Suchergebnisse

Previous historical studies of the care of the insane in nineteenth century England have been based in the history of medicine. In this thesis, such care is placed in the context of the English poor law. The theory of the 1834 poor law was essentially silent on the treatment of the insane. That did not mean that developments in poor law had no effect only that the effects must be established by examination of administrative practices. To that end, this thesis focuses on the networks of administration of the poor law of lunacy, from 1834 to 1870. County asylums, a creation of the old (pre-1834) poor law, grew in numbers and scale only under the new poor law. While remaining under the authority of local Justices of the Peace, mid-century legislation provided an increasing role for local poor law staff in the admissions process. At the same time, workhouse care of the insane increased. Medical specialists in lunacy were generally excluded from local admissions decisions. The role of central commissioners was limited to inspecting and reporting; actual decision-making remained at the local level. The webs of influence between these administrators are traced, and the criteria they used to make decisions identified. The Leicestershire and Rutland Lunatic asylum provides a local study of these relations. Particular attention is given to admission documents and casebooks for those admitted to the asylum between 1861 and 1865. The examination of the asylum documents, the analysis of the broader relationships of the administrators, and a reading of the legislation itself, all point up tensions between ideologies of the old and new poor law in the administration of pauper lunacy.

We are partnered by the World Psychiatric Association, and would like to thank them for financial help with initial research and funding for accommodation. TW acknowledges the support of the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London and her NIHR Senior Investigator Award. ; Background This Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness. Part 1: The patient and treatment Who will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital technology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central. Part 2: Psychiatry and health-care systems Delivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries. Part 3: Psychiatry and society Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatry's development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences. Part 4: The future of mental health law Mental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation. Part 5: Digital psychiatry—enhancing the future of mental health Digital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatments. However, it also carries the risk of commercialised, unproven treatments entering the medical marketplace with detrimental effect. Novel research methods, transparency standards, clinical evidence, and care delivery models must be created in collaboration with a wide range of stakeholders. Psychiatrists need to remain up to date and educated in the evolving digital world. Part 6: Training the psychiatrist of the future Rapid scientific advance and evolving models of health-care delivery have broad implications for future psychiatry training. The psychiatrist of the future must not only be armed with the latest medical knowledge and clinical skills but also be prepared to adapt to a changing landscape. Training programmes in an age in which knowledge of facts is less important than how new knowledge is accessed and deployed must refocus from the simple delivery of information towards acquisition of skills in lifelong learning and quality improvement. Conclusion Psychiatry faces major challenges. The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change. Psychiatrists must work with key stakeholders, including policy makers and patients, to help to plan and deliver the best services possible. The contract between psychiatry and society needs to be reviewed and renegotiated on a regular basis. Mental health law should be reformed on the basis of evidence and the rights of the individual. Psychiatry should embrace the possibilities offered by digital technology, and take an active role in ensuring research and care delivery in this area is ethically sound and evidence based. Psychiatry training must reflect these multiple pressures and demands by focusing on lifelong learning rather than simply knowledge delivery. Introduction ; We are partnered by the World Psychiatric Association, and would like to thank them for financial help with initial research and funding for accommodation. TW acknowledges the support of the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London and her NIHR Senior Investigator Award.