Background: Many countries have adopted new mental health legislation, with the detention of adults for treatment of mental disorders remaining an integral part of such policies. However, there are relatively few publications on the use of mental health legislation in the detention of older adults. This paper examines the civil detention of older adults in one Scottish region under successive mental health legislation.

Method: This prospective study collected data primarily by clinician-based interviews on all emergency detentions under the Mental Health (Scotland) Act 1984 of older adults in 1994 and compared these with all emergency and initial short-term detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 of older adults during 2008 in the same Scottish region.

Results: There were a total of 124 detentions, with an initial rate of 68 increasing to 141 detentions per 100,000 of the respective over-65 year age populations, a two-fold increase. Compared to the 1994 patient cohort, the 2008 cohort had higher rates of over 85-year-olds (18.4% v 5.4%) and organic mental disorders (74.7% v 56.8%) and were significantly more likely to be detained by consultant psychiatrists (73.6% v 18.9%) during working hours (87.4% v 48.6%) and proceed to six-month detention orders (31% v 10.8%).

Conclusion: The observed higher rates and longer periods of detention in the 2008 cohort may reflect changes in clinical attitudes and legal requirements from a previous reliance on the common law doctrine of necessity to the requirements of a more legalistic framework, and may signal future clinical requirements, given the aging population, pointing towards the need for earlier recognition and management of clinical issues in an attempt to minimize the “necessity” of clinico-legal intervention.

Objectives: In recent years there have been a number of high profile cases in Irish psychiatry where consultant psychiatrists have been subjected to serious physical assaults. The last survey of assaults on consultant psychiatrists in Ireland was carried out in 1998. Therefore we sought to update the data on this topic.

Method: An anonymous questionnaire was sent out by post to all consultant psychiatrists (n = 330) identified as currently working in the Republic of Ireland.

Results: The response rate was 48.2%. Sixty per cent of respondents were working in general adult psychiatry and respondents were evenly spread throughout the country. Ninety per cent of respondents had been the victim of verbal aggression/intimidation/threatening behaviour while 55% had been physically assaulted. The majority of incidents involved male patients aged between 21-40 years with a diagnosis of paranoid schizophrenia. Nearly 66% of incidents of physical violence occurred during a relapse of illness. The perpetrator had a history of violence in approximately half of all reported incidents. Physical assaults tended to occur more commonly in inpatient settings (63.7%).

Incident reporting occurred more often in physical assaults with 66% reported informally to colleagues and 20% reported to An Garda Siochana (police force of Ireland). Eighty-nine (56%) consultants described feeling ‘safe’ at work. Less than 50% reported the provision of standard safety equipment in the workplace and nearly half ofrespondents had not attended any safety training courses since their appointment. Longer experience working as a consultant psychiatrist did not appear to have an impact on reducing the rate of assaults. In addition, those who attended safety training courses did not report a reduced rate of physical assaults.

Conclusions: These findings highlight the need for both organisational and personal changes in practice in order to reduce the assault rate. Organisational changes include the provision of appropriate safety equipment, safety training for consultants, enhancing multidisciplinary teams and utilising risk assessment. Consultants' personal practices to improve their safety may offer useful information for inclusion in safety training courses. This is an area which merits further research.