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This chapter presents UK legislation concerning people with mental disorders. It provides an account of both Statute and Case Law, and It explains issues such as competence and coercive treatment in cases of mental disorders. It then focuses on the particular case of eating disorders, and looks at issues of competence to refuse treatment for eating disorders and legislation relating to force-feeding. The legal account is accompanied by a punctual philosophical and ethical critique of UK jurisdiction. It suggests that the Mental Health Act should be abolished.

Ireland’s Mental Health Act 2001 requires that all involuntary admissions for mental disorder be reviewed within twenty-one days by a three-person Mental Health Tribunal. This chapter focuses on key written judgments of the High Court and Supreme Court reviewing decisions of Mental Health Tribunal. Despite some statements to the contrary, the general picture which emerges is that the courts have not engaged in robust supervision of mental health tribunals. Instead, the general tenor of the case-law has been to endorse decisions of tribunals to affirm detentions, and to limit access to the courts to the most extreme violations of procedural rights. The chapter argues that this is a disappointing outcome, in light of the supposed rights-based focus of the Mental Health Act 2001.

This chapter examines the role of country of origin in relation to psychiatric admission status in Ireland. Data presented in this chapter demonstrate that schizophrenia is a particular problem in individuals born outside Ireland and living in Dublin’s inner-city, and that this is associated with involuntary admission under the Mental Health Act 2001. The chapter also shows much lower levels of voluntary admissions. The chapter argues that these differences in patterns of help-seeking should be considered in future planning exercises in Ireland’s mental health services. In particular, increased emphasis on the cultural competence of health care-providers would be a good first step in recognising and addressing the differing health needs and practices of individuals from different ethnic groups and cultural backgrounds.

Family education (FE) shares uniformities of content with FPE but differs in length, format, target group, and expected outcomes. Ranging from six to twelve weeks, FE is group education targeted to families and friends of people with mental illness. Expected outcomes are greater knowledge of illness management and reduced distress and burden of caregivers. Most programs use internal evaluations, but only a few have research findings. FE programs have largely been developed by the National Alliance on Mental Illness (NAMI) and Mental Heath America (MHA). Two NAMI programs, taught by well-trained family members, have been manualized and evaluated in randomized research designs: Journey of Hope (JOH) and Family-to-Family Education Program (FFEP). Together these eight- to twelve-week programs have reached over 100,000 families. The Training and Education Network (TEC), an MHA Southeastern Pennsylvania program, is also manualized with research findings. A sampling of other FE programs is also described, with their manuals and other publications cited in the Appendix.

This chapter examines the contested nature of mental health provision within the context of proposed legislative changes, exploring the key ethical dilemmas that are raised. It discusses the proposed changes to the 1983 Mental Health Act, and the resulting practical and ethical dilemmas they raise for frontline practitioners in health and social services, service users, and indeed for wider society. The chapter then considers the 2004 Draft Mental Health Bill, which raises significant ethical issues with regard to autonomy, beneficence, and individual liberty. It is argued that the proposed changes to the 1983 Mental Health Act are focused on risk and public safety rather than on the health and welfare of those people whose decision making is impaired by reason of their mental disorder. The 2004 Draft Mental Health Bill is also out of step with other current relevant government policy initiatives in this area, particularly the choice agenda, which risks disadvantaging people with mental health problems relative to other patient groups.

This chapter discusses the concepts, definitions, measurement instruments, and sources of data bearing on global mental health and mental illness. The discussion reveals the limited use of system-level instruments and readily comparable global data to help guide international public mental health policy. The chapter includes selected data on mental health systems around the world and gives an overview of mental health–related activities by leading international agencies such as the World Health Organization (WHO) Department of Mental Health and Substance Abuse, the United Nations Interagency Task Force (UNIATF) on the Prevention and Control of Non-communicable Diseases, the United Nations International Children’s Educational Fund (UNICEF), the United Nations High Commissioner for Refugees (UNHCR), and a range of international research consortia. The presence or absence of mental health policy, the presence of law relevant to mental health, and the presence of mental health care facilities around the world are reviewed.

