Mental Health Ethics

Question 1

Define stigma

Answer 1

When a distinguishing personal trait is perceived as socially, physically, or psychologically disadvantageous - including as a mark of shame or discredit

Question 2

Give 4 factors that influence stigma

Answer 2

Ignorance, prejudice, discrimination, stereotypes

Question 3

Define prejudice

Answer 3

A view of something formed without adequate knowledge

Question 4

Define discrimination

Answer 4

Treating a person or thing differently based on prejudice

Question 5

Define stereotyping

Answer 5

A rigid or fixed idea about a class of people or things based on prejudice

Question 6

Describe the results of Phillips’ 1966 survey on mental health stigma

Answer 6

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

Question 7

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?

Answer 7

36%

Question 8

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?

Answer 8

38%

Question 9

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?

Answer 9

93%

Question 10

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?

Answer 10

75%

Question 11

Describe a piece of evidence that the media exacerbates stigma against the mentally ill

Answer 11

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

Question 12

What percentage of murders are committed by the mentally ill every year?

Answer 12

5%

Question 13

Are individuals with mental illness more likely to commit violent crime or be a victim? (Walsh et al, 2003)

Answer 13

14x more likely to be a victim

Question 14

According to Wahl’s 1999 survey, what percentage of individuals with mental illness have lower self-esteem because of stigma?

Answer 14

57%

Question 15

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?

Answer 15

17%

Question 16

Describe the results of Alexander & Link’s study into reducing stigma through contact

Answer 16

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

Question 17

State the 2 components of the UK’s Time to Change project in 2009

Answer 17

Events to encourage contact between people with and without mental illness and mass media campaigns

Question 18

Describe the impact of the UK’s Time to Change campaign

Answer 18

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%)

Question 19

Define coercion

Answer 19

When someone is forced to do something against their will

Question 20

According to the Mental Health Act of 2007, when can a person be kept in a psychiatric hospital against their will (sectioned)?

Answer 20

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)

Question 21

How long can a section for assessment be?

Answer 21

2-28 days

Question 22

How long can a section for treatment be?

Answer 22

3-6 months

Question 23

Name an objective method of assessing an individual’s risk to themselves or others

Answer 23

CARDS violence risk assessment and CARDS suicide risk assessment

Question 24

Give at least 3 problems with assessing an individual’s risk to themselves or others

Answer 24

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)

Question 25

Is it more important for a psychiatrist to protect the patient’s health or the public?

Answer 25

According to the Royal College of Psychiatrists Mental Health Law sub-committee (2001), improving the patient’s health supersedes issues of public protection

Question 26

According to Katsakou et al’s 2011 study, what percentage of patients who voluntarily admit themselves to a psychiatric ward felt coerced?

Answer 26

34%

Question 27

Give some limitations of asking psychiatric patients if they felt coerced into admission

Answer 27

Subjectivity and the possible influence of illness (e.g. paranoid delusions)

Question 28

Define mental capacity

Answer 28

The ability to make a particular decision

Question 29

Give 4 factors necessary for an individual to have mental capacity

Answer 29

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

Question 30

Does the Mental Capacity Act of 2005 apply to mental health care?

Answer 30

No

Question 31

Does the Mental Health Act contain a requirement to assess capacity?

Answer 31

No

Question 32

State the four most common components of a psychiatric advance directive (Swanson et al, 2006a)

Answer 32

Advance agreement to hospitalisation, advance refusal of particular hospitals, advance aggreement or refusal of particular medications, nomination of a proxy decision maker

Question 33

According to the Mental Welfare Commission for Scotland (2007), what percentage of mental health inpatients were aware of and used advance directives?

Answer 33

60% aware, 3% used

Question 34

Why do mental health patients not use advance directives? (Henderson et al, 2004)

Answer 34

They believe it wouldn’t help, believe it would be ignored, and think that they won’t get ill again

Question 35

Can the Mental Health Act override advance directives?

Answer 35

Yes - except where they refuse electroconvulsive therapy

Question 36

What percentage of clinicians comply with advance directives around seclusion or restraint?

Answer 36

50%

Question 37

What percentage of clinicians comply with advance directives around medications agreed to or refused?

Answer 37

90% with agreed to, 89% with refused