Mental Health and the Law

Electroconvulsive therapy (ECT) has a special status in the social imagination. Long associated with asylums, this treatment has not been abandoned by medical practice, and its use has even increased over the last ten years. Yet the controversial nature of this treatment remains. ECT is criticized for a lack of scientific basis, uncertain medium- and long-term risks and side-effects, and its much greater use in older women. In this context, under what circumstances and in what ways is it justified to subject a person to this treatment? This paper focuses on the process of informed consent to ECT for able-bodied adults, and more specifically on the content of physicians' duty to inform. We propose a critical analysis of current practices in the specific context of ECT in Québec. First, the scientific evidence regarding the nature, benefits and risks of ECT will be discussed, in order to account for the controversies and numerous uncertainties that persist concerning this therapeutic approach. Practices regarding consent to ECT will then be described and analyzed in the light of the scientific uncertainties outlined above, and taking into account the normative framework that imposes obligations in terms of physicians' duty to inform and obtain consent. Finally, proposals will be made to improve the informed consent process for ECT in Québec, so that the rights of the patients concerned are better respected.

Nursing homes are special facilities that provide round-the-clock medical care to persons who, due to old age or disability, have difficulties in navigating activities of daily living ("ADL"), such as bathing, dressing, eating, and using the toilet. 1 For

Nursing homes are special facilities that provide round-the-clock medical care to persons who, due to old age or disability, have difficulties in navigating activities of daily living ("ADL"), such as bathing, dressing, eating, and using the toilet. 1 For

Numa caminhada feita de obstáculos concomitantemente com sorrisos fortes de conquista, esboçando-se em palavras e aprendizagens eternas, não posso e nem sequer quero descurar todo o trabalho coletivo existente. Agradeço ao Prof. Doutor Manuel Veríssimo, orientador deste trabalho, por ter abraçado comigo este projeto, apoiando e consentindo as minhas des(venturas). Um agradecimento eterno à Prof. Lia Araújo, coorientadora deste trabalho, por ter aceitado remar comigo nesta maré. Pela disponibilidade constante, empenho persistente, confiança depositada e paciência permanente. Um apoio, uma referência que levo para a vida, não existem palavras suficientes de gratidão. Às UCCI que permitiram entrevistar os cuidadores de pessoas com demência, agradeço a facilitação e mediação dos contactos, assim como toda a amabilidade com que me acolheram e incentivaram a dar continuidade ao projeto. Gostaria de expressar ainda o meu mais profundo agradecimento a todos os familiares que aceitaram colaborar neste estudo, pois sem eles nada disto teria sentido. Aos meus pais agradeço com um beijo eterno tudo o que me têm proporcionado ao longo da vida, fazendo-me crescer com os meus erros, mas curando em conjunto as mazelas. Sinto-me muito feliz e orgulhosa por tê-los comigo e sei que o que fazem é porque desejam sempre o melhor para mim. À minha irmã, em que discussões viram em gargalhadas, lágrimas em sorrisos, agradeço por todos os dias me completar mais um bocadinho. Obrigada, por aturares até sempre as minhas birras. À minha prima, princesa Rita, com quem acredito eternamente, que um dia vamos mudar o mundo, um xicoração bem apertadinho, os raios de sol contemplaram os meus dias. A toda a minha família, uns mais presentes, outros mais ausentes, por darem asas longínquas à minha imaginação e darem-me a mão. Bem-Haja à avó Bina e ao avô Toni, ao Tio Nuno e à Tia Teresa. Um obrigada, a todos os amigos pelo apoio e momentos proporcionados de distração, que foram partilhando de forma a suavizar o cansaço sentido ao longo do percurso, bem como pela sua amizade. À amiga Dani, refúgio permanente das minhas ansiedades, agradeço a amizade, disponibilidade e paciência (muita!) sempre presente.

The Indian legislation has established the Mental Healthcare Act of 2017 offering its citizens the right to accessible mental healthcare services. Yet, reality presents a varied depiction. The accessibility and implementation of mental healthcare services in the majority of India remain critically lacking but are often overlooked, contributing to a silent crisis. Despite the legislation’s progressive intentions the societal barriers like- the rural urban divide in mental healthcare accessibility, social stigma, lack of
awareness, insufficient resources , inadequate funding and insufficient integration of mental health as part of broader healthcare system, have made the practical implementation of the laws having poor impact. This chapter seeks to discuss the lacaune in socio economic realities in application of the mental health regulations and suggest changes needed to make it more efficient.

