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2009. “The Health and Health Care of US Prisoners: Results of a Nationwide Survey.” American Journal of Public Health 99: 666–672.Find this resource: WHO (World Health Organization). Many statutes refer to “assisted outpatient treatment,” but we use the term “mandatory outpatient treatment” because it directly expresses the coercive element of such policies. Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. One participant put it this way: Even if you do not think about it, there is a tendency in our attitude that ‘I have and you have not, I can leave at 3 pm., you have to stay. Mental Health Action Plan: 2013–2020 (Geneva, Switzerland: WHO Document Production Services). A Conceptual Model and Explication.” Psychiatric Services 52: 482–485.Find this resource: Johnston, S. G. 2008. “The Mental Health Security for America’s Families in Education Act: Helping Colleges and Universities Balance Students’ Privacy and Personal Safety.” Duquesne Law Review 46: 211.Find this resource: Kemp, K., Zelle, H., and Bonnie, R. J. Ethics in Community Mental Health Care: Commonplace Concerns examines everyday ethical issues that clinicians encounter as they go about their work caring for people who have severe and persistent mental disorders. The article “‘It’s a national scandal’: 15 stories which show the state of mental health care in the UK” presented by The Guardian in the year 2014 contains a number of stories about ethics code violations that were committed by English psychologists and psychiatrists. (p. 212) (St. Paul, Minn.: West Academic Publishing).Find this resource: Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., and Samuels, S. 2009. “Prevalence of Serious Mental Illness among Jail Inmates.” Psychiatric Services 60: 761–765.Find this resource: Swartz, M. S., Wilder, C. M., Swanson, J. W., Van Dorn, R. A., Robbins, P. C., Steadman, H. J., et al. Unrelated to such programs, proposals to increase access by families to otherwise private health information have been advanced, with proponents arguing that allowing the person’s support system to be engaged in treatment can avoid a worsening of symptoms and result in benefits to the community as well as the individual (Castro, 2015; Johnston, 2008). APA (American Psychiatric Association). Not surprisingly, there have been no controlled trials on the application of civil commitment criteria, and the few before/after studies on this question tend to show that narrowing or broadening the criteria has had relatively little effect compared to other influences on hospitalization and commitment practices, such as reducing the number of beds or the level of insurance reimbursement. It teases out the ethical challenges that mental health nurses can face on a daily basis. Questions arise about the use of coercion, e.g., when a patient doesn’t want to take his … But how does one evaluate involuntary treatment from a population perspective? A Brief History of Mental Health Policy in the United States. As a result, the census of public mental health facilities decreased dramatically: in 1956 the average daily census was 551,390 out of 169 million Americans, but by 2004 the average daily census was 55,000 out of 275 million Americans (Slobogin et al., 2013). Disturbing behavior related to mental illness may attract the attention of law enforcement and begin a process of cycling in and out of the criminal justice system, which is highly disruptive to continuity of care and often worsens symptoms. Litigation led to landmark decisions vindicating rights of persons with mental illness, including due process in civil commitment proceedings, freedom from coerced treatment in the absence of danger to self or others (e.g., O’Connor v. Donaldson, 422 U.S. 563 [1975]), and a right to treatment upon commitment. 2010. To evaluate the justification for coercion in the individual case, the balance is struck at the clinical level, taking the patient’s decisional capacity, the risk of harm, and the availability and effects of alternative interventions into account. Ethical issues in mental health care Nurses working in the care for psychiatric patients daily face dilemma’s concerning respect for autonomy versus paternalistic behavior. In this chapter, we have shifted the focus of ethical discourse to the population level and to the values that ought to be sought in a system for delivering mental health services. In an era that holds dear 'patient autonomy,' it routinely faces patients who suffer disorders that place the capacity for autonomy in question. Similar estimates have been made elsewhere in the world (Kessler et al., 2009). 