ethics in mental health care
Thus, like persons with other chronic conditions, such as diabetes, persons with a mental illness have the opportunity to view their treatment with a preventive and maintenance orientation and to interact with their families and clinicians accordingly. 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. Being a mental health nurse is a challenging role that comes with its own rules, ethics, and issues. Key Facts about the Uninsured Population. 2001. âFrom Constitution to Contracts: Mental Disability Law at the Turn of the Century.â In The Evolution of Mental Health Law, edited by L. E. Frost and R. J. Bonnie, 75â100 (Washington, D.C.: American Psychological Association).Find this resource: Phelan, J. C., Sinkewicz, M., Castille, D. M., Huz, S., and Link, B. G. 2010. âEffectiveness and Outcomes of Assisted Outpatient Treatment in New York State.â Psychiatric Services 61: 137â143.Find this resource: Pouncey, C. L., and Lukens, J. M. 2010. âMadness versus Badness: The Ethical Tension between the Recovery Movement and Forensic Psychiatry.â Theoretical Medicine and Bioethics 31: 93â105.Find this resource: SAMHSA (Substance Abuse and Mental Health Services Administration). 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). 2016. âNew Report Shows Medicaid Expansion Can Improve Behavioral Health Care Access.â http://www.hhs.gov/about/news/2016/03/28/new-report-shows-medicaid-expansion-can-improve-behavioral-health-care-access.html. 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. We next highlight several ethically salient strands of contemporary mental health policy in the United States (which are echoed in international human rights documents and may inform global policy as well [see UN, 2006]). (p. 207) L. No. (p. 206) HHS Publication No. This is a collection of brilliant voices and perspectives that will intrigue and challenge expert and novice alike as it shines light on the complex ethical issues engendered by the messy clinical world that is mental health care. 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). Physicians traditionally acted to benefit their patients based on their own judgments about patientsâ needs (both for information and for treatment), but respect for patient autonomy demands protection of patientsâ rights to receive full information and to make their own judgments about what treatment they receive. Law and the Mental Health System: Civil and Criminal Aspects. ‘Coercive culture’ in mental health care. Recent controlled trials of mandatory outpatient treatment, however, have suggested that being under an MOT order for at least six months increased treatment engagement and reduced violent behavior, as compared with receiving outpatient services without the order (e.g., Phelan et al., 2010; Swartz et al., 2010). The result was that states and localities provided a safety net of emergency A., Thota, A. 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. The legal changes in the 1970s that were noted earlier included case law that narrowed the parameters for civil commitment. Unrelated to such programs, proposals to increase access by families to otherwise private health information have been advanced, with proponents arguing that allowing the personâs 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). One policy strand emphasizes inclusion and integration. The Americans with Disabilities Act (42 US Code Â§Â§ 12101â12213 ), a US civil rights law prohibiting disability discrimination, has become a charter for freedom for persons with mental illness. Disparities in housing, employment, and criminal justice involvement, for example, are closely linked with mental illness because of the ways that mental illness can impact functioning (WHO, 2014). 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. http://www.who.int/mental_health/action_plan_2013/en/.Find this resource: WHO (World Health Organization). 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). (p. 216) Indeed, the preference for terms other than âpatientâ to identify those receiving treatment is one product of increased respect for autonomy and empowerment of those receiving treatment: many view the term âpatientâ to embody the traditional âdoctor knows bestâ power differential, and prefer terms that instead reflect the sense of a personâs engagement with treatment (e.g., a mental health treatment âconsumerâ). Federal policies, including Medicaid and Social Security expansion, aimed to increase availability of services in the community as alternatives to institutionalization (Petrila, 2001). To be incapacitated due to trauma or mental ill-health (for example) means that practitioners will Often work in your best interests (Kulak, 2005). This language-sensitive approach is widely applied in the behavioral health field and is not just âpolitically correctâ but is actually reflective of an enhanced emphasis on autonomy and empowerment, because it does not reduce a person to a mere diagnostic label. You could not be signed in, please check and try again. Thus, a program that increases family involvement may ultimately increase a personâs autonomy rather than infringe it. 2015. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf.Find this resource: Kaiser Family Foundation. 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). 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