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This doctoral project, Re-worlding the Self in Graphic Narratives—A Case Study of Sense, Affect, and Mad-Centered Knowledges of Psychosis, collaboratively explores and addresses experiences of psychosis (sensory breaks from reality) with Mad-identifying participants who describe their earliest memories of these interior events from a sensorial and visual perspective. Co-creating an arts-based ethnography of psychosis through the ongoing production of artworks and media, I survey the ways that participants’ narratives of psychosis materialize through visual and poetic representations of their lived experiences of madness. I examine how individuals distressed by psychosis move beyond their symptomatic illnesses and narrowly prescribed identities and find new ground to (re)make themselves through expressive processes. Within a synergetic inter-arts research setting, I led a series of five online workshops with two unique groups of participants, each of whom had prior past episodes of psychosis and were immersed in outpatient mental health services. Participants drew from and upon their interior, emotionally charged experiences during the workshops to develop multisensory and narrative drawings that became both prompt and foundation for subsequent individual interviews. We then collaborated on participant-led comics that became the foundational impetus for re-imagining the ethnographic text. Through this novel approach to arts-based research, I aimed to understand psychosis from empathic, sensorial, and visual perspectives. This project documents, engages, and theorizes the role of “psychosic” imagination and creativity in the lives of ten participants who have experienced psychosis as a life event and were involved in comics-making activities. Here, I track how participants, as cherished Mad interlocutors and co-collaborators, sought to resolve communication and subject-positioning issues that arose from the equally ineffable and challenging dynamics of psychosis and madness. These conflicts were internally registered and spurred a vital set of self-fashioning, polyphonic dialogics that primed my interlocutors for self-transformation and psychosic re-worldings. These collective efforts not only de-center ethnographic practice through research-creation strategies, but they succinctly clarify aspects of how madness and pressured, non-normative consciousness are experienced, generating a set of symbolic, poetic, and visual languages to capture expressions of psychosis. Moreover, as a collaborative research-creation practice, our extensive, year-long work aided in destigmatizing and reframing mental duress. Participants simultaneously developed ways to navigate emotional tensions, challenge points, and affective accruals wrought by psychosis through graphic narrative modalities, offering this practice as one that sees Mad-inclusive systems of living myth intertwined with post-traumatic growth.

professional group, lawyers, is particularly subject to psychological distress which can manifest in a variety of counterproductive actions and impairment. This danger is of particular societal concern due to the influential and important roles played by lawyers as elected and appointed public officials, as policy advisors, and as advocates of public and private interests. 6 The findings of the research reported in this study, in conjunction with earlier studies, suggest that the professional and the personal well-being of lawyers is in serious jeopardy. Lawyers are working more, reducing vacation time, spending less time with family members, 7 are prone to alcohol abuse, 8 and face high levels of psychological distress. 9 The combination of elements suggests an impending crisis for lawyers' family lives. Although the data are not sufficient to suggest that psychological distress has detrimentally affected the lawyers' ability to practice competently, the warning signs are present. Further empirical study may well reveal that lawyer distress is having an adverse effect on the ability to practice competently and ethically. The data and analyses presented below manifest a highly alarming fact: a significant percentage of practicing lawyers are experiencing a variety of significant psychological distress symptoms well beyond that expected of the general population. These symptoms are directly traceable to law study and practice. They are not exhibited when the lawyers enter law school, 10 but emerge shortly thereafter and remain, without significant abatement, well after graduation from law school. The dangers of psychological distress among members of the legal profession arise, at least in part, from two of the very elements that are traditionally associated with effective litigation strategydirected anger and hostility. Both of these factors may often be counter-productive to one's overall well-being. Posed differently, the environment surrounding lawyers is conducive to the creation of substantial psychological distress. The distress symptoms apply to both male and female lawyers. Although there are gender based distinctions, there is substantial commonalty in regard to stress factors, psychological distress, and alcohol-related problems. Both male and female lawyers exhibit symptoms of distress, well beyond the norm,

The new Mental Health Act for England and Wales is likely to extend the powers of mental health review tribunals (MHRTs) by giving tribunals the power to approve all compulsory treatment (Department of Health, 1999a, b). The medical member may be dropped entirely from the tribunal's proceedings (Richardson & Machin, 2000). In Ireland, a proposed new Mental Health Act will introduce MHRTs for the first time (Calvert, 2000). The 1983 Mental Health Act contains no explicit statement of underlying principles, although some were introduced in the revised Code of Practice. The Expert Committee (Department of Health, 1999b) suggested that the new Act should specify broad principles where these would help in statutory interpretation, particularly because a range of practitioners working in different settings will be required to understand and implement its provisions. The Green Paper initially suggested that the proper place for setting out principles should be a Code of Practice, but e...

