemented one ACF cycle with sub-optimal ACF quality indicators. Reducing the losses between screening and testing, improving data quality and sensitising stakeholders regarding the importance of meeting all ACF quality indicators are recommended. [ABSTRACT FROM AUTHOR]