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Law S, Stergiopoulos V, Zaheer J, Nakhost A. "Everyone means well but the one person who's really going to go to bat" - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101873. [PMID: 36950980 DOI: 10.1016/j.ijlp.2023.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 06/01/2023]
Abstract
In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.
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Affiliation(s)
- Samuel Law
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.
| | - Vicky Stergiopoulos
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addictions and Mental Health, Toronto, Ontario, Canada.
| | - Juveria Zaheer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addictions and Mental Health, Toronto, Ontario, Canada.
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Kim JP, Ryan K, Tsungmey T, Kasun M, Roberts WA, Dunn LB, Roberts LW. Perceived protectiveness of research safeguards and influences on willingness to participate in research: A novel MTurk pilot study. J Psychiatr Res 2021; 138:200-206. [PMID: 33865169 PMCID: PMC8513533 DOI: 10.1016/j.jpsychires.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022]
Abstract
Little is known about how individuals with mood disorders view the protectiveness of research safeguards, and whether their views affect their willingness to participate in psychiatric research. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents' perceptions of the protectiveness of five common research safeguards, as well as their willingness to participate in research that incorporates each safeguard. Perceived protectiveness was strongly related to willingness to participate in research for four of the safeguards. Our findings add to a limited literature on the motivations and perspectives of key stakeholders in psychiatric research.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Max Kasun
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Willa A. Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
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Piper S, Davenport TA, LaMonica H, Ottavio A, Iorfino F, Cheng VWS, Cross S, Lee GY, Scott E, Hickie IB. Implementing a digital health model of care in Australian youth mental health services: protocol for impact evaluation. BMC Health Serv Res 2021; 21:452. [PMID: 33980229 PMCID: PMC8113792 DOI: 10.1186/s12913-021-06394-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/14/2021] [Indexed: 01/15/2023] Open
Abstract
Background The World Economic Forum has recently highlighted substantial problems in mental health service provision and called for the rapid deployment of smarter, digitally-enhanced health services as a means to facilitate effective care coordination and address issues of demand. In mental health, the biggest enabler of digital solutions is the implementation of an effective model of care that is facilitated by integrated health information technologies (HITs); the latter ensuring the solution is easily accessible, scalable and sustainable. The University of Sydney’s Brain and Mind Centre (BMC) has developed an innovative digital health solution – delivered through the Youth Mental Health and Technology Program – which incorporates two components: 1) a highly personalised and measurement-based (data-driven) model of youth mental health care; and 2) an industrial grade HIT registered on the Australian Register of Therapeutic Goods. This paper describes a research protocol to evaluate the impact of implementing the BMC’s digital health solution into youth mental health services (i.e. headspace - a highly accessible, youth-friendly integrated service that responds to the mental health, physical health, alcohol or other substance use, and vocational concerns of young people aged 12 to 25 years) within urban and regional areas of Australia. Methods The digital health solution will be implemented into participating headspace centres using a naturalistic research design. Quantitative and qualitative data will be collected from headspace health professionals, service managers and administrators, as well as from lead agency and local Primary Health Network (PHN) staff, via service audits, Implementation Officer logs, online surveys, and semi-structured interviews, at baseline and then three-monthly intervals over the course of 12 months. Discussion At the time of publication, six headspace centres had been recruited to this study and had commenced implementation and impact evaluation. The first results are expected to be submitted for publication in 2021. This study will focus on the impact of implementing a digital health solution at both a service and staff level, and will evaluate digital readiness of service and staff adoption; quality, usability and acceptability of the solution by staff; staff self-reported clinical competency; overall impact on headspace centres as well as their lead agencies and local PHNs; and social return on investment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06394-4.
