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Tham SS, Solomon P. Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies. Psychiatr Serv 2024:appips20230452. [PMID: 38938096 DOI: 10.1176/appi.ps.20230452] [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] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment. METHODS Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used. RESULTS Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies. CONCLUSIONS A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.
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Affiliation(s)
- Suzanne S Tham
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
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2
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Hormazábal-Salgado R, Whitehead D, Osman AD, Hills D. Person-Centred Decision-Making in Mental Health: A Scoping Review. Issues Ment Health Nurs 2024; 45:294-310. [PMID: 38232185 DOI: 10.1080/01612840.2023.2288181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Person-centred decision-making approaches in mental health care are crucial to safeguard the autonomy of the person. The use of these approaches, however, has not been fully explored beyond the clinical and policy aspects of shared and supported decision-making. The main goal is to identify and collate studies that have made an essential contribution to the understanding of shared, supported, and other decision-making approaches related to adult mental health care, and how person-centred decision-making approaches could be applied in clinical practice. A scoping review of peer-reviewed primary research was undertaken. A preliminary search and a main search were undertaken. For the main search, eight databases were explored in two rounds, between October and November 2022, and in September 2023, limited to primary research in English, Spanish or Portuguese published from October 2012 to August 2023. From a total of 12,285 studies retrieved, 21 studies were included. These research articles, which had mixed quality ratings, focused on therapeutic relationships and communication in decision-making (30%), patients' involvement in treatment decision-making (40%), and interventions for improving patients' decision-making engagement (30%). While there is promising evidence for shared decision-making in mental health care, it is important that healthcare providers use their communicational skills to enhance the therapeutic relationship and engage patients in the process. More high-quality research on supported decision-making strategies and their implementation in mental health services is also required.
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Affiliation(s)
- Raúl Hormazábal-Salgado
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Dean Whitehead
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Abdi D Osman
- College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
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3
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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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4
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Villena-Jimena A, Morales-Asencio JM, Quemada C, Hurtado MM. "It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4614. [PMID: 36901624 PMCID: PMC10002244 DOI: 10.3390/ijerph20054614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.
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Affiliation(s)
- Amelia Villena-Jimena
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - María M. Hurtado
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
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5
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Harding S. Supported Decision Making: Skills and Tools for Clinical Practice. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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6
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Editorial: International Perspectives on Mental Health and Mental Health Social Work. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127387. [PMID: 35742635 PMCID: PMC9224276 DOI: 10.3390/ijerph19127387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
The following collection of articles reflects the diversity of research, policy and practice in mental health social work in a range of international contexts [...].
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7
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Berger M, Fernando S, Churchill A, Cornish P, Henderson J, Shah J, Tee K, Salmon A. Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults. Early Interv Psychiatry 2022; 16:327-341. [PMID: 34018335 PMCID: PMC9292436 DOI: 10.1111/eip.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. METHODS A scoping review was conducted involving both peer-reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12-24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full-text articles and extracted data to create a descriptive summary of the models. RESULTS Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. CONCLUSIONS Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.
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Affiliation(s)
- Mai Berger
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saranee Fernando
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - AnnMarie Churchill
- Student Wellness and Counseling Centre, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Cornish
- Director of Counseling and Psychological Services, University of California, Berkeley, Berkeley, California, USA.,Honorary Research Professor, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Karen Tee
- Foundry, Vancouver, British Columbia, Canada
| | - Amy Salmon
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Bjønness S, Grønnestad T, Johannessen JO, Storm M. Parents' perspectives on user participation and shared decision-making in adolescents' inpatient mental healthcare. Health Expect 2022; 25:994-1003. [PMID: 35129846 PMCID: PMC9122388 DOI: 10.1111/hex.13443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/05/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Parents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision‐making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision‐making and delivery of high‐quality healthcare services. Objective The aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision‐making processes. Design This was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed. Setting and Participants This study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated. Results Four themes were identified: (1) self‐determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination. Conclusion User participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision‐making process. However, user participation and shared decision‐making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family‐oriented services to utilize the potential of parents as a resource and minimize conflicting interests. Patient or Public Contribution Two adolescent user representatives participated in designing the study.
