ethics in mental health care

The Four Principles of Health Care Ethics. 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). The Global Economic Burden of Noncommunicable Diseases. I'm confident that mental health professionals will find themselves consulting this book regularly to help them negotiate the ethics of everyday practice. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. Mental health nursing works with a complex set of patients. 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) 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). 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. A cross-systems approach that connects and coordinates mental health services across health, justice, education, and social service agencies is needed. The basic definitions of each of the four principles of health care ethics are commonly known and used often in the English language, but they take on special meaning when being utilized in a medical setting. 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. 2015. Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. By focusing on ethics and coercion in mental health care, we also should be aware of the potentially infringing culture. 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). Ethical dilemmas in community mental health care is the focus of this article. Only public action can ameliorate this problem (see, e.g., Harki, 2016; Kennedy-Hendricks et al., 2016; Kindy and Elliott, 2015; Morse, 2016; Swanson, 2016). 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. Ethics in Mental Health Care: A Public Health Perspective, Public Health Ethics: an Introduction and Overview, An Overview of Ethics Issues for Public Health in Particular Populations, Aging Populations and Public Health Ethics, Children, Adolescents, and Public Health: Ethical Considerations, Persons with Disabilities and Public Health Ethics, Sexual and Gender Minorities, Public Health, and Ethics, Public Health in the Context of Migration: Ethics Issues Related to Immigrants and Refugees, PRINTED FROM OXFORD HANDBOOKS ONLINE (www.oxfordhandbooks.com).Â, The Oxford Handbook of Public Health Ethics, Sign in to an additional subscriber account, Emergence of the Psychiatric Hospital as the Model of Care, Individuals’ Rights versus Treatment Needs, Ethical Principles for Contemporary Mental Health Policy, Justice, Access, and Utilization of Services and Supports, https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf, 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, http://pilotonline.com/news/government/virginia/virginia-is-outpacing-the-nation-in-police-shootings-of-the/article_de1e5f1d-d893-51fb-9d9d-4c47f034ba66.html, http://www.hhs.gov/about/news/2016/03/28/new-report-shows-medicaid-expansion-can-improve-behavioral-health-care-access.html, https://www.washingtonpost.com/graphics/national/police-shootings-year-end/, 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, https://www.nimh.nih.gov/health/statistics/mental-illness.shtml, http://www.samhsa.gov/data/sites/default/files/spot075-services-affordability-2013/spot075-services-affordability-2013.pdf, https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html, http://www.who.int/mental_health/action_plan_2013/en/, http://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/, http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf, http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Indeed, the preference for terms other than “patient” to identify those receiving treatment is one product of increased respect for autonomy and empowerment of those receiving treatment: many view the term “patient” to embody the traditional “doctor knows best” power differential, and prefer terms that instead reflect the sense of a person’s engagement with treatment (e.g., a mental health treatment “consumer”). The ethical dilemmas encountered are centred on issues of care and control within the realm of mental health. Thus, a program that increases family involvement may ultimately increase a person’s autonomy rather than infringe it. This month's issue explores critical social, cultural, and ethical dimensions of mental illness. 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). 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. 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. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Handbooks Online for personal use (for details see Privacy Policy and Legal Notice). Achieving these goals can reduce the need for coercion and ameliorate the social burden and stigma of mental illness. As recently as 2011, mental health care was financially inaccessible for 51 percent of the population (SAMHSA, 2013). 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 WHO reports that 76 to 85 percent of people with serious mental illness in low-income and middle-income countries receive no treatment, and between 35 and 50 percent of people in high-income countries do not receive care (WHO, 2013). Advances in treatment may allow for activities at the secondary prevention level, but they also implicate autonomy interests. Individuals (psychiatrists, social workers, case managers, nurses, psychologists, (5.) The Americans with Disabilities Act (42 US Code §§ 12101–12213 [1990]), a US civil rights law prohibiting disability discrimination, has become a charter for freedom for persons with mental illness. 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. 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, 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. Health and care ethics have advanced rapidly and mental health practitioners are rapidly facing controversial scrutiny. One social determinant that must be singled out is stigma. Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. The population benefits are obtained by aggregating the benefits of each individual intervention. 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. 2007. “Effectively Implementing Psychiatric Advance Directives to Promote Self-Determination of Treatment among People with Mental Illness.” Psychology, Public Policy, and Law 13: 273–288.Find this resource: Goplerud, E. 2013. 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 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. But how does one evaluate involuntary treatment from a population perspective? http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.Find this resource: (1.) 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. 111-148, 124 Stat. A nurse must be able to face ethical quandaries and make decisions based on experience and key principles learnt in higher education or through training, while also following legislative procedure. To practice ethically requires awareness, sensitivity, and empathy for the patient as an individ-ual, including his or her cultural values and beliefs. Keywords: culture, ethics, mental health In mental health care, ethics and culture are intimately intertwined. 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. In 2013, the cost for treating mental illness in the US topped the list for all medical conditions. § 1185a, 42 U.S.C. (p. 213) : 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. Applied Ethics in Mental Health Care is an important and timely contribution to this ongoing ethical conversation. 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. 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. 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. 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. This book meets that need, providing foundational background for undergraduate, graduate, and professional courses. MOT is an appealing option to many because it serves benevolent aims of providing treatment to those in need of it through a less intrusive method than institutional confinement. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. . Find this resource: CBHSQ (Center for Behavioral Health Statistics and Quality). The costs of mental illness are further amplified by lack of access to treatment. 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). Being a mental health nurse is a challenging role that comes with its own rules, ethics, and issues. 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.

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