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Affiliation(s)
- Sarah Piper
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia.
| | - Tracey A Davenport
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Haley LaMonica
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Antonia Ottavio
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Frank Iorfino
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Vanessa Wan Sze Cheng
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Shane Cross
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Grace Yeeun Lee
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Elizabeth Scott
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
| | - Ian B Hickie
- The University of Sydney, Brain and Mind Centre, 94 Mallett St, Camperdown, Sydney, NSW, 2050, Australia
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Psychiatric Advance Directives: No Longer a Fool's Errand. Harv Rev Psychiatry 2021; 29:176-183. [PMID: 33666397 DOI: 10.1097/hrp.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Deshpande SN, Nimgaonkar VL, Bhatia T, Mishra NN, Nagpal R, Parker LS. Ethical Practices and Legal Challenges in Mental Health Research. Asian Bioeth Rev 2020; 12:87-102. [PMID: 33717331 PMCID: PMC7747337 DOI: 10.1007/s41649-020-00116-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022] Open
Abstract
Considerations of justice and concern for well-being support conducting mental health research and addressing ethical concerns specific to mental health research are critical. We discuss these concerns, provide recommendations to enable the ethical conduct of mental health research, and argue that participants' interests should be given primary weight in resolving apparent dilemmas. We also comment on provisions of two legislative actions in India relevant to mental health research: Rights of Persons with Disability Act 2016 and the Mental Health Care Act 2017. Both conform to the 2006 United Nations Convention on Rights of Persons with Disabilities of which India is a signatory. Both provide protections and enumerate rights relevant to people with mental health conditions but with differing focus. The commonalities and differences between the three are discussed in the background of international literature on research in mental health conditions. Studies involving deception and future directions for ethical requirements regarding genetic research are discussed.
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Affiliation(s)
- Smita N. Deshpande
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vishwajit L. Nimgaonkar
- Program for Genetics and Psychosis, Department of Psychiatry and Department of Genetics, University of Pittsburgh, Pittsburgh, PA USA
| | - Triptish Bhatia
- Indo-US Projects, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lisa S. Parker
- Center for Bioethics & Health Law, University of Pittsburgh, Pittsburgh, PA USA
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Abstract
OBJECTIVE Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual's capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM. METHOD This is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI. RESULTS Many but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers. CONCLUSIONS SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided.
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Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA USA
| | - Graham M.L. Eglit
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA USA
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA USA
| | | | - Peter Blanck
- Burton Blatt Institute, Syracuse University, Syracuse, NY USA
| | - Elyn R. Saks
- Gould School of Law, Saks Institute for Mental Health Law, Policy, and Ethics, University of Southern California, Los Angeles, CA
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Huang J, Chiovenda A, Shao Y, Ma H, Li H, Good MJD. Low level of knowledge regarding diagnosis and treatment among inpatients with schizophrenia in Shanghai. Neuropsychiatr Dis Treat 2018; 14:185-191. [PMID: 29379291 PMCID: PMC5757975 DOI: 10.2147/ndt.s152917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The study was designed to measure the level of knowledge of the diagnosis of illness and its treatment among patients with schizophrenia in China, and to examine the association between the capacity to provide informed consent and participation in treatment. PARTICIPANTS AND METHODS A cross-sectional study was conducted at three clinical inpatient sites in Shanghai, China, during 2015. Patients' knowledge of the illness, as well as the knowledge of the patients' families and psychiatrists, was determined. Logistic regression was used to determine the factors associated with patients' knowledge of schizophrenia. RESULTS Out of 109 enrolled schizophrenic inpatients (mean age 42.46±1.29 years), 60.6% were aware of their diagnosis and 67.0% knew details of their treatment plan. The group with unimpaired capacity for giving informed consent had a greater knowledge of their diagnosis (χ2=5.002, p=0.038) and of their treatment plan (χ2=11.196, p<0.01) in comparison with patients who were regarded to be impaired. Using logistic regression analysis, it was found that patients' capacity to give informed consent to treatment was associated with the level of knowledge surrounding the diagnosis (odds ratio =3.230, p<0.05) and the level of knowledge of treatment (odds ratio =4.962, p<0.01). CONCLUSION The level of knowledge reported by inpatients with schizophrenia was low with respect to the diagnosis of schizophrenia and of the treatment associated with this illness. An association between patients' capacities for giving informed consent and knowledge of their illness was confirmed in the present study. The results suggest that, in clinical practice, the informed consent process should be strengthened to protect the interests of patients with schizophrenia.
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Affiliation(s)
- Jingjing Huang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Andrea Chiovenda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Yang Shao
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huajian Ma
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huafang Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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