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Affiliation(s)
- Stig Bjønness
- Department of Public Health, Centre for Resilience in Healthcare (SHARE), Faculty of Health Science, University of Stavanger, Stavanger, Norway.,Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Trond Grønnestad
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Jan O Johannessen
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway.,Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
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9
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Olorunfemi O, Nwozichi C. Hermeneutic phenomenology of lived experience of family caregivers of critically-ill patients sustained by healthcare technologies in Benin City, Nigeria. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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10
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‘You’d think they’d know’: social epistemology and informal carers of mental health service users. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Gumley A, Glasgow A, McInnes G, Jackson C. Mental Health Professionals' Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis. QUALITATIVE HEALTH RESEARCH 2021; 31:2378-2389. [PMID: 34382884 DOI: 10.1177/10497323211036893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples' wishes, enabling people to have their say (to a point), we know what's best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.
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Affiliation(s)
| | | | - Gordon McInnes
- Mental Health Network Greater Glasgow and Clyde, Suite 11, Templeton House, Templeton Business Centre, 62 Temple Street, Glasgow, G401DA
| | - Calum Jackson
- Inpatient Psychology Services, Dykebar Hospital, Grahamston Road, Paisley, PA2 7DE
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12
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Schaffer MA. Family perspectives of healthcare for relatives living with a mental illness. Perspect Psychiatr Care 2021; 57:1547-1557. [PMID: 33373064 DOI: 10.1111/ppc.12718] [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: 09/16/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study explored how parents, partners or spouses, siblings, and adult children, who had a relative living with a mental illness, experienced interactions with mental healthcare providers and staff. DESIGN AND METHODS A descriptive qualitative research process guided interviews with 20 family members about their experiences with the mental healthcare system. FINDINGS Analysis yielded similar and different themes of experience for each family role. Although navigating the mental system presented challenges, positive experiences affirmed family members' contributions to caregiving. PRACTICE IMPLICATIONS Involvement of family members contributes to inclusive care and promotes family satisfaction with care provided to their relative.
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Affiliation(s)
- Marjorie A Schaffer
- Department of Nursing, University Professor of Nursing Emerita, Bethel University, St. Paul, Minnesota, USA
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13
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Engaging with Transformative Paradigms in Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189504. [PMID: 34574437 PMCID: PMC8472367 DOI: 10.3390/ijerph18189504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.
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14
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Maylea C, Katterl S, Johnson B, Alvarez-Vasquez S, Hill N, Weller P. Consumers' experiences of rights-based mental health laws: Lessons from Victoria, Australia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 78:101737. [PMID: 34428604 DOI: 10.1016/j.ijlp.2021.101737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Many countries embarked on reforms of mental health law in the wake of the Convention on the Rights of Persons with Disabilities. These reforms have had varying levels of success. This paper considers the experience of consumers in the Victorian mental health system, drawing on an evaluation that asked consumers and clinicians about their knowledge and experience of rights under the Victorian Mental Health Act, 2014. The data show that consumers were not informed of their rights, were not involved in decisions about treatment, were not able to access safeguards, and could not exercise their rights. The explanations for this include limited staff time, unclear delegations of responsibility, a lack of knowledge, training, and support for rights, and a preference for 'best interests' approaches. The paper identifies tangible reforms that would maintain rights for consumers, including competent refusal of treatment, legislative and regulatory reforms, and training and resourcing. Consumers in this study found that the rights-based framework in the Mental Health Act, 2014 had such an insignificant effect on clinical mental health practice in Victoria that their rights appeared to be illusory.
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Affiliation(s)
- Chris Maylea
- RMIT University, GPO 2476, Melbourne 3001, Victoria, Australia.
| | - Simon Katterl
- RMIT University, GPO 2476, Melbourne 3001, Victoria, Australia.
| | - Brendan Johnson
- RMIT University, GPO 2476, Melbourne 3001, Victoria, Australia
| | | | - Nicholas Hill
- RMIT University, GPO 2476, Melbourne 3001, Victoria, Australia.
| | - Penelope Weller
- RMIT University, GPO 2476, Melbourne 3001, Victoria, Australia.
