A variation of this test was further developed and advanced by Grisso and Appelbaum (1998 : 31), and includes assessing patients for their abilities to: understand information relevant to treatment decision-making, appreciate the significance of that information for [their] own situation, especially concerning [their own] illness and the probable consequences of [their] treatment options, reason with relevant information so as to engage in a logical process of weighing treatment options. This article will take a closer look at what the therapist's ethical responsibilities entail and examine some common ethical problems faced by mental health professionals. An involuntary commitment to care, or a decision made by a family member on behalf of the patient, is often made to protect the patient from harming herself or others. For example, in what is believed to be the first published national study of its kind, an Australian survey of 143 psychiatrists found that less than 30% supported PADs which involved treatment refusals (e.g. In the weeks following his discharge from hospital, John McEwan continued to express his wish to be allowed to die ( Social Development Committee 1987 : 310–11). There is room to speculate that, had a PAD been in force at the time for this patient, a very different outcome might have resulted in this case. An important problem here, particularly in psychiatric contexts, is that severe mental illness can significantly affect the capacities needed for competent decision-making (for instance, understanding, reasoning and applying values), and hence the ability generally of severely mentally ill persons to make sound decisions about their own wellbeing – including the need for care and treatment. For example, contrary to popular medical opinion, there is nothing to suggest that a person’s decision to suicide is always the product of mental disease or depression. Commenting on the moral standards which should be met when deciding whether to respect or override the expressed preferences of a patient deemed ‘incompetent’, Buchanan and Brock (1989) have classically argued in their foundational text that it is important to be clear about what statements of competence refer to. Whatever the faults, weaknesses and difficulties of such statements, they nevertheless achieve a number of important things; like bills and charters of patient rights generally, they help to remind mental health patients / consumers, service providers, caregivers and the general community that people with mental health problems (including mental illnesses and mental health problems) have special moral interests and entitlements that ought to be respected and protected, they help to inform stakeholders (patients / consumers, service providers, caregivers and the community) of what these special entitlements are and thereby provide a basis upon which respect for and protection of these can be required, they help to delineate the special responsibilities that stakeholders (patients / consumers, service providers, caregivers and the community) all have in ensuring the promotion and protection of people’s moral interests and entitlements in mental health care and in promoting mental health generally. Health Details: The ethical dilemmas encountered are centred on issues of care and control within the realm of mental health. November 13, 2014. Enumerate five ethical guidelines for behavioral health counselors that apply to social media. People get well, stay well for long periods of time, and do the things they want to do with their lives. Colleagues and Ethical Dilemmas in the Mental Health Profession In any work environment problems or difficulties with coworkers and colleagues may arise. Rights and responsibilities of people who provide services – encompassing rights and responsibilities in regards to upholding the highest possible standards of mental health care, including the development and implementation of social, health and mental health policy and service delivery policies and guidelines. But what are PADs, and are they capable of achieving the outcomes that their proponents anticipate and expect? Psychiatric advance directives have been defined as ‘documents that allow users with severe and chronic mental illnesses to notify their treatment preferences for future crisis relapses and to appoint a surrogate decision-maker for a period of incompetence’ ( Nicaise et al 2013 : 1). This test asks how well the patient has actually understood information which has been disclosed. The primary objective of the 2012 revised version of the Mental health statement of rights and responsibilities document is to inform stakeholders of the rights of people experiencing a mental illness to have access ‘to timely assessment, individualised care planning, treatment and support’ and the related rights and responsibilities that consumers, carers, support persons, service providers and the community all have in relation to these rights ( Australian Government Department of Health 2012 : 3). The social work code of ethics are … The ethical standards that guide mental health professionals in their work often conflict with the ethical principles that guide business practices, such as those employed by MCO’s. This work called "Ethical Issues in Mental Health" focuses on human rights and the treatment of mental health. In the last two hundred years, the application of physical restraints in mental health services has resulted in the clinical and ethical controversy encompassing the requisites and abuse of physical restraints .This article focuses on the ethical issue of physical restraints in China. [emphasis original]. For example, a fully comatose patient would be unable to evidence a choice, unlike a semi-comatose patient or a brain-injured person, who could evidence a choice by opening and shutting their eyes or by squeezing someone’s hand to indicate ‘yes’ or ‘no’. oral or intramuscular psychotropic medication, or electroconvulsive therapy). This is in contrast to clinicians, who have consistently been found to be somewhat ambivalent about and even afraid of them ( Amering et al 1999 ; Appelbaum 2004 , 2006 ; Atkinson 2004 ; Atkinson et al 2004 ; Elbogen et al 2006 ; Hobbs 2007 ; Kaustubh 2003 ; Kim et al 2007 ; Puran 2005 ; Srebnik & Brodoff 2003 ; Swanson et al 2006a , 2006b , 2006c , 2007 ; Swartz et al 2006 ; Varekamp 2004 ). Here are 10. In many instances, people with serious mental illnesses might not comply with, and might even refuse altogether to accept, recommended psychiatric treatment (e.g. An involuntary psychiatric patient refuses to take the psychotropic medication he has been prescribed. For example, the WHO estimates that in the United States, the return on investment for improving mental health care delivery is roughly 4 to 1. All rights reserved | Email: [email protected]. References. Some studies have suggested that, overall, clinicians are broadly supportive of the ‘advance-consent’ function of PADs (termed ‘prescriptive function’); however, clinicians are more reticent about their ‘advanced-refusal’ function (termed ‘proscriptive function’) – especially if used to refuse all future treatment ( Swartz et al 2006 ). Victoria), patient preferences can still be overridden under defined circumstances ( Callaghan & Ryan 2016 ; Maylea & Ryan 2017 ). Discussions of key ethical dilemmas in mental health care, including consent, trauma and violence, addiction, confidentiality, and therapeutic boundaries. › Url: https://www.researchgate.net/publication/309211597_Ethical_Issues_in_Mental_Health_Nursing Go Now. Health Details: Third, many ethical dilemmas are usually not choices between right and wrong, but among competing ethical principles geared toward doing good. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. As Dresser (1982 : 842) cautioned over three decades ago, if insufficiently informed persons enter into commitment contracts ‘only to please their psychiatrists, the contracts would become an avenue for the abuse of psychiatric paternalism, thus decreasing individual liberty’. What else then should health care professionals do? Coercive measures commonly used in mental health care contexts have been classified as basically involving four types: ‘seclusion, mechanical constraint, physical restraint / holding, and forced medication’ ( Krieger et al 2018 ; Tingleff et al 2017 ); these can be imposed in either institutional or community health care settings (e.g. The health care professional in turn could be judged, criticised and possibly even censured on grounds of having infringed the patient’s rights. Health care professionals struggle to help patients who lack the resources to cover the treatment they need. The need to do this becomes even more acute when the problem of determining and weighing harms is considered in relation to the broader demand to achieve a balance between protecting and promoting the patient’s wellbeing, protecting and promoting the patient’s autonomy, and protecting others who could be harmed if a mentally ill person is left free to exercise harm-causing choices (as happened in the Tarasoff case, considered in Chapter 7 ). As the Mental Health Consumer Outcomes Task Force argued almost three decades ago (1991: ix): In March 1991, the Australian Health Ministers acknowledged and accepted the above viewpoint and adopted, as part of Australia’s national mental health strategy, the final report of the Mental Health Consumer Outcomes Task Force, titled Mental health statement of rights and responsibilities . Throughout his hospitalisation, he repeatedly asked to be allowed to die. Lack of awareness and education about PADs (on the part of consumers and clinicians alike) has also been identified as a contributing factor ( Peto et al 2004 ). All issues are discussed subjectively from my own value base. Roth and colleagues (1977) suggest that competency tests proposed in the literature basically fall into five categories: The test of evidencing a choice is as it sounds, and is concerned only with whether a patient’s choice is ‘evident’; that is, whether it is present or absent . 