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The Bournewood gap is not as wide as it sometimes seems

The Bournewood gap is not as wide as it sometimes seems Columns Correspondence and 2 out of 103 unsuspected instances in control over the patient’s movements and Blood-borne virus testing the younger group, and 2 out of 9 choices including not allowing visitors and suspected and 11 out of 29 unsuspected home visits to his carers. It was the and Hepatitis B immunisation columns in the older group. The division between completeness of control exercised by the in specialist alcohol and suspected and unsuspected cases was treating team that was the issue at hand dependent on the quality of the referral, rather than the more general point of H.L. drugs service which was often limited. lacking capacity to consent to his stay in In the UK, which has among the highest Our findings suggest that the EEG gives hospital. The court specifically pointed rates of recorded illegal substance misuse useful diagnostic information in a little out that this case should not be consid- in the Western world, 34% of people over a third of cases. However, in practice ered as a precedent but should be diagnosed with Hepatitis B, over 90% the effect is likely to be reduced by such considered on its merits alone. While diagnosed with Hepatitis C and 5.6% factors as the primacy of a clear clinical appreciating that one English judge in diagnosed with HIV were associated with diagnosis in suspected epilepsy, the particular has given the meaning of de injecting drug use. nature of the EEG report being usually facto detention a broader interpretation in In our cross-sectional survey on 150 suggestive rather than indicative, and the his particular judgement, the original individuals under active management by superiority of other investigations (e.g. European Court of Justice ruling should the Trust Alcohol and Drug Services based neuroimaging) in certain situations. The not be ignored. at Great Yarmouth, 3% were diagnosed EEG test remains important in the differ- When the Ministry of Justice introduced positive for Hepatitis B, 19% for Hepatitis ential diagnosis of both possible cerebral the deprivation of liberty safeguards in C and 2% for HIV. About half had no dysfunction (encephalopathy) and the Mental Health Act 2007 (thus documentation regarding blood-borne seizures, as well as the monitoring of amending the Mental Capacity Act 2005) viruses; 36 had at least one dose of epilepsy. In order to keep the rate of they failed to give any reasonable expla- Hepatitis B vaccine, but only 18 had three uninformative tests to a minimum, clini- nation why the safeguards were doses. Those who showed a trend cians should carefully describe the necessary. Their official argument that the towards completing Hepatitis B immuni- amendment will bridge the so-called presenting signs and symptoms, consid- sation were in the age group above 30 Bournewood gap has to be viewed with ering whether these are consistent with years old, known to the services for more some scepticism. This is because the defi- epilepsy and whether other investigations than 2 years,injectors,those who nition of people who fall within the are preferable. This information should be accepted the offer of immunisation and deprivation of liberty safeguards goes included in the EEG referral to improve the those positive for Hepatitis C. This is of much beyond the original case brought to utility of the subsequent report. concern as studies show an emergence of the European Court of Justice. An easier increasing incidence of blood-borne FENTON, G.W. & STANDAGE, K. (1993) Clinical interpretation would have been to use the viruses among new, young and vulnerable electroencepahalography in a psychiatric service. Mental Capacity Act 2005 to make deci- drug users. CanadianJournal of Psychiatry, 38, 333-338. sions in the best interests of a patient and At the time of our study, 22% indivi- thus bridge the Bournewood gap. There STONE, S. & MORAN, G. (2003) The utility of EEG in duals shared injecting equipment. psychiatry and aggression. Psychiatric Bulletin, 27, was no specific need for additional legis- Injecting is not only a key factor in the 171-172. lation in this area but it falls in line with a transmission of blood-borne viruses, but number of local and national decisions also plays a significant role in deaths from Shweta Gangavati Senior House Officer, taken with anticipatory obedience in order overdose, accounting for more than 7% Leicestershire Partnership NHS Trust, not to fall foul of some perceived legal *Chris Meakin Consultant Psychiatrist, Bradgate of all the deaths among those aged 15- obligation. Mental Health Unit, Groby Road, Leicester LE3 9EJ, 39 years old in 2004 (European Moni- This anticipatory obedience or defen- email: [email protected] toring Centre for Drugs and Drug Addic- siveness has certainly contributed to tion, 2006). giving the Human Rights Act a bad name doi: 10.1192/pb.32.4.152b We recommend the following: (1) clini- and the same is potentially possible with cians need to collect, keep, analyse and the Mental Capacity Act if people get the make effective use of patient data impression that they have to do un- including sexual health and injecting prac- reasonable and additional paperwork in tice; (2) drug and alcohol services should order to comply with the Act. Acting in The Bournewood gap increase awareness of harm from injecting anticipatory obedience therefore has is not aswideasitsometimes drug use, with particular regard to blood- negative consequences for the perception borne viruses and overdose; and (3) of perfectly reasonable legislation on top seems effective treatment goals should include of creating a lot of additional administra- In response to Singhal et al (Psychiatric testing, immunisation and treating of tive work and costs for the respective Bulletin, January 2008, 32,17-20), I would blood-borne viruses for all service users. authorities who are charged with the like to point out a common misunder- execution of the new amendments. As EUROPEAN MONITORING CENTRE FOR DRUGS AND standing with regards to the European clinicians we ought to contribute to a DRUG ADDICTION (2006) Drug-Related Infectious Court of Justice judgement on the sensitive interpretation of the new legis- Diseases and Drug-Related Deaths. Annual Report. Bournewood case [H.L. v. UK, 2005]. The lation and prevent a situation where staff The State of the Drug Problem in Europe.European authors give a good description of the on the ground consider far too many Monitoring Centre for Drugs and Drug Addiction case itself, but they then confuse its people to be in danger of potential (http://www.emcdda.europa.eu/html.cfm/ specifics with the details of the so-called index41529EN.html). Human Rights Act breaches. ‘Bournewood gap’. This, however, fails to H. L. v. UK [2005] ECHR. take account of the actual judgement, *Vellingiri Raja Badrakalimuthu Speciality Registrar, Northumberland,Tyne and Wear NHS which concludes that the reason why the Peter Lepping Consultant Psychiatrist/Honorary Trust, Northgate Hospital, GreatYarmouth NR30 court ruled against the Bournewood Trust Senior Lecturer, University ofWales, CentralWrexham 1BU, email: [email protected], in that particular case was because of the Community Mental HealthTeam, North East Wales Daphne Rumball Consultant Psychiatrist, Drug specific circumstances that amounted to a NHS Trust,16 Grosvenor Road,Wrexham LL111BU, and Alcohol Services, Norfolk and Waveney Mental deprivation of liberty under Article 5 of Wales, email: [email protected] Health Partnership NHS Trust the Human Rights Act 1998. They listed a doi: 10.1192/pb.32.4.153 number of points regarding complete doi: 10.1192/pb.32.4.153a http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Psychiatric Bulletin Unpaywall