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15
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O'Cionnaith C, Wand APF, Peisah C. Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness. Clin Interv Aging 2021; 16:1315-1325. [PMID: 34285476 PMCID: PMC8285123 DOI: 10.2147/cia.s311773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.
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Affiliation(s)
- Cathal O'Cionnaith
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anne P F Wand
- Older Persons Mental Health Service, Jara Unit, Concord Centre for Mental Health, Concord Repatriation General Hospital, Concord, NSW, Australia.,Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Capacity Australia, Crows Nest, NSW, Australia
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16
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Gooding P, McSherry B, Arstein-Kerslake A. Supported Decision-Making in Criminal Proceedings: A Sociolegal Empirical Study. JOURNAL OF DISABILITY POLICY STUDIES 2021. [DOI: 10.1177/10442073211026332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article outlines a project in which supported decision-making (SDM) and broader support to exercise legal capacity were provided to accused persons with cognitive disabilities in the Australian criminal justice system. The program was developed to advance the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in relation to unfitness to plead laws. The researchers collaborated with three community legal services in three Australian jurisdictions. Four nonlegal “disability support people” were trained to work with accused persons alongside legal counsel to maximize their participation in the trial process and avoid the need for unfitness to plead determinations under current laws. The article draws on qualitative research conducted in the form of interviews with clients, lawyers, and support persons. The findings provide an evidence base for implementing SDM for persons with disabilities in the criminal justice system. It also helps answer the question of whether unfitness to plead laws should be repealed in pursuit of a “universally accessible” justice system in line with the CRPD.
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Affiliation(s)
- Piers Gooding
- University of Melbourne, Victoria, Australia
- Melbourne Social Equity Institute, Carlton, Victoria, Australia
| | - Bernadette McSherry
- University of Melbourne, Victoria, Australia
- Melbourne Social Equity Institute, Carlton, Victoria, Australia
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Raffard S, Lebrun C, Laraki Y, Capdevielle D. Validation of the French Version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in a French Sample of Individuals with Schizophrenia: Validation de la version française de l'instrument d'évaluation des compétences MacArthur-traitement (MacCAT-T) dans un échantillon français de personnes souffrant de schizophrénie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:395-405. [PMID: 33064578 PMCID: PMC8172341 DOI: 10.1177/0706743720966443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Assessing an individual's capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients' competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients' decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia. METHOD In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated. RESULTS The MacCAT-T's internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of "understanding." Component 2 included all subparts of "appreciation" and "reasoning" and was therefore labeled "reflexivity." After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education. CONCLUSIONS The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.
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Affiliation(s)
- Stéphane Raffard
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Cindy Lebrun
- 27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Yasmine Laraki
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,27038Université Paul Valéry Montpellier 3, EPSYLON EA, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, 26905CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France.,Inserm, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, France
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Paredes AZ, Hyer JM, Tsilimigras DI, Palmer E, Lustberg MB, Dillhoff ME, Cloyd JM, Tsung A, Ejaz A, Wells-Di Gregorio S, Pawlik TM. Association of pre-existing mental illness with all-cause and cancer-specific mortality among Medicare beneficiaries with pancreatic cancer. HPB (Oxford) 2021; 23:451-458. [PMID: 32843275 DOI: 10.1016/j.hpb.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/20/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among patients with pancreatic cancer, the association of pre-existing mental illness with long-term outcomes remains unknown. METHODS Individuals diagnosed with pancreatic adenocarcinoma were identified in the SEER-Medicare database. Patients were classified as having mental illness if an ICD9/10CM code for anxiety, depression, bipolar disorder, schizophrenia or other psychotic disorder was recorded. RESULTS Among the 54,234 Medicare beneficiaries with pancreatic cancer, roughly 1 in 12 (n = 4793, 8.83%) individuals had a diagnosis of a mental illness. The majority (n = 4029, 84.1%) had anxiety or depression, while 16% (n = 764) had bipolar/schizophrenic disorders. On multivariable analysis, among patients with early stage cancer, individuals with pre-existing anxiety/depression and bipolar/schizophrenic disorders had 22% (OR 0.78, 95% CI 0.69-0.86) and 46% (OR 0.54, 95% CI 0.42-0.70) reduced odds, respectively, to undergo cancer-directed surgery. Furthermore, patients with a pre-existing history of bipolar/schizophrenic disorders had a 20% (HR 1.20, 95% CI 1.21-1.40) higher risk of all-cause mortality and 27% (HR 1.27, 95% CI 1.17-1.37) higher risk of pancreatic cancer-specific mortality compared to individuals without a history of mental illness. CONCLUSION One in twelve patients with pancreatic cancer had a pre-existing mental illness. Individuals with mental illness were more likely to have worse overall and cancer-specific long-term outcomes.
