As used in the behavioral health field, “recovery” describes an ongoing process of gaining greater control over one’s own life, partly through gaining control over symptoms, but also through attending to needs in other domains, such as work and relationships. 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). practice and policy decisions such that they feel an ownership of policies, rather than the conceptualization of procedural justice as people’s assessment of the fairness of a legal decision-making process, as described by Tom R. Tyler (2003). http://www.who.int/mental_health/action_plan_2013/en/.Find this resource: WHO (World Health Organization). Its passage signaled the overarching importance of facilitating inclusion and integration of persons with disabilities, including mental disabilities, into the community, and pressed state and local governments to establish services and supports in the community to enable persons with mental disabilities to achieve equal citizenship. Systems and policies that promote these values can be expected to reduce mortality and morbidity in and the accompanying social burden of mental illness. The question to be addressed here is how the lens of public health ethics sheds new light on the ethics of coercion in mental health care. Mental illnesses (and neurological conditions, such as epilepsy) differ from diabetes because they affect the brain, but they are similar because they are rooted etiologically in the genetic predispositions, environmental exposures, and gene-environment interactions that account for all health conditions. The ethical dilemmas encountered are centred on issues of care and control within the realm of mental health. Nonetheless, it is widely accepted that mental illness 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). Similar estimates have been made elsewhere in the world (Kessler et al., 2009). 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. Asa Griggs Candler Professor of Bioethics and Director of the Center for Ethics, Emory University. Although it is difficult to define recovery concretely, several key concepts include autonomy, empowerment, respect, responsibility, and human rights (Davidson et al., 2005; Jacobson and Greenley, 2001). 2010. Throughout this chapter we utilize “person-first language” in which the individual is recognized as a person before specifying that he or she happens to have a mental illness. tendency to see a person with mental illness as a crisis waiting to happen that must be controlled by coercive means. Ethical dilemmas in community mental health care is the focus of this article. The widespread adoption of the recovery model is laudable in part because it does just that. (5.) Another common term is “outpatient commitment.”. 2013. This counteracts the Medical Ethics in Mental Health Care Essay. 5th ed. VanSickle, M., Werbel, A., Perera, K., Pak, K., DeYoung, K., and Ghahramanlou-Holloway, M. 2016. “Perceived Barriers to Seeking Mental Health Care among United States Marine Corps Noncommissioned Officers Serving as Gatekeepers for Suicide Prevention.” Psychological Assessment 28: 1020–1025.Find this resource: Walker, E. R., McGee, R. E., and Druss, B. G. 2015. “Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-Analysis.” JAMA Psychiatry 72: 334–341.Find this resource: Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erksine, H. E., et al. 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. (p. 218) (p. 209) 125) 10 The Experience of Violent Injury for Young African American Men: The Meaning of Being a “Sucker” (pg. Applied Ethics in Mental Health Care is an important and timely contribution to this ongoing ethical conversation. They may also want to build it into the training they give young professionals who are entering the field. Thus, not only are bacteria and viruses (which are in the purview of medicine) of concern in the practice of health care, so … 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. I'm confident that mental health professionals will find themselves consulting this book regularly to help them negotiate the ethics of everyday practice. unless a person poses a serious danger to themselves or others. Thus, a program that increases family involvement may ultimately increase a person’s autonomy rather than infringe it. Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. Considering earlier sections of this chapter, it is worth asking whether improved access and decreased stigma would encourage a young person in the early stages of mental illness to engage in treatment and share information, and thus abate the tension between privacy and well-being. 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. 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. A cross-systems approach that connects and coordinates mental health services across health, justice, education, and social service agencies is needed. ‘Coercive culture’ in mental health care. Consistency of Large Employer and Group Health Plan Benefits with Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Washington, D.C.: US Department of Health and Human Services). To be incapacitated due to trauma or mental ill-health (for example) means that practitioners will Often work in your best interests (Kulak, 2005). Systematic research on these long overlooked questions is just emerging (e.g., Swanson et al., 2015), posing the ethical challenge of weighing the population benefits of categorical restrictions against the principle of individualized decision-making that has generally characterized mental health law and ethics. Mental health is “an essential element” of overall health, “a state of complete physical, mental and social well-being” (WHO, 2013, 43). The four principles of health care ethics are autonomy, beneficence, non-maleficence, and justice. A corollary of empowerment is responsibility. 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. 