Involuntary outpatient commitment is a measure which provokes a strong ethical and legal debate. In the literature we can find defenders and detractors of IOC. There are a variety of clinical, ethical and legal reasons for both accepting and rejecting such measures. In this paper we try only to argue its legitimacy from an ethical and legal point of view. Moreover, we wish to debate and defend the proposed regulation of the Law of Civil Procedure.

Liste des abréviations ACPM-Association canadienne de protection médicale ALDO-Aspects légaux, déontologiques et organisationnels de la pratique de la médecine au Québec C.c.Q.-Code civil du Québec CDCM-Conseil de discipline du Collège des médecins C.D.M.-Code de déontologie des médecins CMQ-Collège des médecins du Québec CSC-Cour suprême du Canada DSP-Directeur des services professionnels ÉT-Écart-type IC-Intervalle de confiance L.S.S.S.S.-Loi sur les services de santé et services sociaux MMIC-Multi-Measure of Informed Consent

In this article, we will explore evidence for structural and public stigmatization and marginalization of forensic psychiatric patients within mental health services and the human rights justice system. It can be argued that patients in secure and forensic services (often referred to as mentally disordered offenders) are potentially the most marginalized and extensively stigmatized of all patient cohorts, and that the extent to which they are discriminated against should not be underestimated. We will also consider the potential for breaches of the Human Rights Act (1998) and associated injustices which may present in the treatment of these individuals, and how praxis can be improved so that harms are remedied and well-being and mutual respect improved.

This paper focuses on the policy context that led to the development of the New Ways of Working in child and adolescent mental health services (NWW CAMHS) project and the future direction of change that is its legacy. NWW CAMHS represents a merging of policy and practice across what is sometimes a divide between adult and child services. In some aspects, CAMHS had already adopted what became known as a NWW in adult mental health with multidisciplinary teams characterised by dispersed patterns of responsibility and leadership. In other areas, particularly the involvement of service users and carers, CAMHS has been less forward‐thinking. There continues to be a significant workforce challenge for children's services and a risk that innovation and development will not be fully inclusive of the full range of service users' needs. It is important that the lessons learned from the national workforce programme are kept while the usual boundaries to development across services are b...

Judicial procedures for involuntary admission and forced psychiatric
treatment have been on the rise over the past 15 years in Quebec, as well as
across Global North countries. Research reveals that these judicial practices tend to target marginalized social groups and are characterized by the violation of their judicial and civil rights. Judicial ethnographies have highlighted the multijudicialization of individuals subject to such procedures, in the mental health area, as well as in others such as criminal law and youth protection. These ethnographies also documented the content of court proceedings, which were focused on the socio-economic conditions of the involved individuals, rather than on the law. Based on these inductively analyzed ethnographic fields, this article describes how, in the context of social distance between judges and defendants, civil and administrative justice in the mental health area is exercised on the basis of an indefinite risk deeply rooted in a stereotyped conception of gender and race.

Mobile mental health presents many ethical challenges in the wild. These ethical issues and associated values were explored through a content analysis and ethical review of the depression app marketplace. App search and data collection was performed in Google Play Store (UK) and Apple iTunes (UK) between October to November 2018. Iterative data extraction and coding of ethical variables and values were conducted prior to synthetization of issues and themes. Search found 353 unique apps for depression. Analysis uncovered a range of ethical issues including: limited evidence of intervention validity, fidelity, and outcomes; insufficient safeguarding and duty of care; non-multisector development teams; lack of independent certification and regulation; lack of information and transparency for informed user choices; and concerns with privacy, confidentiality, and user permissions. These findings highlighted the presence and absence of ethical values in apps for depression, with most apps failing to reflect many key values. Our findings suggest a need for greater ethical value sensitive design in mobile mental health. This is challenging given the field's multidisciplinarity and value conflicts. We encourage designers to adopt a responsible innovation approach to creating technologies that meet these ethical demands.

