Background
Methods
Study design
Setting
Statistics
Sample
Instruments used
Working Alliance Inventory and Interpersonal Trust in Physician
Global function and mental state
Possible confounding factors
Perceived coercion, perceived procedural justice and impact of hearing
Results
Relationship between hearings and perceived coercion
WAI and ITP before and after hearings
Mental Health Tribunal n = 17 | Mental Health Review Board, n = 58 | All n = 75 | |||||||
---|---|---|---|---|---|---|---|---|---|
T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | |
Patient rates consultant psychiatrist | |||||||||
WAI | 57.2(14.9) | 56.3(18.2) | 51.2(21.8) | 60.8(15.8) | 64.7(17.5) | 64.0(15.8) | 59.9(15.6) | 63.3(17.2) | 61.1(17.9) |
ITP | 35.6(7.1) | 36.7(7.7) | 32.1(9.0) | 39.4(6.9) | 39.9(8.0) | 39.4(8.7) | 38.5(7.1) | 39.5(7.6) | 37.8(9.2) |
Patient rates primary nurse | |||||||||
WAI | 58.6(16.7) | 56.7(19.2) | 51.6(19.9) | 63.1(13.7) | 64.3(16.4) | 63.7(15.5) | 61.9(14.5) | 62.9(16.5) | 60.9(17.2) |
ITP | 36.4(6.5) | 36.3(6.9) | 33.9(7.6) | 38.6(5.0) | 39.6(8.2) | 38.4(8.4) | 38.1(5.5) | 39.2(7.5) | 37.4(8.4) |
Patient rates doctors in general | |||||||||
ITP | 40.2(7.6) | 37.7(6.4) | 35.8(8.7) | 40.1(6.8) | 41.3(8.9) | 41.4(8.6) | 40.1(6.9) | 40.9(7.9) | 40.2(8.9) |
Consultant psychiatrist rates patient | |||||||||
WAI | 43.7(15.7) | 43.9(18.3) | 41.5(18.2) | 55.1(15.0) | 55.8(14.0) | 56.5(15.1) | 52.6(15.8) | 53.2(15.8) | 53.1(16.9) |
ITP | 22.0(8.1) | 21.2(6.3) | 19.2(7.1) | 28.5(8.6) | 29.8(8.1) | 30.0(9.3) | 27.0(8.9) | 27.9(8.5) | 27.6(9.9) |
Primary nurse rates patient | |||||||||
WAI | 51.3(10.3) | 48.7(14.2) | 48.4(14.6) | 58.2(13.4) | 57.1(13.9) | 57.9(12.3) | 56.6(13.0) | 55.2(14.3) | 55.8(13.3) |
ITP | 24.8(4.1) | 26.4(5.5) | 26.9(7.8) | 31.6(7.2) | 32.2(7.4) | 31.9(7.9) | 30.0(7.2) | 30.9(7.4) | 30.8(8.1) |
MHTs and MHRBs compared
T1 | T2 | T3 | ||||
---|---|---|---|---|---|---|
Mental Health Act 2001 | Criminal Law (Insanity) Act 2006 | Mental Health Act 2001 | Criminal Law (Insanity) Act 2006 | Mental Health Act 2001 | Criminal Law (Insanity) Act 2006 | |
Patient rates consultant psychiatrist | ||||||
WAI | 57.2(14.9) | 60.8(15.8) | 56.3(18.2) | 64.7(17.5) | 51.2(21.8) | 64.0(15.8) |
ITP | 35.6(7.1) | 39.4(6.9) | 36.7(7.7) | 39.9(8.0) | 32.1(9.0) | 39.4(8.7) |
Patient rates primary nurse | ||||||
WAI | 58.1(16.7) | 63.1(13.7) | 56.7(19.2) | 64.3(16.4) | 51.6(19.9) | 63.7(15.5) |
ITP | 36.4(6.5) | 38.6(5.0) | 36.3(6.9) | 39.6(8.2) | 33.9(7.6) | 38.4(8.4) |
Patient rates doctors in general | ||||||
ITP | 40.2(7.6) | 40.1(6.8) | 37.7(6.4) | 41.3(8.9) | 35.8(8.7) | 41.4(8.6) |