6 years ago. Examine the notions of competency and its implications for persons with impaired decision-making capacity. Ten facts on mental health: fact 2. For example, as Buchanan and Brock (1989 : 318) comment: It is precisely in situations such as these that attending health care professionals need a reliable framework within which to decide how best to act – notably: (1) whether to respect a patient’s preferences even though the patient is deemed ‘incompetent’, or (2) whether to override patients’ preferences in the interests of protecting or upholding what has been deemed by others to be in the patient’s overall ‘best interests’. Third, even when persons with mental illness later acknowledge the need for their earlier involuntary or non-voluntary admission to hospital, they are sometimes left feeling very dissatisfied with the situation – not least because they feel that their humanity and dignity have been violated in the process. All issues are discussed subjectively from my own value base. Before his accident he had been a committed sportsman and for him the life of a helpless quadriplegic was intolerable. This article includes a review of the literature as well as recommendations from an expert panel convened with funding from the US National Institute of Mental Health. Ethical dilemmas emerge when attorneys keep mental health struggles private. These professionals have the responsibility of maintaining safety and security along with the responsibility of treating clients and engaging in ethical practice (Springer & Roberts, 2007). Our website is a unique platform where students can share their papers in a matter of giving an example of the work to be done. This is so even in jurisdictions which have progressive legislative provisions enabling patients to determine in advance their ‘will and preferences’ apropos care, treatment and supported decision-making options ( Callaghan & Ryan 2016 ; Hem et al 2018 ; Molodynski et al 2014 ; Tingleff et al 2017 ). While many people talk about the benefits of counseling, there is no question that mental health professionals are often confronted with tricky and complex legal and ethical issues.In this article, we discuss some of those issues, how counselors confront them, and what legal obligations attach ... › Url: https://www.paperdue.com/essay/ethical-legal-dilemmas-counseling-essay-2173375 Go Now. In mental health court, the goals are to address the underlying reason that the person is interacting with the judicial system and to reduce the chances that it will recur. Autonomy means "self-rule" and involves the right of an individual to make choices that may go against a physician's treatment advice concerning treatment, or non-treatment, of an existing health issue. A little over a decade later, in the cultural context of Australia, the need to assure the rights of people with mental illness and the ‘provision of recovery-orientated practice in mental health services’ was positioned as a core principle in the Australian Commonwealth Government’s National framework for recovery-oriented mental health services ( Australian Health Ministers Advisory Council (AHMAC) 2013 ) and the Council of Australian Governments’ (2012) Roadmap for national mental health reform 2012–2022 . It was (and continues to be) believed that, when completing PADs during periods of ‘competency’, persons with severe mental illnesses will be enabled to feel ‘empowered’ and to have a sense of ‘self-determination’ ( Nicaise et al 2013 : 8; see also Berghmans & van der Zanden 2012 ). There is, however, one notable caveat to this stance: because the rights of people with mental illness are disproportionately vulnerable to being infringed in health care contexts (both psychiatric and non-psychiatric), a more nuanced approached to the issue is required. This, in turn, has contributed to a lack of competence on the part of both health service providers and service users to honour and implement PADs (Nicaise et al 2013: 2). Just which model or models are appropriate, and under what circumstances they should be used, will, however, depend ultimately on the people involved (and the relationships between them), the moral interests at stake, the context in which these moral interests are at stake, the resources available (human and otherwise) to protect and promote the moral interests that are at risk of being harmed, and, finally, the accurate prediction of possibilities and probabilities in regard to the achievement of desirable and acceptable moral outcomes. a proxy directive , in which a patient ‘appoints a surrogate decision-maker who has legal authority to make treatment decisions on behalf of the patient when incapacitated’ ( Srebnik 2005 : S42). In a later appraisal and application of this test, Appelbaum (2007 : 1835) reiterates that legal standards for assessing the decision-making capacity of patients still generally embody ‘the abilities to communicate a choice, to understand the relevant information, to appreciate the medical consequences of the situation, and to reason about treatment choices’. The rights and responsibilities of people who seek assessment, support, care, treatment, rehabilitation and recovery – encompassing the right of people (including children) to ‘participate in all decisions that affect them, to receive high-quality services, to receive appropriate treatment, including appropriate treatment for physical or general health needs, and to benefit from special safeguards if involuntary assessment, treatment or rehabilitation is imposed’ (p 12).

ethical dilemmas in mental health

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