In Criminal Trials and Mental Disorders Thomas Hafemeister, a law professor and psychologist, provides a lengthy and detailed discussion on how defendants with mental health issues are viewed by, and treated in, the US criminal justice system. Given that the aim of the US legal system is to serve fairness and justice for all, this is an extremely important book because a defendant's mental disorder can play a significant role in his being provided with a fair and just trial. This book is particularly relevant today when it is being increasingly acknowledged that mental disorders are pervasive and undertreated and are even more so within the criminal justice system.

En el presente trabajo se abordara la tematica referida al Consentimiento Informado en investigacion psicologica con ninos y ninas. El interes por la problematica radica en que si bien en la actualidad existe una amplia literatura acerca del consentimiento informado en el ambito de la salud en general, cuando de ninos y ninas se trata nos encontramos con un escaso tratamiento del tema y mas especificamente referido al campo de la Psicologia. Por lo antedicho nos parece de gran relevancia adentrarnos en que ocurre con la capacidad de consentir de los/as menores a la hora de iniciar un proceso de investigacion y cuales serian las implicancias eticasmorales y legales a considerar por los/as investigadores/as. Dicho topico se pretende enmarcar desde la optica de aquellas declaraciones y normativas provenientes desde el ambito de la psicologia y de los derechos humanos que velan por el bienestar y la proteccion los/as menores, introduciendo de este modo el concepto de asentimiento, que s...

Psychiatric nurses who work with people who are involved with the justice system experience ethical and moral tension arising from their dual role (care and control). This is known to significantly affect the development of a therapeutic relationship between nurses and patients. (a) better understand how justice system involvement affects people living with mental disorders and the nurses who work with them; (b) explore the influence of judiciarization on social interactions between these actors. Grounded theory (GT) was used as the qualitative methodology for this research. Semi-structured interviews were conducted with participants. The study was carried out in three different units of a psychiatric institution: Psychiatric Intensive Care Unit, Emergency Department, and Brief Intervention Unit. A sample of 10 patients and 9 psychiatric nurses was recruited (n = 19). Theoretical sampling was used to recruit participants. We followed the iterative steps of qualitative GT analysis (open coding, axial coding, constant comparison, and modelization). Three main themes emerged from the qualitative analysis: (a) Experience of Justice System Involvement, (b) Crisis, (c) Relational Aspects and Importance of the Approach. These results will inform nurses and healthcare providers about the impacts of justice system involvement on people living with mental illness and how clinical practices can be better adapted to this population with complex health needs.

La catastrophe de la psychiatrie, et en particulier de la pédopsychiatrie, que nous annoncions lors des précédentes Assises est maintenant avérée, rendue publique dans la grande presse et l'ensemble des médias. Des services sont supprimés, tant dans les hôpitaux que dans les centres ambulatoires, entravant l'accès à des soins de proximité, avec des listes d'attente dont se plaignent à juste titre patients, familles et soignants. Ayant à prendre en charge les personnes en souffrance psychique, la psychiatrie devrait s'intéresser à leurs conditions sociales, anthropologiques, culturelles… Les pratiques de psychothérapie Institutionnelle témoignent de la possibilité de faire autrement dans les Collectifs qui résistent à l'air du temps, en construisant avec les patients des moments d'accueil et d'hospitalité. Dans les clubs thérapeutiques, dans les interstices des institutions, mais aussi dans les groupes d'entraide mutuelle, nous pouvons être sensibles à l'émergence d'espaces de solidarité et de rencontres entre patients et soignants oeuvrant ensemble à des tâches communes. Ce travail sur l'ambiance est précieux dans les moments de vie quotidienne et ouvre également aux potentialités créatrices de chacun(e). Ce qui vaut pour les institutions de soin psychiatriques garde toute sa pertinence pour le soin dans le médicosocial et le social. Aujourd'hui un grand nombre de patients Pro PROJECTIONS Dans le cadre des Assises citoyennes auront lieu les projections suivantes :

This is the thirty-second report in a monograph series authorized by the Hoard of Trustees of the American Psychiatric Association to give wider dissemination to the findings of the Association many commissions. committees, and task forces that are called upon from time to time to evaluate the state of the art in a problem area of current concern to the profession, to related disciplines, and to the public. Manifestly. the findings, opinions, and conclusions of the Task Force Reports do not necessarily represent the views of the officers, trustees, or all members of the Association. Each report. however, does represent the thoughtful judgment and consensus of the task force of experts who formulated it. These reports are considered a substantive contribution to the ongoing analysis and eva]uation of problems. issues. and practices in a given area of concern.