The Bournewood gap is not as wide as it sometimes seems

Lepping, Peter
Psychiatric Bulletin – Apr 1, 2008
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Abstract

Columns Correspondence and 2 out of 103 unsuspected instances in control over the patient’s movements and Blood-borne virus testing the younger group, and 2 out of 9 choices including not allowing visitors and suspected and 11 out of 29 unsuspected home visits to his carers. It was the and Hepatitis B immunisation columns in the older group. The division between completeness of control exercised by the in specialist alcohol and suspected and unsuspected cases was treating team that was the issue at hand dependent on the quality of the referral, rather than the more general point of H.L. drugs service which was often limited. lacking capacity to consent to his stay in In the UK, which has among the highest Our findings suggest that the EEG gives hospital. The court specifically pointed rates of recorded illegal substance misuse useful diagnostic information in a little out that this case should not be consid- in the Western world, 34% of people over a third of cases. However, in practice ered as a precedent but should be diagnosed with Hepatitis B, over 90% the effect is likely to be reduced by such considered on its merits alone. While diagnosed with Hepatitis C and 5.6% factors as the primacy of a clear clinical appreciating that one English judge in diagnosed with HIV were associated with diagnosis in suspected epilepsy, the particular has given the meaning of de injecting drug use. nature of the EEG report being usually facto detention a broader interpretation in In our cross-sectional survey on 150 suggestive rather than indicative, and the his particular judgement, the original individuals under active management by superiority of other investigations (e.g. European Court of Justice ruling should the Trust Alcohol and Drug Services based neuroimaging) in certain situations. The not be ignored. at Great Yarmouth, 3% were diagnosed EEG test remains important in the differ- When the Ministry of Justice introduced positive for Hepatitis B, 19% for Hepatitis ential diagnosis of both possible cerebral the deprivation of liberty safeguards in C and 2% for HIV. About half had no dysfunction (encephalopathy) and the Mental Health Act 2007 (thus documentation regarding blood-borne seizures, as well as the monitoring of amending the Mental Capacity Act 2005) viruses; 36 had at least one dose of epilepsy. In order to keep the rate of they failed to give any reasonable expla- Hepatitis B vaccine, but only 18 had three uninformative tests to a minimum, clini- nation why the safeguards were doses. Those who showed a trend cians should carefully describe the necessary. Their official argument that the towards completing Hepatitis B immuni- amendment will bridge the so-called presenting signs and symptoms, consid- sation were in the age group above 30 Bournewood gap has to be viewed with ering whether these are consistent with years old, known to the services for more some scepticism. This is because the defi- epilepsy and whether other investigations than 2 years,injectors,those who nition of people who fall within the are preferable. This information should be accepted the offer of immunisation and deprivation of liberty safeguards goes included in the EEG referral to improve the those positive for Hepatitis C. This is of much beyond the original case brought to utility of the subsequent report. concern as studies show an emergence of the European Court of Justice. An easier increasing incidence of blood-borne FENTON, G.W. & STANDAGE, K. (1993) Clinical interpretation would have been to use the viruses among new, young and vulnerable electroencepahalography in a psychiatric service. Mental Capacity Act 2005 to make deci- drug users. CanadianJournal of Psychiatry, 38, 333-338. sions in the best interests of a patient and At the time of our study, 22% indivi- thus bridge