The Cost-effectiveness of Alternative HIV Intervention Portfolios in South Africa

The Cost-effectiveness of Alternative HIV Intervention Portfolios in South Africa. Robert Stavert and Elisa Long (Sponsored by David Paltiel). Department of Epidemiology and Public Health, Yale University, School of Medicine, New Haven, Ct. A dynamic compartmental model was instantiated with recent epidemiological data from South Africa to compare the effectiveness and cost-effectiveness of different portfolios of interventions to prevent HIV infection over a twenty year time horizon. We hypothesized that portfolios which combined scaling up the delivery of highly active antiretroviral therapies (HAART), increasing availability of HIV screening and counseling, and establishing widespread circumcision campaigns would be the most effective and most cost-effective strategies. Portfolios which utilized widespread circumcision for adult men were found to be the most cost-effective, while portfolios which utilized a combination of interventions were found to be the most effective, in terms of quality adjusted life years (QALYs) gained. These findings highlight the urgency of scaling up access to life-saving antiretroviral treatments, and providing concomitant investments in HIV prevention and testing programs in a generalized HIV epidemic setting such as South Africa

Mental health, community care and human rights in Europe: Still an incomplete picture?

Mental health issues are increasingly finding their way onto national, European and international agendas. Moreover, the term ‘mental health’, though sometimes difficult to define with precision, has been taken to include not only mental ill health but also the maintenance of good mental health in general.This article examines progress in the field of human rights recognition as it pertains to mental health, in a European and a wider context

Editorial

Lead Editor Jill Stavert provides an overview of this issue's contents

Editorial

We are delighted to present the fourth issue of the International Journal of Mental Health and Capacity Law. The journal is now regularly receiving excellent submissions on mental health and capacity law and practice from across the globe, several of which are published in this issue, and clearly demonstrates the cross-sectorial demand for such a periodical

Deprivation of liberty and adults with incapacity: A Scottish Perspective

No abstract available

The exercise of legal capacity, supported decision- making and Scotland’s mental health and incapacity legislation: working with CRPD challenges.

Article 12 of the UN Convention on the Rights of Persons with Disabilities, particularly as interpreted in the Committee on the Rights of Persons with Disabilities General Comment No. 1, presents a significant challenge to all jurisdictions that equate interventions permitted under their mental health and incapacity laws with mental capacity. This is most notable in terms of the General Comment’s requirement that substitute decision-making regimes must be abolished. Notwithstanding this, it also offers the opportunity to revisit conceptions about the exercise of legal capacity and how this might be better supported and extended through supported decision-making. This article will offer some preliminary observations on this using Scottish mental health and incapacity legislation as an illustration although this may also have relevance to other jurisdictions.(This article belongs to the Special Issue Competency and Capacity: Issues Affecting Health Law, Policy and Society

Supported Decision-Making and Paradigm Shifts: Word Play or Real Change?

Article 12(3) CRPD requires states parties to provide access by persons with disabilities to the support they may require in exercising their legal capacity. This is to ensure that the rights, will and preferences of persons with disabilities are enjoyed on an equal basis with others [Articles 12(1)(2) and (4) CRPD]. Moreover, the Committee on the Rights of Persons with Disabilities has made it clear that supported decision-making must replace substitute decision-making arrangements as these are discriminatory and deny equal enjoyment of the right to exercise of legal capacity for persons. At the same time, there is ongoing debate as to whether or not the absence of substitute decision-making regimes is essential for the non-discriminatory realization of an individual's rights, will and preferences to be achieved. To resolve this debate, however, specific attention needs to be paid to the CRPD message on what it actually means to give effect to the equal and non-discriminatory enjoyment of rights for all. In the context of persons with mental disabilities this requires looking beyond human rights simply in terms of limiting unwarranted interventions to the proactive removal of obstacles to full rights enjoyment and the creation of environments that respect and support such enjoyment. With this in mind this paper will therefore critically consider the use of supported decision-making within existing substitute decision-making regimes with particular reference to Scotland's mental health and capacity laws. It will consider the challenges this poses and whether it is indeed possible to adapt existing regimes to achieve CRPD compliance. In doing so, it is suggested that a full appreciation of the overarching CRPD message about equality and non-discrimination in the enjoyment of rights is required to bring about such compliance

Deprivation of liberty and adults with incapacity: A Scottish Perspective

No abstract available

Respecting the autonomy of the living and dying

PurposeTo inform those who are supporting persons who are dying and are responsible for planning, commissioning or delivering palliative care about the need to support and maximise the decision-making ability and choices of persons with advanced dementia or severe frailty.ApproachThis article will consider the legal and human rights principles applicable to Scotland, and indeed to other jurisdictions, which govern decisions about care and treatment of persons with and without capacity and the application of these principles to palliative care situations.Implications It is a well-established legal and human rights principle that the decisions of a person with capacity must be respected, including decisions about palliative care and treatment at the end of life. Moreover, recent developments in international human rights law reinforce the message that this principle applies equally to all. Applying this principle into persons with advanced dementia or severe frailty therefore requires skilled assessment and supported decision making in order to optimise capacity and respect autonomy.ValueAn awareness of the underpinning legal and human rights framework which underpins decisions made that concern persons with advance dementia or severe frailty and their palliative care respects and enhances their choices and dignity