Consultant psychiatrist rates patient | ||||||
WAI | 43.7(15.7) | 55.1(15.0) | 43.9(18.3) | 55.9(14.0) | 41.5(18.2) | 56.5(15.1) |
ITP | 22.0(8.1) | 28.5(8.7) | 21.2(6.3) | 29.8(8.1) | 19.2(7.1) | 30.0(9.3 |
Primary nurse rates patient | ||||||
WAI | 51.3(10.3) | 58.2(13.4) | 48.7(12.2) | 57.1(13.9) | 48.4(14.6) | 57.9(12.3) |
ITP | 24.8(4.1) | 31.6(7.2) | 26.4(5.5) | 32.2(7.4) | 29.9(7.8) | 31.9(7.9) |
Perceived coercion, perceived procedural justice and impact of hearing on WAI and ITP
T1: six months before hearing | T2: two weeks before hearing | T3: two weeks after hearing | |||||||
---|---|---|---|---|---|---|---|---|---|
Perceived Coercion | |||||||||
Negative N = 49 | Positive N = 26 | ANOVA F/p | Negative N = 49 | Positive N = 26 | ANOVA F/p | Negative N = 49 | Positive N = 26 | ANOVA F/p | |
Patient rates consultant psychiatrist | |||||||||
WAI | 59.3(15.0) | 61.1(16.9) | 0.2/NS | 61.4(18.9) | 65.6(15.7) | 0.9/NS | 58.3(18.6) | 66.4(15.7) | 3.6/NS |
ITP | 37,7(6.9) | 39.9(7.3) | 1.6/NS | 38.5(8.2) | 40.5(7.6) | 1.1/NS | 36.6(9.4) | 40.0(8.7) | 2.4/NS |
Patient rates primary nurse | |||||||||
WAI | 61.6(14.1) | 62.7(15.5) | 0.1/NS | 61.4(18.5) | 64.7(14.7) | 0.6/NS | 58.6(18.2) | 65.4(14.6) | 2.7/NS |
ITP | 37.7(5.7) | 39.0(4.9) | 1.0/NS | 38.1(8.2) | 40.4(7.5) | 1.4/NS | 36.2(8.8) | 39.6(7.3) | 2.9/NS |
Patient rates doctors in general | |||||||||
ITP | 39.9(6.6) | 40.4(7.7) | 0.1/NS | 39.2(8.9) | 42.9(7.4) | 3.1/NS | 38.6(9.1) | 43.1(7.9) | 4.7/0.034 |
T1: six months before hearing | T2: two weeks before hearing | T3: two weeks after hearing | |||||||
---|---|---|---|---|---|---|---|---|---|
Patient's Rating of Perceived Procedural Justice (Legal) | |||||||||
Negative N = 15 | Positive N = 60 | ANOVA F/p | Negative N = 15 | Positive N = 60 | ANOVA F/p | Negative N = 15 | Positive N = 60 | ANOVA F/p | |
Patient rates consultant psychiatrist | |||||||||
WAI | 45.9(13.5) | 63.3(14.3) | 17.0/0.001 | 48.3(19.6) | 66.5(15.6) | 14.7/0.001 | 41.9(15.9) | 65.9(15.1) | 29.9/0.001 |
ITP | 31.4(5.5) | 40.2(6.4) | 22.4/0.001 | 32.8(7.8) | 40.8(7.3) | 14.0/0.001 | 27.2(8.4) | 40.4(7.4) | 36.4/0.001 |
Patient rates primary nurse | |||||||||
WAI | 52.3(15.4) | 64.3(13.5) | 8.5/0.005 | 45.9(20.7) | 66.7(13.5) | 22.8/0.001 | 42.1(19.6) | 65.7(13.0) | 31.5/0.001 |
ITP | 33.5(6.5) | 39.2(4.6) | 14.7/0.001 | 32.1(9.2) | 45.6(6.7) | 16.4/0.001 | 27.2(7.7) | 39.9(6.5) | 42.6/0.001 |
Patient rates doctors in general | |||||||||
ITP | 37.8(8.3) | 40.7(6.5) | 1.9/NS | 34.0(8.5) | 42.1(7.8) | 12.6/0.001 | 30.5(7.2) | 42.6(7.6) | 31.4/0.001 |