The 2003 Act introduces for the first time the Mental Health Tribunal for Scotland. It also creates a new category of party to proceedings: the “named person”. Various other persons are entitled to receive intimation of and be given the opportunity to participate in proceedings. The Mental Health Officer and the Responsible Medical Officer each has a raft of statutory responsibilities in terms of the Act. Here we consider those who may be parties to proceedings, and the role of each in proceedings before the Tribunal, by reference both to the Act and to the Rules.

There has been much debate on Mental Health Act reforms with little discussion of broader principles. Although everyone agrees that there are problems and have a view on how those problems ought to be solved, the longer view of how the current situation relates to the historical picture seems to have been lost in the immediacy of the present presumed crisis. This chapter provides a start at some of that broader debates. It focuses on matters of civil regulation, since people found to be insane in a criminal context raise rather different issues. At issue are the broader pictures: how did we get to our current legal and political position regarding mental health, and in particular how novel are the problems we face; and what sort of a Mental Health Act do we want? On the latter point, the premise is that consistently with the developing law and politics of human rights, legislation should not inappropriately discriminate on the basis of mental disability.

This chapter explores the interactions of voluntary, professional and state provision in the field of mental health throughout the period 1870 to 1970, focusing on the Mental After Care Association: the only voluntary group in this sector whose history spans the entire period under study. This long, unbroken chronology offers an unrivalled opportunity to explore how it affected, and was in turn affected by, other agents in the field of mental health, illuminating the interconnections between state provision, healthcare professionals, patients/service users, the public and voluntarism. The chapter explores how the Association represented mental illness when trying to solicit public support, and demonstrates how professional groups worked through the Association to advance their objectives. The strategies adopted by the Association in different eras are contextualising by drawing a comparison to the path taken by the National Association for Mental Health.

This chapter is about statutory mental health social work, particularly in relation to the contemporary concern with risk management and risk minimisation. Social work here is seen as having a primary role in the assessment of risk. By discussing the wider societal preoccupation with risk avoidance, its incorporation into social policy and social work can be highlighted, providing a clear example of where social work practice cannot be divorced from wider societal trends. A new Mental Health Act that amends the 1983 Act has been influenced, to a large extent, by high-profile tragedies where psychiatric patients have killed themselves or others. By discussing the actual threat posed by such people, it can be shown that the fear outweighs the reality of danger, and the dangers to civil liberties inherent in the proposed changes can be highlighted. This chapter also focuses on the increase in coercive measures by social workers under the Mental Health Act of 1983.

The idea of dual diagnosis is investigated and what care pathways are available to offenders who have been identified as dually diagnosed clients (DDCs) under the Mental Health Act 1983. The problems of working with conditions that have no statutory definition and in care pathways that are defined by exclusion criteria are discussed. The centrality of risk and its impact on the care pathway available to this group is also examined in this framework. Risk thresholds determine changes in dual diagnosis terminology, which can be used to enable hospital treatment via legal mechanisms; a process that is also influenced by the media and MAPPA.

This chapter reviews the history and current status of community behavioral health organizations (CBHOs) in the United States. The vast majority of individuals receiving behavioral health care today are served by outpatient community settings, with only a small proportion receiving care in inpatient facilities. This chapter provides an understanding of the vital role CBHOs play in providing both therapeutic and rehabilitative services to some of the nation’s most vulnerable citizens. It outlines the origins of CBHOs within the publicly funded health care system in the United States, provides examples of available programs and services, and delineates the range of challenges faced by contemporary CBHOs as they strive to meet the needs of people with serious mental illnesses.