149) IV Addiction (pg. Importantly, mental illness (and health) implicate a person’s functioning, not merely the presence or absence of symptoms. Diagnostic and Statistical Manual of Mental Disorders. Being a mental health nurse is a challenging role that comes with its own rules, ethics, and issues. Mental Health Ethics encourages readers to heighten their awareness of the key ethical dilemmas found in mainstream contemporary mental health practice. What is more, the gaps in mental health services are accompanied by gaps in subsidized and supportive housing and other community supports. Deinstitutionalization was driven by several factors, including the high costs of institutional care, critiques of institutional care as oppressive and dehumanizing, nascent sensitivity to the civil rights of persons with mental illness, allegations that psychiatry was used as a form of social control, and a renewed optimism about the ameliorative effects of new pharmacotherapies and community-based mental health services. Topics include central questions such as evolving views of the morality and pathology of deviant behavior; patient competence and the decision to refuse treatment; recognizing and treating people who have suffered trauma; addiction as illness; the therapist's responsibility to report dangerousness despite patient confidentiality; and boundaries for the therapist's interaction with patients outside of therapy, whether in the form of tennis games, gift-giving, or social media contact. Despite the gains of the last few decades, stigma remains a prevalent problem. ‘Coercive culture’ in mental health care. Ethics in Tele Mental Health* Teacher Jennifer Roofner, LCSW, LCAS $37.00 Buy this course Add to cart Overview Curriculum Instructor COURSE OVERVIEW Telehealth has become ever-growing popular and it will likely continue to grow and increase following the recent COVID-19 … 2015. “Piercing the Privacy Veil: Toward a Saner Balancing of Privacy and Health in Cases of Severe Mental Illness.” Hastings Law Journal 69: 1769.Find this resource: CBHSQ (Center for Behavioral Health Statistics and Quality). 2016. “Federal Parity in the Evolving Mental Health and Addiction Care Landscape.” Health Affairs 35: 1009–1016.Find this resource: Bartlett, J., and Manderscheid, R. 2016. “What Does Mental Health Parity Really Mean for the Care of People with Serious Mental Illness.” Psychiatric Clinics of North America 39: 331–342.Find this resource: Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Reddy Bloom, L., Fathima, S., et al. Then there are three stories describing everyday interactions in an acute psychiatric unit. (p. 208) The journal was developed in association with The Ontario Shores Centre for Mental Health Sciences and McMaster University (Canada). § 1185a, 42 U.S.C. Although debates over these issues are ongoing, there are few comprehensive resources for addressing such dilemmas in the practice of psychology, psychiatry, social work, and other behavioral and mental health care professions. 2016. The insufficiency of public mental health services is not due solely to lack of insurance and lack of public funding for direct care. Ethics and rural mental health care. Laura Weiss Roberts, Frederic G. Reamer, Charles P. O'Brien, and Thomas McLellan. In the absence of a specific reference, such as the US National Survey on Drug Use and Health (NSDUH), or unless a specific technical meaning is intended, this chapter uses the terms mental disorder and mental illness interchangeably. 2017. “Serious Mental Illness (SMI) among U.S. Adults.” https://www.nimh.nih.gov/health/statistics/mental-illness.shtml. The United States established its first state hospital dedicated to the provision of mental health care in 1773, and the number of psychiatric hospitals in Europe and America increased dramatically during the 1800s (Eghigian, 2010). 2015 National Survey on Drug Use and Health: Detailed Tables. Find this resource: CBHSQ (Center for Behavioral Health Statistics and Quality). Mental health acts attempt to address two different issues; the need to protect the patient him/herself and to protect the general public from the patient. 