T1: six months before hearing | T2: two weeks before hearing | T3: two weeks after hearing | |||||||
---|---|---|---|---|---|---|---|---|---|
Patient's Rating of Perceived Procedural Justice (Medical) | |||||||||
negative | positive | ANOVA F/p | negative | positive | ANOVA F/p | negative | Positive | ANOVA F/p | |
Patient rates consultant psychiatrist | |||||||||
WAI | 48.8(12.8) | 61.9(15.3) | 7.1/0.009 | 46.6(14.8) | 65.6(16.9) | 12.1/0.001 | 38.0(13.8) | 65.1(15.5) | 29.5/0.001 |
ITP | 32.6(4.8) | 39.5(6.9) | 9.9/0.002 | 32.6(6.6) | 40.3(7.7) | 9.9/0.002 | 26.2(8.5) | 39.8(7.8) | 27.7/0.001 |
Patient rates primary nurse | |||||||||
WAI | 47.8(16.5) | 64.5(12.7) | 14.6/0.001 | 46.3(16.1) | 65.3(15.9) | 13.5/0/001 | 39.1(17.4) | 64.7(14.3) | 28.3/0.001 |
ITP | 33.0(6.9) | 39.0(4.7) | 13.3/0.001 | 33.1(6.9) | 39.9(7.8) | 7.3/0.008 | 26.6(4.4) | 39.2(7.5) | 28.7/0.001 |
Patient rates doctors in general | |||||||||
ITP | 39.1(8.5) | 40.3(6.7) | 0.3/NS | 37.4(4.8) | 41.0(8.9) | 1.8/NS | 31.6(6.1) | 41.6(8.5) | 14.2/0.001 |
T1: six months before hearing | T2: two weeks before hearing | T3: two weeks after hearing | |||||||
---|---|---|---|---|---|---|---|---|---|
Patient's Rating of Perceived Impact of Hearing | |||||||||
Negative | positive | ANOVA F/p | negative | positive | ANOVA F/p | negative | Positive | ANOVA F/p | |
Patient rates consultant psychiatrist | |||||||||
WAI | 51.9(14.9) | 61.4(15.4) | 3.5/NS | 49.5(16.5) | 65.4(17.1) | 8.7/0.004 | 45.4(17.7) | 64.1(16.5) | 12.6/0.001 |
ITP | 33.6(7.8) | 39.4(6.6) | 11.3/0.011 | 33.1(8.2) | 40.4(7.5) | 9.2/0.003 | 28.9(9.5) | 39.4(8.2) | 15.8/0.001 |
Patient rates primary nurse | |||||||||
WAI | 49.3(16.3) | 64.2(13.1) | 11.3/0.001 | 45.3(18.6) | 65.8(14.9) | 17.6/0.001 | 43.6(21.5) | 64.3(14.3) | 17.8/).001 |
ITP | 32.2(5.4) | 39.2(4.8) | 19.2/0.001 | 32.3(9.6) | 40.1(7.1) | 10.8/0.002 | 28.4(9.5) | 39.1(7.1) | 20.3/0.001 |
Patient rates doctors in general | |||||||||
ITP | 37.4(7.6) | 40.6(6.7) | 2.1/NS | 34.9(9.4) | 41.6(7.9) | 6.6/0.012 | 29.8(8.5) | 42.1(7.5) | 26.2/0.001 |
Counfounding factors: baseline (T1) effect of WAI and ITP, GAF and PANSS on perceived coercion, perceived procedural justice and impact of hearing
AUC | 95% CI | P | ||
---|---|---|---|---|
Lower bound | Upper bound | |||
Dependent variable: Patient's Perceived Coercion (dichotomised)
| ||||
Patient rates consultant psychiatrist | ||||
WAI | 0.554 | 0.412 | 0.696 | NS |
ITP | 0.625 | 0.485 | 0.764 | NS |
Patient rates primary nurse | ||||
WAI | 0.529 | 0.382 | 0.676 | NS |
ITP | 0.625 | 0.485 | 0.764 | NS |
Patient rates doctors in general | ||||
ITP | 0.538 | 0.392 | 0.885 | NS |