Chapter Two provides an historical overview of national social work research capacity – building efforts, especially in the context of the roles of national social work organizations and the National Institutes of Health (NIH). It provides a brief history of the development of social work research, the widening funding base for social work research and the impact of university research culture on the social work field, particularly as universities have turned their attention to community development and needs. The authors describe the significant impact of the Task Force on Social Work Research, the significant roles of social work professional organizations, and the development of doctoral education programs towards meeting the need for an increasing social work knowledge base to address the demand for evidence based practice.

This chapter explores how in the 1940s, mental hospitals comprised land, buildings, and workforces used by the states to feed and house hundreds of thousands of people. Conscientious objectors who did service work at mental hospitals in lieu of military conscription founded the National Mental Health Foundation. They also collaborated with journalists to craft exposés about concentration camp–like conditions in hospitals. The author and former patient Mary Jane Ward published her book The Snake Pit, in which she argued against the loss of freedom that people with mental illness experienced. Policy makers responded to this anti-institutionalism by implementing mental health reforms that made hospitals larger and more therapeutic, and kept involuntary commitments intact. These initiatives made up the early stages of deinstitutionalization.

This chapter examines health promotion campaigns and policies designed to raise the profile of mental health, and more specifically to help those suffering from mental illness. It begins with an overview of mental illnesses such as schizophrenia, depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, eating disorders, and personality disorders. It then considers the NHS policy on mental health; the mental health promotion strategies in the UK, including the Scottish Health Survey of 2016, the All Wales Mental Health Promotion Network, and the Mental Health Foundation report in Northern Ireland; the implications of the coexistence of physical and mental illness for policy makers and practitioners; and mental health charities such as Anxiety UK, Centre for Mental Health, Rethink Mental Illness, SANE and Time to Change. The chapter also discusses various mental health promotion strategies throughout the UK, locations for mental health promotion, and economic evaluations of mental health promotion.

This chapter discusses the importance of clinical outcome data in improving the quality of care for those struggling with serious mental illness so that they can have a life of recovery in their home community. It first provides an overview of clinical outcome data and clinical outcome research before emphasizing the importance of outcome-oriented and evidence-based practice in the field of mental health, along with the reasons why providers are reluctant to use outcome measures. It then evaluates Virginia's outcome-oriented pilot project called the Performance Outcomes Measurement System, the Substance Abuse and Mental Health Services Administration's national outcome measures for mental health services, and the New Freedom Commission on Mental Health's identification of major problems in the mental health service system and potential solutions. It concludes by presenting recommendations aimed at transforming America's mental health service system.

This book concludes with a postscript that presents two important sources of information for people with mental illness, both of which are web sites: the Substance Abuse and Mental Health Services Administration (www.samhsa.gov) and the National Alliance on Mental Illness (www.nami.org). SAMHSA is one of the country's two federal mental health agencies while NAMI is a leading mental health advocacy organization. The two sites contain information on mental disorders, the latest in treatment options, how to connect with others with similar needs, and books and articles on mental illness. The SAMHSA site has sections titled “Treatment Locators” and “Browse by Topic,” whereas the NAMI site has the subheadings “Inform Yourself” and “Find Support.”

An essential form of psychological literacy that is required in all psychology courses is an understanding of and ability to work with the many cultural groups that make up a given society. Psychology as a profession is part of a society that is shaped and directed by the history, values, norms and biases that characterise a cultural and temporal location in history. Therefore, this chapter argues that cultural competence should be the foundational lens through which all psychological knowledge is viewed. The chapter begins with a historical positioning of Aboriginal and Torres Strait Islander peoples within the context of colonisation and the ongoing consequences of disadvantaged derived from that. The chapter argues for the inclusion of cultural competence as a vehicle to overcoming social disadvantage and identifying the hidden barriers to equality. The chapter provides personal experiences both as students and educators, and discusses developments in Australian Aboriginal and Torres Strait Islander studies in the psychology curriculum, with detailed descriptions of particular initiatives. While this chapter focuses on the Australian context, the issues raised are likely to be applicable to a global perspective.