2013. “Global Burden of Disease Attributable to Mental and Substance Use Disorders: Findings from the Global Burden of Disease Study 2010.” Lancet 382: 1575–1586.Find this resource: Wilper, A. P., Woolhandler, S., Boyd, W., Lasser, K. E., McCormick, D., Bor, D. H., et al. The recovery model’s adoption has also led to a definition of quality of life by people with mental illness, rather than by a paternalistic society—people do not seek to be “cured” and made “normal,” but rather to achieve a level of wellness that allows them to take meaningful control over their lives. Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. More specifically, A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. (3.) 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. B., et al. For example, in 2015, 34.7 percent of adults with serious mental illness did not receive any treatment (CBHSQ, 2016). 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). SMA 15–4927, NSDUH Series H-50. In an era that holds dear 'patient autonomy,' it routinely faces patients who suffer disorders that place the capacity for autonomy in question. 2015. “Advance Directives for Mental Health Care: Innovation in Law, Policy, and Practice.” Psychiatric Services 66: 7–9. On one side, courts have insisted on narrow and specific criteria to justify involuntary hospitalization or forcible medication of involuntarily hospitalized patients. Ethical Principles for Contemporary Mental Health Policy. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. . In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. 2007. “Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women from Seeking Mental Health Care?” Psychiatric Services 58: 1547–1554.Find this resource: NIMH (National Institute of Mental Health). 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. In attempting to secure protection of the rights of the mentally ill from abuse and neglect, a human rights model of mental health care ethics has been adopted. As recently as 2011, mental health care was financially inaccessible for 51 percent of the population (SAMHSA, 2013). During the 1960s, the modern era of mental health policy began to emerge, marked by the downsizing and closing of state psychiatric hospitals. : Jones and Bartlett Learning).Find this resource: Crisanti, A. S., Luo, L., McFaul, M., Silverblatt, H., and Pyeatt, C. 2016. “Impact of Mental Health First Aid on Confidence Related to Mental Health Literacy: A National Study with a Focus on Race-Ethnicity.” Psychiatric Services 67: 350–353.Find this resource: Davidson, L., O’Connell, M. J., Tondora, J., Lawless, M., and Evans, A. C. 2005. “Recovery in Serious Mental Illness: A New Wine or Just a New Bottle?” Professional Psychology: Research and Practice 36: 480–487.Find this resource: Eghigian, G., ed. Shifting ethical discourse to the population level is an important step in the continuing transformation of mental health care and policy in the twenty-first century. 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. Ethics and rural mental health care. The insufficiency of public mental health services is not due solely to lack of insurance and lack of public funding for direct care. 9 Sanctity of Human Life in War: Ethics and Post-traumatic Stress Disorder (pg. 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. 2010. “Assessing Outcomes for Consumers in New York’s Assisted Outpatient Treatment Program.” Psychiatric Services 61: 976–981.Find this resource: Swanson, J., 2016. “Mental Illness, Release from Prison, and Social Context.” JAMA 316: 1771–1772.Find this resource: Swanson, J. W., McGinty, E., Fazel, S., and Mays, V. 2015. “Mental Illness and Reduction of Gun Violence and Suicide: Bringing Epidemiologic Research to Policy.” Annals of Epidemiology 25: 366–376.Find this resource: Treffert, D. A. Psychiatry is a critical yet often neglected area of medicine. 179) A rich discourse on the ethics of mental health policy and law has emerged since the beginning of deinstitutionalization. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. Health and care ethics have advanced rapidly and mental health practitioners are rapidly facing controversial scrutiny. Disruption in mood, thinking, and/or relationships can destabilize employment and/or housing, yet without stable housing and income, mental illness is exacerbated. Despite the gains of the last few decades, stigma remains a prevalent problem. Importantly, mental illness (and health) implicate a person’s functioning, not merely the presence or absence of symptoms. Petrila, J. While the term “medical care” designates the intention to identify and to understand disease states in order to be able to diagnose and treat patients who might suffer from them, the term “health care” has a broader application to include not only what is entailed by medical care but also considerations that, while not medical, nevertheless exercise a decided effect on the health status of people. 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. 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. The “Journal of Ethics in Mental Health” is an international, peer-reviewed, web-based journal, available free on-line worldwide. One policy strand emphasizes inclusion and integration. services for persons experiencing mental health crises. This month's issue explores critical social, cultural, and ethical dimensions of mental illness. 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). Report presented at the World Economic Forum, Geneva, September 2011.Find this resource: Boldt, R. C. 2014. “Perspectives on Outpatient Commitment.” New England Law Review 49: 39.Find this resource: Castro, J. From a population perspective, what were the effects of narrowing these criteria? Applied Ethics in Mental Health Care. With what effect on individuals and on the population? Leggi «Applied Ethics in Mental Health Care An Interdisciplinary Reader» di disponibile su Rakuten Kobo. The Mental Health … is a pervasive health condition around the globe. It has always been puzzling that more attention has not been paid to the profound ethical challenges of mental health care, posing perhaps the most difficult and thorny ethical questions in all of medicine. ... Hospital News is Canada's health care newspaper since 1987. The population benefits are obtained by aggregating the benefits of each individual intervention. 