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Affiliation(s)
- Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Elizabeth Palmer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Maryam B Lustberg
- Division of Medical Oncology, Supportive Care Services, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 1250 Lincoln Tower, Columbus, OH 43210, USA
| | - Mary E Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, College of Medicine, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 504 McCampbell Hall North, 1581 Dodd Drive, Columbus, OH 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210, USA.
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"When I'm Thinking Straight, I Can Put Things in Place for When I'm Not." | Exploring the Use of Advance Statements in First-Episode Psychosis Treatment: Young People, Clinician, and Carer Perspectives. Community Ment Health J 2021; 57:18-28. [PMID: 33058044 DOI: 10.1007/s10597-020-00721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Advance statements represent a promising but relatively unexplored means to empower young people with first-episode psychosis to actively participate in their own mental health care. This qualitative study explored the use of advance statement's for young people with first-episode psychosis, as well as their carers and clinicians, and provided actionable feedback on how to better meet the needs and preferences of these key stakeholders and more effectively implement advance statements in clinical settings.
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20
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Khalily MT, Rehman AU, Bhatti MM, Hallahan B, Ahmad I, Mehmood MI, Khan SH, Khan BA. Stakeholders' perspective on mental health laws in Pakistan: A mixed method study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101647. [PMID: 33246231 DOI: 10.1016/j.ijlp.2020.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
The present study explored awareness and opinions pertaining to mental health legislation in Pakistan in the context of the United Nation Convention on Rights of People with Disabilities (UNCRPD) through a mixed method research design. In the quantitative arm of the study, a structured questionnaire examined awareness and opinions of key stakeholders pertaining to national mental health legislation. In the qualitative arm, face-to-face interviews further elaborated stakeholders perspectives pertaining to these topics with thematic analysis conducted. Stakeholders demonstrated a good awareness of legislation pertaining to guardianship (83.0 %) appointment of property managers (89.7%) and salary or pension entitlements (89.2%). Compared to other stakeholders, patients had less understanding of processes pertaining to involuntary admission (χ2 = 20.54, p = 0.02) and appointing a guardian (χ2 = 34.67, p < 0.01). High consensus across stakeholders was noted for processes of involuntary detention (83.5%) and appointment of guardians or property managers (80.0%) albeit patients demonstrated less agreement on these topics (p <0.01). Minimal support was noted for an involuntary patient to be discharged solely on a psychiatrist's recommendation (25.4%). Thematic analysis indicated fifteen emergent themes: 1) Alienation/ Seclusion; 2) Capacity building; 3) Communication Gap; 4) Conflict of interests; 5) Discomfort at hospital; 6) Economic burden; 7) Government's liability; 8) Family involvement; 9) Imbalance; 10) Acceptance of Legal Incapacity; 11) Legal reforms; 12) Patient centred environment; 13) Quality assurance; 14) Under developed infrastructure and 15) Potential unethical practices. This study advocates for increased patient involvement in collaborative decision making with mental health professionals and the creation of more appropriate inpatient treatment environments.
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Affiliation(s)
| | - Aziz Ur Rehman
- Department of Law, International Islamic University, Islamabad, Pakistan
| | - Mujeeb Masud Bhatti
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Irshad Ahmad
- Department of Psychology, International Islamic University, Islamabad, Pakistan.
| | | | - Shamsher Hayat Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Bilal Ahmed Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
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21
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Fox J. Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment. Front Psychiatry 2021; 12:637560. [PMID: 33776818 PMCID: PMC7987805 DOI: 10.3389/fpsyt.2021.637560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/18/2021] [Indexed: 12/03/2022] Open
Abstract
Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.