This is the thirty-second report in a monograph series authorized by the Hoard of Trustees of the American Psychiatric Association to give wider dissemination to the findings of the Association many commissions. committees, and task forces that are called upon from time to time to evaluate the state of the art in a problem area of current concern to the profession, to related disciplines, and to the public. Manifestly. the findings, opinions, and conclusions of the Task Force Reports do not necessarily represent the views of the officers, trustees, or all members of the Association. Each report. however, does represent the thoughtful judgment and consensus of the task force of experts who formulated it. These reports are considered a substantive contribution to the ongoing analysis and eva]uation of problems. issues. and practices in a given area of concern.

In nearly all criminal justice systems, a defendant's severe mental disorder can trigger special rules that excuse or exempt the defendant. Swedish criminal law adopts an alternative approach that considers all defendants to be equal in terms of accountability, or capacity for responsibility, and lacks any rules that excuse or exempt a defendant with a severe mental disorder or disability. This paper presents the first comprehensive study of how Swedish criminal law functions without an insanity defence. The analysis focuses on the legal assessment of mens rea and offers observations regarding the Swedish model that are of particular relevance for discussions concerning the potential and pitfalls of an ''integrated'' model for criminal responsibility.

Pós-doutorando como professor visitante em estágio pós-doutoral sênior em Direito na PUC-MG e em Administração na FUMEC. Doutor em Direito pela UFMG (2007), possui mestrado e especializações. Avaliador de cursos de direito pelo INEP-MEC (desde 2010). Professor titular do mestrado e da graduação da Universidade de Itaúna (MG), titular na graduação da FACED-Divinópolis (MG), UNIPAC, FUPAC-Nova Lima e na especialização da UNA-BH.

By examining a decade of newspapers accounts in the Midwest, the current study explores the nature of repeat or recidivist police sexual violence (PSV) in comparison to first-time offending in the characteristics of the offenders, nature of the PSV acts, and the departments and criminal justice system response. Results show that more than 41% of PSV cases are committed by recidivist officers who averaged 4 victims each over a 3-year span of offending. The idea of the officer shuffle is explored in the context of sexual offending by police, indicating that a minority of officers move across jurisdictions maintaining police certification despite allegations of violence and misconduct. Implications explore how policy changes, such as a national reporting system for police sexual offending, would impact problem-prone PSV offending.

Background There is a lack of instruments to measure the needs, stigma and informal care of people with schizophrenia that take account of sociocultural variation and patients' and formal and informal carers' opinions and experiences. Aims To develop questionnaires to measure stigma, needs and informal (non-professional) care for people with schizophrenia. Method We undertook the study in seven countries and in English, Spanish and Portuguese. We first held focus group discussions with patients, formal carers (professionals) and informal carers (family and friends) in Spain, the UK, Argentina, Brazil, Chile and Venezuela to elicit the main dimensions of needs, stigma and informal care. We then held nominal group discussions about these dimensions with patients, family members and professionals in Spain, Portugal and the UK, to develop the instruments. Results Three hundred and three people participated in 46 focus groups and results were discussed in three nominal groups, ea...

Introduction 256 I. Background: The Family and Medical Leave Act 260 A. Statutory and Regulatory Background 261 1. Legislative Intent 261 2. Deference to Department of Labor Regulations ....... 264 3. Employer Rights and Responsibilities Under FMLA 265 4. Employee Responsibilities Under FMLA 267 5. FMLA Accrued Leave Substitution Policies 268 6. Interaction Between FMLA with Individual State Laws and Employer Policies 268 B. Judicial Enforcement 270 1. Judicial Rights of Action: Interference Claims ........ 271 2. An Employee’s Ability to Waive FMLA Claims ..... 273 3. An Employee’s Ability to Refuse FMLA Protection 275 II. Background: Escriba v. Foster Poultry Farms, Inc. 276 A. Factual Background 277

