Ethical issues in mental health Flashcards
Under what stipulations can a person be kept in a psychiatric hospital against their will?
If they are believed to be a danger to themselves or others due to mental illness.
The decision is made by an approved clinician (psychiatrist, clinical psychologist or MH social worker)
What is an objective measure of risk?
CARDS violence risk assessment. Assesses factors which are known to predict future violence.
These need to be paired with decisions based on experience- division of risk factors into ever and never allos for objectivtiy but not range/quantificaiton.
What are some problems with risk?
Seen as dichotomous
Seen as fixed
Subjective
Influenced by fear of violence or self harm- clinician is overly cautious.
This has led to risk aversion in psychiatry: Where if there is doubt, the patient is sectioned.
Is there overemphasis on risk, and less fucks given about patient health?
Do psychiatrists heal or maintain public order?
What 3 themes that characterise coercion did Katsakou et al (2011) find?
Perceiving hospitals as ineffective
Not participating in admission
Not feeling respected.
What are the limitations of the Katsakou study?
- Subjectivity of experience recall
- Influence of mental illness
- Small sample size decreases generalisability
- Different pre-post measures of coercion.
What are community treatment orders and what did the OCTET trial find?
This is when patients released into the community must take their medication, otherwise they will be re-admitted regardless of their mental health state. This is to prevent them relapsing.
The trial found CTOs were not effective at reducing hospital readmission compared to methods such as section 17 leave (close monitoring after discharge). In S17, patients must deteriorate before being readmitted.
How may an individual not have the capacity to make a decision?
Unable to:
- Understand information relevant to decision
- To retain information long enough to make a decision
- Use it and weigh it to arrive at a choice
- To communicate the decision in any way.
How does capacity law differ between mental and physical health?
In physical, the mental capacity acts gives clinicians the ability to make decisions when the patient lacks mental capacity.
In psychiatry, they do not have to consider patient capacity when hospitalising them and treating their mental health.
What is capacity in mental illness?
Dementia: 68% lak capacity
Depression: 20%
Schizophrenia: 54%
What are advance directives and what can they be used for?
Statement of wishes regarding treatment, should capacity be lost.
- Advance agreement of hospitalisation
- Advance refusal of particular hospitals
- Advance agreement or refusal of particular medications
- Nominate a proxy decision maker.
What effect did the RCt of intervention to facilitate PADs by Swanson et al have?
3% of control group completed PADS, 61% in the educated group.
They promote trust and service user empowerment, as well as facilitating crisis planning.
An RCT found this crisis planning reduced involuntary hospitalisations over a 15 month period (Henderson et al).
Are PADs followed?
Mental capacity code of practice can use MHA to override PADs, except for ECT..
Clinicians should try to comply and document reasons for non-compliance,
Turn over for key reading.
SEE SLIDES FOR WAY MORE FURTHER READING.
Alexander & Link (2003). The impact of contact on stigmatizing attitudes
towards people with mental illness.
Carpenter WT, Gold JM, Lah2 AC et al. (2000). Decisional capacity for
informed consent in schizophrenia research.
Department of Health (2010). Attitudes to Mental Illness 2010:
Morgan (2007). Giving up the culture of blame: Risk assessment and risk
management in psychiatric practice.
