Mental Health Ethics Flashcards
Define stigma
When a distinguishing personal trait is perceived as socially, physically, or psychologically disadvantageous - including as a mark of shame or discredit
Give 4 factors that influence stigma
Ignorance, prejudice, discrimination, stereotypes
Define prejudice
A view of something formed without adequate knowledge
Define discrimination
Treating a person or thing differently based on prejudice
Define stereotyping
A rigid or fixed idea about a class of people or things based on prejudice
Describe the results of Phillips’ 1966 survey on mental health stigma
100% of women would rent a room to a man who had never needed psychiatric treatment but below 50% would to a man who had been a psychiatric inpatient. Similarly, 98% would let their daughter marry a man who had never needed psychiatric treatment, but just 17% would if he had been a psychiatric inpatient
According to the 2010 Department of Health report into attitudes to mental illness, what percentage of the public believes the mentally ill are prone to violence?
36%
According to the 2010 Department of Health report into attitudes to mental illness, what percentage of the public believes the mentally ill are incapable of making simple decisions about their life?
38%
According to the 2010 Department of Health report into attitudes to mental illness, what percentage of the public believes there is a responsibility of care for the mentally ill?
93%
According to the 2010 Department of Health report into attitudes to mental illness, what percentage of the public believes the mentally ill have the same rights to a job as everyone else?
75%
Describe a piece of evidence that the media exacerbates stigma against the mentally ill
In 2007, Chopra & Doody analysed 98 local newspaper and found that 36% of articles about schizophrenia were negative in tone and just 7% positive, concluding that the media continues to receive a distorted and negative image and associations with dangerousness predominate
What percentage of murders are committed by the mentally ill every year?
5%
Are individuals with mental illness more likely to commit violent crime or be a victim? (Walsh et al, 2003)
14x more likely to be a victim
According to Wahl’s 1999 survey, what percentage of individuals with mental illness have lower self-esteem because of stigma?
57%
According to Wahl’s 1999 survey, what percentage of individuals with mental illness have been turned down for a job after revealing their mental illness?
17%
Describe the results of Alexander & Link’s study into reducing stigma through contact
Increased contact with homeless people with mental illness correlated with less perceived dangerousness and less desired distance - regardless of age, gender, ethnicity, political conservativism, and level of education
State the 2 components of the UK’s Time to Change project in 2009
Events to encourage contact between people with and without mental illness and mass media campaigns
Describe the impact of the UK’s Time to Change campaign
Fewer people expressed that they wouldn’t want a mentally ill individual for a neighbour (11% -> 9%) but more believed that the mentally ill were incapable of making simple decisions about their lives (32% -> 38%)
Define coercion
When someone is forced to do something against their will
According to the Mental Health Act of 2007, when can a person be kept in a psychiatric hospital against their will (sectioned)?
If they are believed to be a danger to themselves or others due to mental illness, and the decision is made by an approved clinician (psychiatrist, clinical psychologist, or mental health social worker)
How long can a section for assessment be?
2-28 days
How long can a section for treatment be?
3-6 months
Name an objective method of assessing an individual’s risk to themselves or others
CARDS violence risk assessment and CARDS suicide risk assessment
Give at least 3 problems with assessing an individual’s risk to themselves or others
Risk is often seen as dichotomous
Risk is often seen as fixed
Risk assessment if subjective
Risk assessment is influenced by politics and fear (e.g. pressure to prevent violence and self-harm)
Is it more important for a psychiatrist to protect the patient’s health or the public?
According to the Royal College of Psychiatrists Mental Health Law sub-committee (2001), improving the patient’s health supersedes issues of public protection
According to Katsakou et al’s 2011 study, what percentage of patients who voluntarily admit themselves to a psychiatric ward felt coerced?
34%
Give some limitations of asking psychiatric patients if they felt coerced into admission
Subjectivity and the possible influence of illness (e.g. paranoid delusions)
Define mental capacity
The ability to make a particular decision
Give 4 factors necessary for an individual to have mental capacity
Ability to understand information relevant to the decision, ability to retain the information for long enough to make a decision, ability to use and weigh the information to arrive at a choice, and ability to communicate the decision in any way
Does the Mental Capacity Act of 2005 apply to mental health care?
No
Does the Mental Health Act contain a requirement to assess capacity?
No
State the four most common components of a psychiatric advance directive (Swanson et al, 2006a)
Advance agreement to hospitalisation, advance refusal of particular hospitals, advance aggreement or refusal of particular medications, nomination of a proxy decision maker
According to the Mental Welfare Commission for Scotland (2007), what percentage of mental health inpatients were aware of and used advance directives?
60% aware, 3% used
Why do mental health patients not use advance directives? (Henderson et al, 2004)
They believe it wouldn’t help, believe it would be ignored, and think that they won’t get ill again
Can the Mental Health Act override advance directives?
Yes - except where they refuse electroconvulsive therapy
What percentage of clinicians comply with advance directives around seclusion or restraint?
50%
What percentage of clinicians comply with advance directives around medications agreed to or refused?
90% with agreed to, 89% with refused