149) IV Addiction (pg. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.Find this resource: (1.) The journal was developed in association with The Ontario Shores Centre for Mental Health Sciences and McMaster University (Canada). FRCPC; Senior Editor, Journal of Ethics in Mental Health, https://mitpress.mit.edu/books/applied-ethics-mental-health-care, International Affairs, History, & Political Science. 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. The recovery model emerged from the psychiatric rehabilitation movement, which expanded the view of mental health treatment to encompass consumers’4 psychosocial needs, and the mental health consumer movement, which emphasized the importance of basic human rights and decried social discrimination and stigma (Pouncey and Lukens, 2010). L. No. 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. (p. 217) 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). It teases out the ethical challenges that mental health nurses can face on a daily basis. Incidence and burden estimates for mental illness depend upon definitional, demographic, and geographic factors. health care resources. 6th ed. (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. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. Deinstitutionalization has been the distinguishing feature of twentieth-century mental health policy in the United States. PRINTED FROM OXFORD HANDBOOKS ONLINE (www.oxfordhandbooks.com). © Oxford University Press, 2018. Find this resource: CBHSQ (Center for Behavioral Health Statistics and Quality). Results of other studies have been mixed, though, so it is not yet clear whether a strong balance of benefits is accrued and whether infringement of autonomy is offset by claims of effectiveness. 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. This chapter explores mental health nursing practice within an ethics context. 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. This chapter focuses on overarching ethical challenges in mental health policy at the population level—enhancing access of persons with mental illness to preventive services and community supports, and facilitating their successful community integration. 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. Around the world, mental and substance use disorders were the leading cause of years lived with disability in 2010 (Whiteford et al., 2013), and an estimated $16 trillion will be lost between 2011 and 2030 due to the direct costs of care and lost income as a result of disability or mortality attributable to mental disorder (Bloom et al., 2011). 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? Ethical discourse about mental health treatment has typically focused on paradigmatic concepts of individual autonomy, competence, paternalism, and appropriate justifications for overriding individual decision-making and restricting individual liberty. Indeed, advances in understanding of the neurobiological underpinnings of mental illnesses help to normalize them as health problems. 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. Social Determinants of Mental Health (Geneva, Switzerland: WHO Document Production Services). 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. During the Enlightenment period in the 1700s, an era of therapeutic optimism emerged, characterized by a belief that scientific study would reveal the causes of mental illness and would yield a cure. Legal authority in the United States was firmly grounded in the state’s “police power” to protect public health and safety and in its obligation (as “parens patriae”) to protect citizens unable to protect themselves. Individuals (psychiatrists, social workers, case managers, nurses, psychologists, 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). All issues are discussed subjectively from my own value base. Applied Ethics in Mental Health Care: An Interdisciplinary Reader. Praise and blame of managed mental health care are on the rise on many fronts, including allegations that it could adversely affect quality of care, access to care, the physician/patient relationship, and informed patient choice. 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. In the legal context, this theme translated into debates, which continue into the present day, about the justifications for coercive confinement/treatment and the scope of the individual’s right to refuse psychiatric treatment. 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. MIT Press began publishing journals in 1970 with the first volumes of Linguistic Inquiry and the Journal of Interdisciplinary History. Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. Today we publish over 30 titles in the arts and humanities, social sciences, and science and technology. A person who fails to meet requirements of an MOT plan may be taken into custody for evaluation or treatment. However, shifting the locus of mental health services from institutions to communities amounts simply to ending an old policy rather than creating a new one. 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). Mental health nursing works with a complex set of patients. 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. 2013. “Affordability Most Frequent Reason for Not Receiving Mental Health Services.” NSDUH Report, 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? Courts and subsequent legislation made clear that a person’s liberty cannot be infringed merely because treatment may be beneficial; people have a right to refuse treatment, no matter how “unwise” that decision may be, 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
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