Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with (...) the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

Commenting on Alfaro and Bui’s article “Mental Health Professionals’ Attitudes, Perceptions, and Stereotypes Toward Latino Undocumented Immigrants,” this article explores and confirms the importance of continued and increased attention to language and word choice regarding Latina/latino/latinx immigrants as well a multicultural awareness and competence training for mental health professionals. Mental health professionals must be aware of connections between social determinants of health and well-being, as well as the impact of their own cultural awareness (...) and language use, on their implicit bias and capacity for empathy with clients who they may perceive to be different than themselves. Ethical guidelines require mental health professionals to consistently seek learning opportunities to increase their cultural awareness in order to provide competent mental health services to Latina/latino/latinx undocumented immigrant clients that ameliorate suffering and facilitate flourishing. (shrink)

While a standard procedure in mental health internment facilities, physical restraint, as an extreme form of coercion in mental health, has been claimed to be abolished. Three sorts of arguments have been provided: an argument from dignity, and argument from informed consent, and a consequentialism argument. In this chapter we discuss these arguments and conclude that these arguments are not decisive to completely ban such forms of coercion. Restraint, in particular, may be justified in exceptional circumstances, (...) where an imminent risk for the personal integrity of anybody involved, including the person with the mental health problem. However, this sort of case is infrequent, while restraint is often the first option. This conclusion also suggests that much can be done to prevent reaching such extreme circumstances where coercion may be the only option. The discussion also clarifies how coercion should be carried out, when justified, making it supervised and as short as possible. (shrink)

With the increasing prevalence of Internet usage, Internet-Delivered Psychological Treatment (IDPT) has become a valuable tool to develop improved treatments of mental disorders. IDPT becomes complicated and labor intensive because of overlapping emotion in mental health. To create a usable learning application for IDPT requires diverse labeled datasets containing an adequate set of linguistic properties to extract word representations and segmentations of emotions. In medical applications, it is challenging to successfully refine such datasets since emotion-aware labeling (...) is time consuming. Other known issues include vocabulary sizes per class, data source, method of creation, and baseline for the human performance level. This paper focuses on the application of personalized mental health interventions using Natural Language Processing (NLP) and attention-based in-depth entropy active learning. The objective of this research is to increase the trainable instances using a semantic clustering mechanism. For this purpose, we propose a method based on synonym expansion by semantic vectors. Semantic vectors based on semantic information derived from the context in which it appears are clustered. The resulting similarity metrics help to select the subset of unlabeled text by using semantic information. The proposed method separates unlabeled text and includes it in the next active learning mechanism cycle. Our method updates model training by using the new training points. The cycle continues until it reaches an optimal solution, and it converts all the unlabeled text into the training set. Our in-depth experimental results show that the synonym expansion semantic vectors help enhance training accuracy while not harming the results. The bidirectional Long Short-Term Memory (LSTM) architecture with an attention mechanism achieved 0.85 Receiver Operating Characteristic (ROC curve) on the blind test set. The learned embedding is then used to visualize the activated word's contribution to each symptom and find the psychiatrist's qualitative agreement. Our method improves the detection rate of depression symptoms from online forum text using the unlabeled forum texts. (shrink)

Background: Coercion can cause harm to both the patient and the patient’s family. Few studies have examined how the coercive treatment of a close relative might affect young next-of-kin. Research questions: We aimed to investigate the views and experiences of health professionals being responsible for supporting young next-of-kin to patients in mental health care in relation to the needs of these young next-of-kin in coercive situations and to identify ethical challenges. Research design: We conducted a qualitative (...) study based on semistructured, focus group interviews and an individual interview. Participants and research context: We held three focus group interviews with six to seven children-responsible staff in each group and one individual interview with a family therapist. The participants were recruited from three hospital trusts in the eastern part of Norway. Ethical considerations: The study was approved by the National Data Protection Official for Research and based on informed consent and confidentiality. Findings: Coercion was not a theme among the participants in relation to their work with young next-of-kin, and there was much uncertainty related to whether these young people need special support to deal with the coercive treatment of their close relative. Despite the uncertainty, the study indicated a need for more information and emotional support among the youth. Discussion: Few studies have addressed the potential impact of coercive treatment of a close family member on young next-of-kin. The findings were consistent with existing research but highlighted disagreement and uncertainty among the children-responsible staff about to what extent the young next-of-kin should visit and whether they should enter the ward unit or not. We identified ethical challenges for the children-responsible staff related to the principle of not inflicting harm. Conclusion: From the perspective of children-responsible staff, it appears that the coercive treatment of a close family member entails a need for extra support of young relatives both in relation to information and the facilitation of visits, but more systematic knowledge about these issues is needed. (shrink)