5th ed. This section focuses on two distinctive features of that debate regarding mental health care: lack of access (or parity in access) to health insurance (or free services), and the role of stigma in deterring utilization of available services. September 24. http://www.samhsa.gov/data/sites/default/files/spot075-services-affordability-2013/spot075-services-affordability-2013.pdf.Find this resource: Scheyett, A. M., Kim, M. M., Swanson, J. W., and Swartz, M. S. 2007. “Psychiatric Advance Directives: A Tool for Consumer Empowerment and Recovery.” Psychiatric Rehabilitation Journal 31: 70–75.Find this resource: Sipe, T. A., Finnie, R. K. C., Knopf, J. Traditionally, each instance of involuntary treatment is considered to affect only that case: Did the intervention prevent suffering by, or injury to, the person (e.g., suicide) or someone else (e.g., assault), or did the failure to intervene result in an otherwise avoidable suffering or injury? In the United States, as well as many other countries, many people with mental illness have no meaningful access to mental health care at all or are severely underserved. L. No. Indeed, advances in understanding of the neurobiological underpinnings of mental illnesses help to normalize them as health problems. To practice ethically requires awareness, sensitivity, and empathy for the patient as an individ-ual, including his or her cultural values and beliefs. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Because of the complicated nature of psychiatric illness, ethical dilemmas arise in mental health nursing that other fields don't have to contend with 2. (p. 206) 111-148, 124 Stat. By focusing on ethics and coercion in mental health care, we also should be aware of the potentially infringing culture. Asa Griggs Candler Professor of Bioethics and Director of the Center for Ethics, Emory University. (p. 216) 135) 11 The Psychological Impact of Rape Victims' Experiences with the Legal, Medical, and Mental Health Systems (pg. 2013. “Affordability Most Frequent Reason for Not Receiving Mental Health Services.” NSDUH Report, The “Journal of Ethics in Mental Health” is an international, peer-reviewed, web-based journal, available free on-line worldwide. Broadly speaking, the civil rights movement of the 1960s and expansion of federal funding for community mental health services propelled the public mental health system in the United States toward a community-based model (Petrila, 2001). Justificatory conditions are considerations that rebut the presumption in favor of individual rights concerns such as liberty, privacy, and confidentiality. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.Find this resource: (1.) From Madness to Mental Health: Psychiatric Disorder and Its Treatment in Western Civilization (New Brunswick, N.J.: Rutgers University Press).Find this resource: Elbogen, E. B., Swanson, J. W., Swartz, M. S., Van Dorn, R., Ferron, J., Wagner, H. R., et al. Legal and ethical discourse in mental health policy during the period of deinstitutionalization largely focused on the tension between benevolence and respect for patient autonomy, and on the meaning and normative significance of decisional capacity (Appelbaum, 1994). Deinstitutionalization has been the distinguishing feature of twentieth-century mental health policy in the United States. Ethical analysis of civil commitment (and other preventive or coercive interventions, such as warning a potential victim or taking other precautionary action) can be analogized to traditional public health crisis management. Physicians traditionally acted to benefit their patients based on their own judgments about patients’ needs (both for information and for treatment), but respect for patient autonomy demands protection of patients’ rights to receive full information and to make their own judgments about what treatment they receive. Medical Ethics in Mental Health Care Essay. https://aspe.hhs.gov/report/consistency-large-employer-and-group-health-plan-benefits-requirements-paul-wellstone-and-pete-domenici-mental-health-parity-and-addiction-equity-act-2008.Find this resource: Harki, G. A. Another interesting question is whether disqualifying persons who have been involuntarily committed from purchasing or carrying a firearm reduces suicides or firearm-related injuries and deaths to other victims. The key values are enhancing access, promoting recovery and empowerment, nurturing community integration and equality of citizenship, and encouraging personal responsibility for managing one’s own chronic health condition. 