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Affiliation(s)
- Joanna Fox
- School of Education and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
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22
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Thimm JC, Antonsen L, Malmedal W. Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction. Health Expect 2020; 23:1477-1484. [PMID: 32935451 PMCID: PMC7752195 DOI: 10.1111/hex.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment. OBJECTIVE To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction. DESIGN Cross-sectional. SETTING AND PARTICIPANTS The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection. MAIN VARIABLES STUDIED Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire. RESULTS About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction. DISCUSSION AND CONCLUSION The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention. PATIENT OR PUBLIC CONTRIBUTION The hospital's user panel was involved in the development of items assessing user involvement.
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Affiliation(s)
- Jens C Thimm
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Liss Antonsen
- Psychiatric Centre, Helgeland Hospital Trust Mo i Rana, Mo i Rana, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Webb P, Davidson G, Edge R, Falls D, Keenan F, Kelly B, McLaughlin A, Montgomery L, Mulvenna C, Norris B, Owens A, Shea Irvine R. Key components of supporting and assessing decision making ability. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 72:101613. [PMID: 32889426 DOI: 10.1016/j.ijlp.2020.101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
People's ability to make decisions may be impaired for a wide range of reasons, including by mental health problems and learning disabilities. Individual autonomy, the ability to make decisions about our own lives, is a fundamental tenet of democratic societies. This has been reinforced by laws governing substitute and supported decision making and most significantly by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 12 of the UNCRPD requires everyone to have equal recognition before the law and, to achieve this, the necessary support and safeguards must be available. There has been considerable debate about the important theoretical and philosophical issues involved and growing research about the practice complexities of supporting and assessing decision making ability or mental capacity. This article aims to present some of the key components of the support and assessment process to inform further service development and training in this area. The key components were identified as part of a qualitative, participatory research project which explored the decision making experiences of people with mental health problems and/or learning disabilities. The conventional approach to the assessment of capacity is to consider four main components, whether the person is able to: understand, retain, use and weigh, and communicate the information needed to make the decision at that time. The findings from this research study suggest that people generally don't usually talk about their experiences of decision making in terms of these four components and approaches to supporting people to make decisions don't necessarily break the support down to explicitly address the assessment process. However, considering support for all aspects of the functional test may be helpful to ensure it is as comprehensive as possible. The challenges involved in providing effective support and assessing decision making ability are discussed and the article concludes with some of the implications for training, service development and practice.
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Affiliation(s)
- Paul Webb
- Praxis Care, 25-31 Lisburn Road, Belfast, Northern Ireland BT9 7AA, UK.
| | - Gavin Davidson
- Queen's University Belfast, Northern Ireland BT7 1NN, UK.
| | - Rosalie Edge
- Mencap NI, 5 School Road, Newtownbreda, Belfast, Northern Ireland BT8 6BT, UK.
| | - David Falls
- Praxis Care, 25-31 Lisburn Road, Belfast, Northern Ireland BT9 7AA, UK.
| | - Fionnuala Keenan
- Praxis Care, 25-31 Lisburn Road, Belfast, Northern Ireland BT9 7AA, UK.
| | - Berni Kelly
- Queen's University Belfast, Northern Ireland BT7 1NN, UK.
| | | | | | - Christine Mulvenna
- Mencap NI, 5 School Road, Newtownbreda, Belfast, Northern Ireland BT8 6BT, UK.
| | - Barbara Norris
- Mencap NI, 5 School Road, Newtownbreda, Belfast, Northern Ireland BT8 6BT, UK.
| | - Aine Owens
- Mencap NI, 5 School Road, Newtownbreda, Belfast, Northern Ireland BT8 6BT, UK.