How are we to make sense of madness and psychosis? For most of us the words conjure up images from television and newspapers of seemingly random, meaningless violence. It is something to be feared, something to be left to the experts. But is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs, but is this actually so? There is no convincing evidence that the brain (...) is disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. So, how do we make sense of this situation? Postpsychiatry addresses these questions. It involves an attempt to rethink some of the fundamental assumptions of mental health work, showing how recent developments in philosophy and ethics can help us to clarify some of the dilemmas and conflicts around different understandings of madness. Throughout, the authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice. This new direction emphasises the importance of cultural contexts in understanding madness, placing ethics before technology in responding to madness, and minimising 'therapeutic' coercion. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with (...) psychiatrists, patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of (...) treatment. In sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding (...) by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with (...) psychiatrists, patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

This paper reports the responses of 251 mental health care practitioners to a mail survey examining their views concerning ethical conflicts and practices within their work environments. Besides identifying the sources and types of conflicts they experience, respondents were asked how ethical standards have changed over the last 10 years as well as the factors influencing these changes. Conclusions and implications are outlined and future research needs are described.

Serious mental illness (SMI) has long posed a dilemma to society. The use of community treatment orders (CTOs), a legal means by which to deliver mandated psychiatric treatment to individuals while they live in the community, is a contemporary technique for managing SMI. CTOs (or a similar legal mechanism) are used in every province in Canada and in many jurisdictions around the world in the care and management of clients with severe and persistent mental illness (most (...) frequently schizophrenia) who have a history of treatment non‐compliance and subsequent relapse. Although there is ongoing controversy around CTOs, their use continues to be on the rise. René Girard's mimetic theory, in which he posits the social utility of the scapegoat mechanism, may shed some light on how established cultural patterns contribute to contemporary responses to SMI: how culture depends on the reproduction of certain narratives, and how these act to shape the identity of those involved. The CTO specifically can be seen to act as a scapegoating mechanism, wherein, by singling out and controlling individuals who appear to threaten social order, social order is restored. This paper reviews Girard's theory, looks at how it has been applied to SMI, and then considers how it may illuminate the social role of the CTO. This examination may provide mental health nurses with insight into the constructed identities of their patients, as well as the role of mental health care within broader cultural narratives. (shrink)

IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (...) (shown here to represent 'counter stories' to the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)

Should mental health insurance cover only disorders found in DSM‐IV, or should it be extended to treatment for ordinary shyness, unhappiness, and other responses to life's hard knocks?

AimHealthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam.MethodsA descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients (...) to May 01, 2020.ResultsThe results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19.ConclusionDuring the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam. (shrink)

Shortly following the Second World War, and under the medical direction of ex-army psychiatrist T. F. Main, the Cassel Hospital for Functional Nervous Disorders emerged as a pioneering democratic ‘therapeutic community’ in the treatment of mental illness. This definitive movement away from conventional ‘custodial’ assumptions about the function of the psychiatric hospital initially grew out of a commitment to sharing therapeutic responsibility between patients and staff and to preserving patients’ pre-admission responsibilities and social identities. However, by the mid-1950s, (...) hospital practices had come to focus pre-eminently on patients’ relationships with family members, and staff had developed a social model of mental health that focused on the family as the irreducible unit of mental treatment. By the late 1950s, this culminated in the in-patient admission of entire families for mental treatment, even when only one family member was exhibiting symptoms. At the heart of this growing post-war social-psychiatric preoccupation with the family was a new emphasis on the close relationship between mental health and individuals’ successful development toward mature responsible adulthood. The family came to be conceived as the quintessential space where both were forged. This article examines the process through which the Cassel’s social-psychiatric commitment to ‘therapeutic community’ became focused on the family as a key therapeutic site. While the family had become a central point of focus in social, political and psychological discussions of the foundation for stable democratic culture and political peace in post-war Britain, the Cassel Hospital actively experimented with these connections in therapeutic practice. This article thus illuminates the important, but frequently overlooked, role of psychiatric practices in the development of a post-war psychopolitics that established important links between the nuclear family, mental health and democratic social life. (shrink)

