Review of the implementation of Brunei Darussalam’s New Mental Health Order in a psychiatric ward in RIPAS Hospital

Correspondence: Hilda Ho, MBChB, MPhil, FRCPsych, Raja Isteri Pengiran Anak Saleha Hospital Ministry of Health, Brunei Darussalam BA1710 Email: [email protected] INTRODUCTION Brunei Darussalam is a small country (population 406,000) in Southeast Asia, which scores highly in economic, health and aa social indicators. Mental health care services have undergone a period of expansion and development. The new Mental Health Order was implemented on 1 November 2014, replacing the 1929 Lunacy Act. The development and contents of this legislation have ABSTRACT Introduction The Brunei Darussalam New Mental Health Order was implemented on 1 st November 2014, replacing the 1929 Lunacy Act. The aim of this study was to evaluate the implications of the new Mental Health Order on admissions to the psychiatric ward in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital in the first year of implementation. Method All new psychiatric in-patient admissions and readmissions between 1 November 2014 and 31 October 2015 were included in the study. Each new admission or readmission was regarded as a “case”. Admission, demographic, diagnostic data and length of stay were collected from the ward admission register, hospital electronic records and completed involuntary treatment forms. Comparisons were made between voluntary and involuntary “cases”. Results One hundred and fifty-eight patients were included in the study. There were 179 cases in total, of which 21(11.7%) were readmissions for 15 patients. 105 (58.7%) cases were involuntary and 74 (41.3%) were voluntary. There were higher proportions of schizophrenia, acute and transient psychotic disorder, schizoaffective disorder and primary diagnosis of mental and behavioural disorder due to psychoactive substance abuse in the involuntary group. The mean length of admission was 26.11 (sd= 29.69, range = 1 170) days for all cases, 28.24 (sd = 31.41, range = 1-170) days for involuntary cases and 23.09 (sd = 26.97, range = 1-156) days for voluntary cases. Long term (six month) involuntary treatment orders were used only for 16 (6.1%) of cases. Conclusions Involuntary admissions make up the majority of admissions for patients admitted with a diagnosis of mental disorder. Those presenting with a psychotic disorder or substance abuse disorder were more likely to be involuntarily admitted. Long-term involuntary treatment orders were not commonly used.