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What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care. Int J Integr Care 2020; 20:8. [PMID: 32874167 PMCID: PMC7442175 DOI: 10.5334/ijic.5419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The aim of this study is to advance our understanding of key components of integrated Youth Care from a parental perspective. Methods: Semi-structured interviews were administered to 21 parents of children receiving Youth Care from integrated care teams in the Netherlands. Qualitative content analysis was conducted by means of a grounded theory approach following qualitative reporting guidelines. Results and discussion: Parental perspectives were clustered into six key components: a holistic, family-centred approach; addressing a broad range of needs in a timely manner; shared decision making; interprofessional collaboration; referral; and privacy. Parents emphasized the importance of a tailored, family-centred approach, addressing needs across several life domains, and active participation in their own care process. However, they simultaneously had somewhat opposing expectations regarding these key components, for example, concerning the changing roles of professionals and parents in shared decision making and the value of involving family members in a care process. Professionals should be aware of these opposing expectations by explicitly discussing mutual expectations and changing roles in decision making during a care process. To enable parents to make their own decisions, professionals should transparently propose different options for support guided by an up-to-date care plan.
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25
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Gooding P, McSherry B, Roper C. Preventing and reducing 'coercion' in mental health services: an international scoping review of English-language studies. Acta Psychiatr Scand 2020; 142:27-39. [PMID: 31953847 PMCID: PMC7496148 DOI: 10.1111/acps.13152] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
This article discusses initiatives aimed at preventing and reducing 'coercive practices' in mental health and community settings worldwide, including in hospitals in high-income countries, and in family homes and rural communities in low- and middle-income countries. The article provides a scoping review of the current state of English-language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals' rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non-English-language studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.
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Affiliation(s)
- P. Gooding
- University of MelbourneParkvilleVicAustralia
| | - B. McSherry
- University of MelbourneParkvilleVicAustralia
| | - C. Roper
- University of MelbourneParkvilleVicAustralia
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26
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Rogers E, Pilch M, McGuire BE, Flynn E, Egan J. Psychologists' perspectives on supported decision making in Ireland. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:234-245. [PMID: 31975473 DOI: 10.1111/jir.12712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decision-making capacity from the perspective of psychologists working with adults with an intellectual disability. METHODS A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis. RESULTS Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward. CONCLUSIONS Participants described that people with intellectual disabilities were often excluded from decision-making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified.
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Affiliation(s)
- E Rogers
- Brothers of Charity Services, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - M Pilch
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - B E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
| | - E Flynn
- Centre for Disability Law and Policy, National University of Galway, Galway, Ireland
| | - J Egan
- School of Psychology, National University of Ireland, Galway, Ireland
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Abstract
OBJECTIVE Discussions of capacity to consent in mental health care usually revolve around capacity to consent to treatment. This paper instead explores the issue of capacity to consent to sexual activity in a mental health inpatient setting as a way of exploring capacity from a different perspective. This is not a purely theoretical exercise, with both consensual sexual activity and sexual assault commonplace in mental health inpatient units, current policy and practice approaches are clearly not working and require re-examination. METHODS Four key frameworks are explored: human rights law, mental health law, the criminal law and the law of tort governing the duty of care. These frameworks are explored by highlighting relevant case law and statutes and considering their potential application in practice. This is undertaken using the state of Victoria, Australia, as a case study. RESULTS The four frameworks are shown to be consistent with each other but inconsistent with contemporary policy. All four legal frameworks explored require clinicians to take a case-by-case assessment to ensure that a person's right to make their own decisions is preserved 'unless the contrary is demonstrably justified' or where it is 'legally demanded'. While Victorian inpatient units attempt to enforce a blanket ban on consensual sexual activity in inpatient settings, this ban may be without legal basis and may be in breach of both human rights and mental health law. CONCLUSION In policing the lawful bodily interactions of their patients and pushing sexual activity out of sight, clinicians may be breaching their duty of care to provide sexual health support and risk creating an environment in which the therapeutic relationship will be sacrificed to the enforcement of institutional policy. Clinicians and policymakers must understand the relevant legal frameworks to ensure that they are acting ethically and lawfully.
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Affiliation(s)
- Christopher Maylea
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
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28
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Abstract
OBJECTIVE To examine capacity assessment, coercive care and principles by which a seemingly reasonable request for the discontinuation of treatment may be considered. CONCLUSIONS A clinical and socio-legal case may be made for 'coercive care'.
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Affiliation(s)
- John D Little
- Consultant Psychiatrist, Kapiti Community Mental Health Team, Paraparaumu, New Zealand
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Thomas EC, Zisman-Ilani Y, Salzer MS. Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care. Psychiatr Serv 2019; 70:801-807. [PMID: 31109262 PMCID: PMC6718300 DOI: 10.1176/appi.ps.201800544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
SELF-DETERMINATION AND CHOICE IN MENTAL HEALTH.