Lawyering with cross-cultural awareness is a current topic of interest in criminal law practice. In order to address cross cultural mental health assessments effectively, lawyers much be able to identify qualified experts, and to recognize legally reliable cross cultural assessment methodology. This paper, from a long time practitioner who as addressed the lawyering of mental health issues for a number of years,  covers source materials that should be of interest to practitioners.

drug-resistant strain of tuberculosis. 2 This event prompted a public outcry against the actions of the "tuberculosis traveler," 3 who failed to heed the warnings of various local, state, and federal officials. However, the implications of the tuberculosis incident reverberated throughout the aviation, legal, and medical communities in a way in which fictional killer snakes cannot. While few travelers might like to ponder it, germs on a plane, and associated issues immediately after disembarking, are a more realistic, if less glamorous, threat to the flying public than a Hollywood created movie. Although travelers are offered some measure of protection from illness through the terms of the World Health Organization's International Health Regulations ("IHR") 4 and the actions of governments and air carriers, 5 the tuberculosis traveler incident illustrates that there are several areas where travelers are protected by neither law nor medicine. This article examines two issues which were highlighted by the tuberculosis traveler incident and its aftermath: 1) the effectiveness of the current legal regimes in international law in stopping the health threat posed by individual carriers of communicable diseases who attempt to travel on an aircraft and 2) the legal standards-or lack thereof-applicable to international travelers when their course of travel is interrupted because they are deemed to constitute a threat to public health by the nation to which they are traveling or at an intermediate point during their travels. Part II of this article describes the various applicable international law regimes and provisions which govern air travel and the identification, handling, and procedures to be used in the event of a suspected or confirmed outbreak of infectious disease. 6

Over the past few decades, the boundaries around involuntary admission and treatment in psychiatry ("psychiatric coercion" or "coercive psychiatry") have become blurred. On the one hand, between the 1970s and 2000, the use of involuntary admissions decreased, along with the number of available hospital beds. On the other hand, in order to rationalize expenses, alternatives to involuntary admission were developed. 1 The use of involuntary hospitalization and treatment in the community ("community treatment order," "compulsory community care," "authorization for care") became increasingly important in several jurisdictions. This coercive care blurs the boundaries between hospital, clinic, and community and between what is coerced and what is voluntary. In many jurisdictions, such as Ontario, community treatment orders ("CTOs") are agreed upon by psychiatrists and their patients, who consent to undergo treatment in exchange for their release from hospital. This freedom is conditional on their compliance with treatment, with involuntary admission remaining a possibility, like a sword of Damocles hanging over their heads. As freedom is exchanged for submission to treatment, the meaning and value of consent in psychiatry is diminished, enabling practices that are not permissible in other areas of the healthcare field. In practice, as freedom is exchanged for submission to treatment, hospitals move into communities. In the days of the asylum, coercion was explicit. The coercion of current practices, in contrast, is implicit, masked as negotiation and consent, taking place in the private sphere of homes-what some authors have called the "invisible asylum." 2

Digital phenotyping uses smartphone and wearable signals to measure cognition, mood, and behavior. This promising new approach has been developed as an objective, passive assessment tool for the diagnosis and treatment of mental illness. Digital phenotyping is currently used with informed consent in research studies but is expected to expand to broader uses in healthcare and direct-to-consumer applications. Digital phenotyping could involve the collection of massive amounts of individual data and potential creation of new categories of health and risk assessment data. Because existing ethical and regulatory frameworks for the provision of mental healthcare do not clearly apply to digital phenotyping, it is critical to consider its possible ethical, legal, and social implications. This paper addresses four major areas where guidelines and best practices will be helpful: transparency, informed consent, privacy, and accountability. It will be important to consider these issues early in...

Esta comunicación se realiza en el marco de una beca CIN-UNLP, vinculada al proyecto de investigación El consentimiento informado en investigaciones psicológicas con niños. Consideraciones ético-normativas i , cuyo objetivo principal se orienta a revisar y analizar