the Bournewood gap. There STONE, S. & MORAN, G. (2003) The utility of EEG in duals shared injecting equipment. psychiatry and aggression. Psychiatric Bulletin, 27, was no specific need for additional legis- Injecting is not only a key factor in the 171-172. lation in this area but it falls in line with a transmission of blood-borne viruses, but number of local and national decisions also plays a significant role in deaths from Shweta Gangavati Senior House Officer, taken with anticipatory obedience in order overdose, accounting for more than 7% Leicestershire Partnership NHS Trust, not to fall foul of some perceived legal *Chris Meakin Consultant Psychiatrist, Bradgate of all the deaths among those aged 15- obligation. Mental Health Unit, Groby Road, Leicester LE3 9EJ, 39 years old in 2004 (European Moni- This anticipatory obedience or defen- email: [email protected] toring Centre for Drugs and Drug Addic- siveness has certainly contributed to tion, 2006). giving the Human Rights Act a bad name doi: 10.1192/pb.32.4.152b We recommend the following: (1) clini- and the same is potentially possible with cians need to collect, keep, analyse and the Mental Capacity Act if people get the make effective use of patient data impression that they have to do un- including sexual health and injecting prac- reasonable and additional paperwork in tice; (2) drug and alcohol services should order to comply with the Act. Acting in The Bournewood gap increase awareness of harm from injecting anticipatory obedience therefore has is not aswideasitsometimes drug use, with particular regard to blood- negative consequences for the perception borne viruses and overdose; and (3) of perfectly reasonable legislation on top seems effective treatment goals should include of creating a lot of additional administra- In response to Singhal et al (Psychiatric testing, immunisation and treating of tive work and costs for the respective Bulletin, January 2008, 32,17-20), I would blood-borne viruses for all service users. authorities who are charged with the like to point out a common misunder- execution of the new amendments. As EUROPEAN MONITORING CENTRE FOR DRUGS AND standing with regards to the European clinicians we ought to contribute to a DRUG ADDICTION (2006) Drug-Related Infectious Court of Justice judgement on the sensitive interpretation of the new legis- Diseases and Drug-Related Deaths. Annual Report. Bournewood case [H.L. v. UK, 2005]. The lation and prevent a situation where staff The State of the Drug Problem in Europe.European authors give a good description of the on the ground consider far too many Monitoring Centre for Drugs and Drug Addiction case itself, but they then confuse its people to be in danger of potential (http://www.emcdda.europa.eu/html.cfm/ specifics with the details of the so-called index41529EN.html). Human Rights Act breaches. ‘Bournewood gap’. This, however, fails to H. L. v. UK [2005] ECHR. take account of the actual judgement, *Vellingiri Raja Badrakalimuthu Speciality Registrar, Northumberland,Tyne and Wear NHS which concludes that the reason why the Peter Lepping Consultant Psychiatrist/Honorary Trust, Northgate Hospital, GreatYarmouth NR30 court ruled against the Bournewood Trust Senior Lecturer, University ofWales, CentralWrexham 1BU, email: [email protected], in that particular case was because of the Community Mental HealthTeam, North East Wales Daphne Rumball Consultant Psychiatrist, Drug specific circumstances that amounted to a NHS Trust,16 Grosvenor Road,Wrexham LL111BU, and Alcohol Services, Norfolk and Waveney Mental deprivation of liberty under Article 5 of Wales, email: [email protected] Health Partnership NHS Trust the Human Rights Act 1998. They listed a doi: 10.1192/pb.32.4.153 number of points regarding complete doi: 10.1192/pb.32.4.153a

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Psychiatric Bulletin – Unpaywall

Published: Apr 1, 2008

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