Dependent variable: Patient's perceive procedural justice re legal actors in hearing (dichotomised)
| ||||
Patient rates consultant psychiatrist | ||||
WAI | 0.828 | 0.696 | 0.960 | < 0.001 |
ITP | 0.857 | 0.762 | 0.952 | < 0.001 |
Patient rates primary nurse | ||||
WAI | 0.732 | 0.578 | 0.886 | 0.007 |
ITP | 0.795 | 0.649 | 0.941 | 0.001 |
Patient rates doctors in general | ||||
ITP | 0.659 | 0.487 | 0.830 | NS |
Dependent variable: Patients' perceived procedural justice re consultant psychiatrist's role in hearing (dichotomised)
| ||||
Patient rates consultant psychiatrist | ||||
WAI | 0.772 | 0.616 | 0.928 | 0.004 |
ITP | 0.815 | 0.705 | 0.925 | 0.001 |
Patient rates primary nurse | ||||
WAI | 0.798 | 0.628 | 0.968 | 0.002 |
ITP | 0.795 | 0.649 | 0.941 | 0.001 |
Patient rates doctors in general | ||||
ITP | 0.659 | 0.487 | 0.830 | NS |
Dependent variable: Patients' perceived impact of the hearing (dichotomised)
| ||||
Patient rates consultant psychiatrist | ||||
WAI | 0.697 | 0.508 | 0.886 | 0.038 |
ITP | 0.735 | 0.548 | 0.923 | 0.013 |
Patient rates primary nurse | ||||
WAI | 0.779 | 0.605 | 0.953 | 0.003 |
ITP | 0.830 | 0.703 | 0.957 | 0.001 |
Patient rates doctors in general | ||||
ITP | 0.656 | 0.475 | 0.837 | NS |
AUC | 95% CI | P | ||
---|---|---|---|---|
Lower bound | Upper bound | |||
Dependent variable: Patient's Perceived Coercion (dichotomised) | ||||
GAF | 0.467 | 0.330 | 0.604 | NS |
PANSS total score | 0.534 | 0.392 | 0.676 | NS |
PANSS positive | 0.460 | 0.324 | 0.595 | NS |
PANSS negative | 0.573 | 0.434 | 0.711 | NS |
PANSS general | 0.492 | 0.354 | 0.629 | NS |
Dependent variable: Patient's perceived procedural justice re legal actors in hearing (dichotomised) | ||||
GAF | 0.810 | 0.714 | 0.907 | < 0.001 |
PANSS total score | 0.807 | 0.709 | 0.904 | < 0.001 |
PANSS positive | 0.711 | 0.567 | 0.856 | 0.014 |
PANSS negative | 0.779 | 0.675 | 0.882 | 0.001 |
PANSS general | 0.509 | 0.318 | 0.699 | NS |
Dependent Variable: Patients' perceived procedural justice re consultant psychiatrist's role in hearing (dichotomised) | ||||
GAF | 0.802 | 0.670 | 0.935 | 0.001 |
PANSS total score | 0.837 | 0.738 | 0.936 | < 0.001 |
PANSS positive | 0.828 | 0.668 | 0.987 | < 0.001 |
PANSS negative | 0.738 | 0.621 | 0.856 | 0.012 |
PANSS general | 0.530 | 0.354 | 0.704 | NS |
Dependent variable: Patients' perceived impact of the hearing (dichotomised) | ||||
GAF | 0.673 | 0.511 | 0.835 | NS |
PANSS total score | 0.721 | 0.588 | 0.854 | 0.016 |
PANSS positive | 0.677 | 0.503 | 0.852 | NS |
PANSS negative | 0.608 | 0.457 | 0.759 | NS |
PANSS general | 0.588 | 0.410 | 0.766 | NS |