2015. Were commitments reduced? The ethical concerns I am most interested in addressing here involve offering payment, incentives or discounts for referrals from colleagues or clients. Critics, however, argue that such policies weight population (including family) interests over the individual’s rights and may further stigmatize mental illness (e.g., Mathis, 2016). A., Thota, A. That discourse has focused almost entirely on balancing the benefits to the individual and society achieved by involuntary treatment and unwanted disclosure of information against the affront to individual liberty and privacy that they entail. The emphasis on taking responsibility for managing one’s own condition also has the potential effect of eroding stigma, because it highlights the similarities (rather than the differences) between mental illness and other chronic health conditions. Subscriber: University of Lodz; date: 03 December 2020. The unfinished business of deinstitutionalization is the creation of the mental health services and supports that are needed to enable persons with mental illness to function successfully in the communities where they live. In this context, it is important to assist persons with mental illness to take control of their treatment; for example, an advance directive can be a tool of empowerment in mental health treatment (Elbogen et al., 2007; Scheyett et al. An ethicist provides insight into the ethics and the stigma of mental illness and addictions even amongst health professionals who work with these patients. Continued movement in these directions may contribute a great deal to empowering people with mental illness to utilize health care services. 2015. “Embedding Advance Directives in Routine Care for Persons with Serious Mental Illness: Implementation Challenges.” Psychiatric Services 66: 10–14.Find this resource: Kennedy-Hendricks, A., Huskamp, H. A., Rutkow, L., and Barry, C. L. 2016. “Improving Access to Care and Reducing Involvement in the Criminal Justice System for People with Mental Illness.” Health Affairs 35: 1076–1083.Find this resource: Kenny, A., and Bizumic, B. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf.Find this resource: Kaiser Family Foundation. (Washington, D.C.: American Psychiatric Publishing).Find this resource: Appelbaum, P. S. 1994. This chapter explores ethical issues in mental health policy from a public health perspective, with a focus on the United States. Despite a significant decline in the number of uninsured persons in recent years attributable to federal legislation, mental health care is typically underinsured, leading to insufficient and/or low-quality care (Barry, Goldman, and Huskamp, 2016; Bartlett and Manderscheid, 2016; Goplerud, 2013). Although mental health and substance use disorders are the leading cause of disability worldwide [1], World Health Organization (WHO) statistics from 2014 indicate that the median number of practicing … SMA 15–4927, NSDUH Series H-50. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf.Find this resource: Childress, J. F., and Gaare Bernheim, R. 2015. “Introduction: A Framework for Public Health Ethics.” In Essentials of Public Health Ethics, edited by R. G. Bernheim, J. F. Childress, R. J. Bonnie, and A. L. Melnick, 3–19 (Burlington, Mass. The trend in health care seems unstoppable: Managed care, including attempts to manage mental health care, is on the upswing. This chapter explores mental health nursing practice within an ethics context. This final part of the chapter focuses the population-level ethical discourse on three ethical issues related to persons with mental illness: enhancing access to and utilization of services, preventing harm, and respecting the interests of families. For example, in 2015, 34.7 percent of adults with serious mental illness did not receive any treatment (CBHSQ, 2016). For the most part the selections address contemporary issues in contemporary terms, but the book also offers a few historic or classic essays, including Thomas S. Szasz's controversial 1971 article “The Ethics of Addiction.”, Contributors Health and care ethics have advanced rapidly and mental health practitioners are rapidly facing controversial scrutiny. Applied Ethics in Mental Health Care: An Interdisciplinary Reader. The ethical dilemmas encountered are centred on issues of care and control within the realm of mental health. Ethical Principles for Contemporary Mental Health Policy. When considering the ethics of public health situations, individual rights are typically given priority over government considerations; however, a public health action that infringes on those rights could be justified if certain considerations are deemed to outweigh the importance of individual rights (Childress and Gaare Bernheim, 2015). A cross-systems approach that connects and coordinates mental health services across health, justice, education, and social service agencies is needed. 