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Affiliation(s)
| | | | - Mark S Salzer
- College of Public Health, Temple University, Philadelphia
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30
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Verbeke E, Vanheule S, Cauwe J, Truijens F, Froyen B. Coercion and power in psychiatry: A qualitative study with ex-patients. Soc Sci Med 2019; 223:89-96. [PMID: 30739039 DOI: 10.1016/j.socscimed.2019.01.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Coercion is a controversial issue in mental health care. Recent research highlights that coercion is a relational phenomenon, although, it remains unclear how this intersubjective context should be understood. The aim of this study is to propose an interactional model of the relational aspects of coercion that enhances theoretical understanding, based on the assumptions of patients. METHOD The research question was studied by means of interpretative phenomenological analysis. Twelve people who had psychiatric hospitalisations were interviewed in-depth, using broad open questions relating to the experience of coercion and power in psychiatry. Data were collected in 2016 and 2017 in Belgium. RESULTS Across participants' accounts we observed a specific structure. The relational quality of coercion seemed to be embedded within a process where individuals were one-sidedly approached as a 'sick patient', which led to profound segregation between staff and patients. This segregation caused a form of de-subjectivation: participants felt that important aspects of their subjectivity were neglected and they experienced professionals as de-subjectivated. They felt as if power resides within the (non-) interactions between patients and mental health workers. De-subjectivation arose and was enlarged within relations by broken contact, by silence in coercive acts, and by the necessity of patients to conform to the professionals' treatment regime. Helpful encounters that were not deemed coercive were those where patients and staff were individuated, which altered their relation. CONCLUSIONS To understand the relational quality of coercion, interventions like seclusion and house rules should also be understood within this structure of de-subjectivation. We need to tackle this dynamic if we want to reduce coercion in psychiatric care.
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Affiliation(s)
- Evi Verbeke
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Stijn Vanheule
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Joachim Cauwe
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Femke Truijens
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
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Brophy L, Kokanovic R, Flore J, McSherry B, Herrman H. Community Treatment Orders and Supported Decision-Making. Front Psychiatry 2019; 10:414. [PMID: 31244699 PMCID: PMC6580382 DOI: 10.3389/fpsyt.2019.00414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
This paper presents findings from an interdisciplinary project undertaken in Victoria, Australia, investigating the barriers and facilitators to supported decision-making (SDM) for people living with diagnoses including schizophrenia, psychosis, bipolar disorder, and severe depression; family members supporting them; and mental health practitioners, including psychiatrists. We considered how SDM can be used to align Australian laws and practice with international human rights obligations. The project examined the experiences, views, and preferences of consumers of mental health services, including people with experiences of being on Community Treatment Orders (CTOs), in relation to enabling SDM in mental health service delivery. It also examined the perspectives of informal family members or carers and mental health practitioners. Victoria currently has high rates of use of CTOs, and the emphasis on SDM in the Mental Health Act, 2014, is proposed as one method for reducing coercion within the mental health system and working towards more recovery-oriented practice. Our findings cautiously suggest that SDM may contribute to reducing the use of CTOs, encouraging less use of coercive practices, and improving the experience of people who are subject to these orders, through greater respect for their views and preferences. Nonetheless, the participants in our study expressed an often ambivalent stance towards CTOs. In particular, the emphasis on medication as the primary treatment option and the limited communication about distressing side effects, alongside lack of choice of medication, was a primary source of concern. Fears, particularly among staff, about the risk of harm to self and others, and stigma attached to complex mental health conditions experienced by consumers and their families, represent important overarching concerns in the implementation of CTOs. Supporting the decision-making of people on CTOs, respecting their views and preferences about treatment, and moving towards reducing the use of CTOs require system-wide transformation and a significant shift in values and practice across mental health service delivery.
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Affiliation(s)
- Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Mind Australia, Heidelberg, VIC, Australia
| | - Renata Kokanovic
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Jacinthe Flore
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Bernadette McSherry
- Melbourne Social Equity Institute and Melbourne Law School, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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