Guardianship for the severely mentally ill

The process of appointing a guardian in the mental health field is a complex and important one. The guardian's duty is to protect a patient who is incompetent in making his own decisions. The guardian's role can be to correct past mistakes made by the patient (i.e. loss of property), manage the patient's present affairs and prevent future undesirable consequences. Characteristics of patients who are in need of guardianship have not previously been studied in Israel. We examined the characteristics of 60 hospitalized patients for whom a guardian was appointed, comparing them with another group of patients. Variables relating to disease severity such as diagnosis, duration of illness and employment status contrasted the groups. We may tentatively conclude that patients in need of legal guardianship are more severely ill than other mentally ill.     

The use of CS spray in the mentally ill

CS sprays are now being widely used by police in the UK. Concerns are being expressed regarding the toxicity of this substance and some of the situations in which it is being used. This is the first reported case in the UK of CS spray being used to restrain a mentally ill person in police custody. It raises important issues regarding the welfare of mentally ill people who happen to find themselves in contact with the police. There is a need for open debate, specific guidelines and a system of monitoring the use of CS in such situations.     

Psychopathic disordered, mentally ill, and mentally handicapped sex offenders: a comparative study.

Although there currently exists a large amount of research on the characteristics and treatment of psychopathic disordered (PD) sex offenders, little if any empirical studies have addressed the mentally ill (MI) and mentally handicapped (MH) offender populations. A total of 106 PD, MI, and MH sex offender records from Rampton (Special) Hospital were reviewed for the study. Offender categories were compared by age of first documented sex offence, IQ at the time of admission, sex offence type, frequency of each offence type, history of violence during sex offences, age and gender of sex offence victims and number of victims for age and gender. Results revealed that 88 per cent of PD, 98 per cent of MI, and only 56 per cent of MH offenders' victims were female. Further analysis revealed that PD and MI offenders' victims were primarily female, with the largest proportion being pubescent and adult females. MH offender victims were primarily males and females under the age of 16. IQ correlated positively with history of violence during sexual assault and mean IQs were higher for 'violent' than 'non-violent' offenders in each offender category. A discussion of these and other significant findings, as well as implications for clinical treatment, is presented.     

Ethical dilemmas of Statutory Committees for involuntary hospitalization of mentally ill patients

Mentally ill patients whose reality judgements are severely impaired by reason of their illness and consequently present a danger to themselves and others, may be involuntarily admitted to a secure psychiatric ward for the safety of both themselves and the public. The Israeli Statute for the Treatment of Mentally Ill Patients, enacted in 1955 and amended in 1991, sets out rules and procedures for such involuntary confinement, and grants authority to the MOH District Psychiatrist to issue initial involuntary admission orders. However, a patient can appeal a District Psychiatrist order before a judicial statutory committee, comprising two senior psychiatrists and a legal expert in the capacity of magistrate. Such committee is also the statutory forum for determining whether involuntary hospitalization should be extended. The committee may quite often face ethical dilemmas when, on the one hand, there is no question that the patient's judgement is severely impaired but on the other hand, his/her condition does not fully meet the criteria of the statutory requirements for involuntary confinement. This paper discusses the legal aspects and requirements of involuntary admissions vis-a-vis the ethical dilemmas that such Statutory Committees may face when deciding to extend hospitalization or to release the patient from committal. The paper shall also illustrate dilemmas actually brought before the Committee that have ended in a final ruling that balances moral ethical dilemmas with the strict statutory requirements.     

Shoplifting in the mentally ill: the role of bipolar affective disorder and mental retardation

This study explores shoplifting behaviour in mentally ill patients, and evaluates the association between shoplifting and different mental illnesses in a local Chinese population. A comparison is made between shoplifting offenders and a matched control group of non-offenders among the psychiatric patients registered at a university department of psychiatry. Major depression, bipolar affective disorder (BAD) and mental retardation (MR) are the most common diagnoses among mentally ill shoplifters, while patients with a diagnosis of BAD or MR are at higher risk of committing an offence than patients with other diagnoses. Bipolar affective disorder has not been described as a risk factor for shoplifting behaviour in the psychiatric literature. Such a possibility should be seriously considered in the psychiatric assessment of shoplifting cases.     

Assisted suicide in the care of mentally ill patients: The Lucio Magri's case

A year after Mario Monicelli's suicide, the death of another famous person in Italy, Lucio Magri, reawakened the Italian debate on social, ethical and juridical issues in end-of-life decisions. Unlike Monicelli, Lucio Magri decided to end his own life in Switzerland with the help of a physician because his mental illness rendered his life unbearable. Both Monicelli and Magri suffered from a severe depression. The authors analyze the ethical issues regarding the right to die for mentally ill patients and neurological disabled patients, discussing the decision-making autonomy in persons suffering from severe depression. The role of the psychiatry in the management of end-of-life decision requests is considered along with pros and cons of suicide prevention and rationale suicide.     

Psychiatric care of the homeless mentally ill: an opportunity for military psychiatry training

This paper reviews the phenomenon of homelessness in the United States and locally in Washington, D.C. Prevalence data of psychiatric illness in the homeless is presented, as is the formation of a psychiatric service network to treat the homeless mentally ill. Additionally, the author describes the development of an innovative training program in community psychiatry, focusing specifically on issues inherent in understanding the work of the psychiatric resident in community-based training and service delivery. The relevance of this experience to military medicine involves training psychiatric residents to develop service-delivery schemes in times of rapidly expanding mental health needs, such as combat.     

Treatability of the sex offender: considerations of etiology, pathology, and treatment in repealing sexually dangerous offender statutes

This article embraces legal and legislative concerns about treatability of dangerous sex offenders; the disease concept of chronic offenders; treatment modalities; an evaluation of treatment; a consideration of treatability. The shortcomings of clinical methods must be borne in mind when evaluating and redesigning sexually dangerous offender statutes.     

From the memories about father--colonel of medical service A. E. Ender

The article is made as memories, written by Inna Lukina--daughter of famous military physician Anany Efimovich Ender--in 2012 at the instance of editorial staff Central figure of the essay--participant of two World wars and three revolutions. The most interesting part of the memories is referred to period of the Great Patriotic War, when A. E. Ender leaded medical evacuation hospital No 3240. During the war medical evacuation hospital was displaced 17 times at Stalingrad, South-Western, Don, Central and 1st Belorussian fronts and made a long way 5000 kilometers in length from Rostov-on-Don to Berlin. A. E. Ender was the chef of military hospital No 104 of the administration of commandant of Soviet sector of Berlin from September 1946. During 1950 he worked at senior division of the University of Rostov-on-Don, than he worked as a senior lecturer at senior division of the Rostov State Medical University.