2016. “New Report Shows Medicaid Expansion Can Improve Behavioral Health Care Access.” http://www.hhs.gov/about/news/2016/03/28/new-report-shows-medicaid-expansion-can-improve-behavioral-health-care-access.html. For example, courts may require that there be a substantial likelihood of harm to self or others as a result of the mental illness, the likelihood of which must be demonstrated by “clear and convincing” evidence in most jurisdictions. Thus, not only are bacteria and viruses (which are in the purview of medicine) of concern in the practice of health care, so … 119 [2010]) and the Mental Health Parity and Addiction Equity Act (26 U.S.C. 2009. “The Global Burden of Mental Disorders: An Update from the WHO World Mental Health (WMH) Surveys.” Epidemiologia e Psichiatria Sociale 18: 23–33.Find this resource: Kessler, S. 2014. “Mental Health Parity: The Patient Protection and Affordable Care Act and the Parity Definition Implications.” Hastings Science and Technology Law Journal 6: 145, 158–160.Find this resource: Kindy, K., and Elliott, K. 2015. “2015 Police Shootings Investigation.” Washington Post, December 26. https://www.washingtonpost.com/graphics/national/police-shootings-year-end/.Find this resource: Mathis, J. Almost a Revolution: Mental Health Law and the Limits of Change (New York: Oxford University Press).Find this resource: Barry, C. L., Goldman H. H., and Huskamp, H. A. With what effect on individuals and on the population? Given the heterogeneity among managed mental health care organizations … Reliance on institutional care grew during the nineteenth century in the United States and elsewhere in the Western world, undergirded by civil commitment laws authorizing involuntary confinement of mentally ill persons. Applied Ethics in Mental Health Care is an important and timely contribution to this ongoing ethical conversation. Because of isolation and poor resources, rural clinicians commonly provide care without optimal supports, services, and safeguards for their patients (1,3,4,6,23,24,25,26,27). The Mental Health … Social Determinants of Mental Health (Geneva, Switzerland: WHO Document Production Services). This book discusses some of the most critical ethical issues in mental health care today, including the moral dimensions of addiction, patient autonomy and compulsory treatment, privacy and confidentiality, and the definition of mental illness itself. (p. 217) 2011. Treatment of persons with dangerous contagious diseases, such as tuberculosis, includes restraint of a person for treatment, whether through isolation (i.e., separation from people without the disease), directly observed therapy (i.e., provision of treatment by a health professional who observes the patient take the medication), or aggressive community treatment (e.g., intensive preventive treatment of those without the disease). Applied Ethics in Mental Health Care is an important and timely contribution to this ongoing ethical conversation. Interventions like these implicate justificatory conditions,5 such as necessity (i.e., the strategy is necessary to achieve the public health goal) and least infringement (i.e., the strategy is the least restrictive and least intrusive possible), at the level of the individual, but the benefits of the interventions are assessed by measuring the incidence of disease in the population (e.g., the number of new infections prevented by the intervention). On the other side, critics of the “right to refuse” treatment have argued that the commitment laws should focus on the “needs” (i.e., treatment) of persons with mental illness and have bemoaned the tragic consequences of allowing suicidal or helpless persons with mental illness to “die with their rights on” (i.e., respecting autonomy to the point of allowing harm to occur; Treffert, 1973). The population benefits are obtained by aggregating the benefits of each individual intervention. 179) Cultural and social norms around the world have long marginalized people with mental illness, eroded their rights, and stymied development of supportive health care practices and policies. Key Facts about the Uninsured Population. Advances in treatment and the emergence of recovery-oriented frameworks have highlighted the nature of mental illness as a chronic health condition because they have increased the ability to attain and maintain wellness. Mental health is “an essential element” of overall health, “a state of complete physical, mental and social well-being” (WHO, 2013, 43). These are used to help unravel ethical issues relating to patient autonomy. Hill, S. K., Cantrell, P., Edwards, J., and Dalton, W. 2016. “Factors Influencing Mental Health Screening and Treatment among Women in a Rural South Central Appalachian Primary Care Clinic.” Journal of Rural Health 32: 82–91.Find this resource: Jacobson, N. and Greenley, D. 2001. “What Is Recovery? In this book, Sisti, Caplan, and Rimon-Greenspan offer a compendium of thoughtful, reasoned, and down-to-earth discussions of these issues and many others that face the mental health professional on a daily basis. 