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Few international studies have investigated factors affecting domiciliary non-invasive ventilation (D-NIV) compliance, and data from the UK are limited. We assessed compliance (defined as ≥ 4 h/night for at least 70% of the time) in a retrospective UK population study, at three time points (0–1 month, 3–4 months and 11–12 months), for all patients commenced on D-NIV over a 5-year period. A total of 359 patients were included. Non-compliant vs. compliant patients were significantly younger (median age 64 (IQR 52–72) vs. 67 (58–75) years, p = 0.032) and more likely to have schizophrenia, consistent at both 3–4 months (5% vs. 1%, p = 0.033) and 11–12 months (5% vs. 2%, p = 0.049). Repeated measures ANOVA demonstrated that the minutes [median (IQR)] of D-NIV used significantly increased at the three time points (0–1 month, 3–4 months and 11–12 months) for patients with hypertension [310 (147.5–431) vs. 341 (89–450) vs. 378 (224.5–477.5), p = 0.003]; diabetes [296.5 (132.5–417.5) vs. 342.5 (94.5–438.5) vs. 382 (247.5–476.25), p = 0.002] and heart failure [293 (177–403) vs. 326 (123–398) vs. 365 (212–493), p = 0.04]. In conclusion, younger and comorbid schizophrenic patients have lower D-NIV compliance rates, and our data suggest that persistence with D-NIV over a year may improve overall use. [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]

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]

The article presents the summary of a safety report from the National Patient Safety Agency (NPSA) of Great Britain in partnership with the Prescribing Observatory for Mental Health and the National Pharmacy Association published in December 2009 aimed at improving the safety of lithium therapy, along with key actions for staff. It cites the two problems identified by NPSA. Measures that the health care industry can adopt like issuing repeat prescriptions are explained. It describes indicators that a practice has become safer.