Asthma is a growing societal and industrial problem in the United States. Asthmatic employees cause many disruptions and lost productivity in the workplace due to their unexpected and frequent absences. Should the problem persist employers will want to take actions such as progressive discipline to correct the situation. However, companies must be aware of the various legal pitfalls they will encounter along the way. Asthmatic workers are covered by various federal and state disability and family leave laws. This article discusses the ramifications of these laws primarily from a federal legal perspective (Americans with Disabilities Act and Family Medical Leave Act) when dealing with an asthmatic employee. There are currently about 17 million asthma sufferers in the United States [1]. This represents a 26 percent rise over 1993-1994, and the number is expected to continue to rise [1]. Once thought of as just a childhood disease, asthma is striking adults at an alarming rate [2]. In fact, reported cases among adults have more than doubled over the past 20 years [2], and as many as 15 percent of all asthma cases may be traced to on-the-job irritants [3]. This can lead to many unforeseen absences from work. Asthma also poses serious problems for employers in terms of having to cover the job, overtime, administrative hassles, loss of job continuity, and even lost production and sales. In fact, annual national treatment for asthma costs on a national basis is over 6 billon dollars [4]. Employers who take affirmative steps 297

Le secteur de la santé mentale connaît un certain nombre de difficultés et dysfonctionnements (Laforcade, 2016) qui paraissent souvent liés à des facteurs entremêlés d'ordre organisationnel, institutionnel et culturel. Diverses analyses scientifiques et opérationnelles, au plan international, incitent à explorer de nouveaux modèles de prise en charge, permettant une approche plus globale et mieux coordonnée, s'appuyant notamment sur l'imbrication des soins et des services sociaux et médico-sociaux. Cet article examine, à partir d'un cadre théorique interdisciplinaire (santé publique, psychiatrie, management et organisation) et d'une étude de cas approfondie, en quoi la mise en oeuvre d'un dispositif structurel et managérial innovant et s'efforçant de répondre à des besoins identifiés, peut se heurter à des obstacles tels que des formes de conservatisme sociétal et diverses manifestations de résistance au changement. Ainsi, cette recherche exploratoire met en avant d'une part la faisabilité et l'opportunité de nouveaux modèles de prise en charge du patient en santé mentale, et également les défis à surmonter et les conditions de réussite de ce type d'évolution.

A dignidade fundamenta uma conceção dualista de direitos constitucionais, direitos de liberdade, tributários de uma dignidade pessoal e direitos sociais, subsidiários de uma dignidade social (Neto, 2014), cuja garantia é da responsabilidade do Estado. O aumento da esperança de vida articulado com um persistente risco de pobreza e privação material na população com 65 ou mais anos, tornam pertinente uma análise das políticas sociais de velhice na garantia do direito a uma vida com dignidade. Este artigo apresenta resultados de um estudo que procura identificar alterações e/ou processos de reconfiguração de medidas e políticas com impacto na garantia dos direitos das pessoas idosas a uma vida digna e a referência específica ao termo dignidade, a partir da observação documental de medidas legislativas publicadas entre 01/01/2006 e 31/12/2015. Identificam-se quatro períodos temporais refletindo opções políticas, condicionantes internas e externas e verifica-se uma quase ausência do term...

Law Center. Mr. Hayes contributed to this article and to the amicus brief in Sisk during an internship with the AARP Foundation Litigation. AARP is a nonpartisan, nonprofit membership organization of more than 35 million people age 50 or older dedicated to addressing the needs and interests of older Americans. One of AARP's primary objectives is to achieve dignity and equality in the workplace through positive attitudes, practices, and policies, regarding work and retirement. 1. 29 U.S.C. § § 621-34 (2000) (prohibiting discrimination based on an individual's age in places of employment). 2.

Mental health law and practice has been instrumental in the development of non-adversarial justice, particularly through the development of therapeutic jurisprudence which emerged from insights gathered in the mental health context. The expanding articulation of non-adversarial perspectives beyond mental health is, in turn, reshaping critical debate about current mental health tribunal practice. Tribunals are also being encouraged to consider human rights perspectives. Human rights concerns and non-adversarial perspectives intersect with the longstanding debates in mental health tribunal practice about participation, representation and the role of the tribunal in the management of a dispute. They also raise new questions about the scope of the tribunal powers with respect to the oversight of medical treatment decisions and the provision of medical services. This article considers the intersection of human rights and non-adversarial justice perspectives in mental health review tribunals. It examines the common conceptual ground occupied by human rights and non-adversarial justice and considers four 'psycho-legal soft spots' in tribunal practice. These are the timing of tribunal review, the participation of the person in tribunal hearings, legal representation before tribunals and the scope of tribunal powers. This article argues for an integration of non-adversarial justice and human rights perspectives.