2016. “Mental Health Privacy: Do Inquiring Minds Really Need to Know?” Human Rights 41: 10.Find this resource: Morse, D. 2016. “Mental-Health Crisis Ensnares Inmates, Judges, Jailers and Hospitals.” Washington Post, June 7. https://www.washingtonpost.com/local/public-safety/mental-health-crisis-ensnares-inmates-judges-jailers-and-hospitals/2016/06/07/b5379c7c-2aa1-11e6-a3c4-0724e8e24f3f_story.html.Find this resource: Nadeem, E., Lange, J. M., Edge, D., Fongwa, M., Belin, T., and Miranda, J. Disruption in mood, thinking, and/or relationships can destabilize employment and/or housing, yet without stable housing and income, mental illness is exacerbated. Systems and policies that promote these values can be expected to reduce mortality and morbidity in and the accompanying social burden of mental illness. Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. 2007), and facilitating the use of advance directives as part of routine care of persons with serious mental illness should be an explicit goal of contemporary mental health policy (Kemp, Zelle, and Bonnie, 2015; Zelle, Kemp, and Bonnie, 2015). 1973. “Dying with One’s Rights On.” JAMA 12: 1649.Find this resource: Tyler, T. R. 2003. “Procedural Justice, Legitimacy, and the Effective Rule of Law.” Crime and Justice 30: 283–357.Find this resource: UN (United Nations). As recently as 2011, mental health care was financially inaccessible for 51 percent of the population (SAMHSA, 2013). 2015. “Effects of Mental Health Benefits Legislation: A Community Guide Systematic Review.” American Journal of Preventive Medicine 48: 755–766.Find this resource: Slobogin, C., Hafemeister, T. L., Mossman, D., and Reisner, R. 2013. The paper begins with a brief statement about the centrality of autonomy or self governance as a core ethical value in the interaction between health care worker and patient. Richard J. Bonnie, LLB, Harrison Foundation Professor of Law and Medicine, School of Law, Director, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, Virginia, Heather Zelle, PhD, JD, MS, Assistant Professor of Research, Department of Public Health Sciences, School of Medicine, Institute of Law, Psychiatry, and Public Policy, University of Virginia, Charlottesville, Virginia. These gaps in services and community supports are widely believed to be at least partially responsible for the increasing number of arrests and detentions of persons with mental illness in local jails, as well as the steady stream of police shootings of persons with mental illness (Kennedy-Hendricks et al., 2016; Steadman et al., 2009; Wilper et al., 2009). Achieving these goals can reduce the need for coercion and ameliorate the social burden and stigma of mental illness. (p. 214) For example, psychotic symptoms (e.g., hallucinations and delusions) often first present in late adolescence or early adulthood, and recent clinical research has underscored the importance of intervening as early as possible with emergent psychotic disorders. A corollary of empowerment is responsibility. Edited by Dominic A. Sisti, Arthur L. Caplan and Hila Rimon-Greenspan. Professor of Psychology, Swarthmore College; coauthor of Practical Wisdom: The Right Way to Do the Right Thing. In an era that holds dear individuals' rights to pursue the life paths they value, it routinely faces the challenge to distinguish what are merely unwise, or perhaps even immoral, life choices from real pathology. Even seemingly less-related determinants can have large impacts: elements of the built environment (e.g., public transportation) can be critical barriers to obtaining consistent care, for example. The justification for coercion is measured one case at a time, and the courts generally insist on proof of a serious and immediate threat. This counteracts the Second, reducing unwarranted coercion, by itself, provides a thin and inadequate ethical foundation for the transformative mental health policies needed to vindicate both the rights and needs of persons with mental illness and to assure the mental health and well-being of the population. Rural caregivers face serious clinical ethical dilemmas every day. As a result, mental illness is associated with increased mortality: a recent meta-analysis found the median reduction in life expectancy was 10.1 years, with a range from 1.4 to 32 years (Walker, McGee, and Druss, 2015). MIT Press Direct is a distinctive collection of influential MIT Press books curated for scholars and libraries worldwide.

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