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare (...) providers and patients, proposing that ‘liberal’ approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust. (shrink)

This paper is the first of two in a series. In this paper, we identify mental health needs and challenges in the age of COVID-19 among Nepali-speaking, Bhutanese resettled refugees in the USA. We argue for a public health justice framework that looks critically at social determinants impacting mental health (SDIMH) barriers, which negatively impact our Bhutanese population, and serves as a theoretical foundation toward public policy and law that will inform healthcare decisions and fair (...) treatment of resettled refugees at the clinical bedside and in the community. We first describe our Bhutanese refugee population and the critical mental health issues that, for many, originated during political persecution and violent ethnic cleansing initiatives, or while living in refugee camps prior to resettlement to the USA. We present a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19, which are guided by the social determinants of economic stability; neighborhoods and physical environment; education; nutrition and exercise; community and social context; healthcare system; and legal system. We illustrate specific SDIMH of our resettled Bhutanese refugees during the pandemic, followed by a second paper that details recommendations for applying the SDIMH in a collective effort to address specific barriers to mental healthcare and support. (shrink)

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine (...) residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)

Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent (...) preventive models: those aiming to avert subsequent mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions. (shrink)

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. (...) Ethics of service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

This commentary describes limitations of mental health parity requirements in ensuring access to insurance coverage for mental health treatment and surveys regulatory options employed by states in Medicaid managed care programs as supplements to parity that can further reduce the risk of inappropriate denials of coverage.

Mental health acts allow for interference with the liberty of the individual. As such, they serve as test cases for theories of liberty, and thus the question of what Mill would think about them arises. My aim is to answer this question. I argue that Mill would embrace mental health acts to protect mentally disturbed individuals from themselves and others from them, and that they should have broad admission criteria, allow capable patients to refuse treatment, (...) and have treatment decisions made by patients or their families on the basis of substituted judgements rather than representatives of the state acting on best interest judgements. This interpretation will show that many writers who claim Mill's support cannot properly do so. It is also a combination of views that cannot be readily found in mental health acts themselves, but which, as Mill's reasons for it show, is a serious candidate for legislative adoption. (shrink)

The involuntary admission or treatment of a mentally ill individual is highly controversial, as it may be argued that such intervention infringes on individual autonomy and the right to choose a particular treatment. However, this argument must be balanced with the need to provide immediate healthcare services to a vulnerable person who cannot or will not make a choice in his or her own best interests at a particular time. A study carried out in Gauteng Province, South Africa, (...) highlighted the fact that the annual rate of involuntary admissions increased by almost double from 2007 to 2008. This could indicate that healthcare providers are not treating patients without their consent only when this is absolutely necessary. Alternatively, it could indicate that healthcare professionals are more aware of the provisions of the Mental Health Care Act and relevant national policy guidelines. Or it could suggest that more patients are presenting with mental illnesses or disorders that require their involuntary admission. It remains for strategies to be developed that change negative perceptions and inequities for individuals with mental illness. Above all, the strategies should be underpinned by inalienable respect for mentally ill individuals – a concept that was blatantly disregarded in the Life Esidimeni case. In this article, we highlight the functions of mental health review boards and their accountability where involuntary admissions are concerned, while emphasising the protections for mentally ill persons as a vulnerable population group, as set out in the SA Constitution. (shrink)

This paper is the second of two in a series. In our first paper, we presented a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19 and illustrated specific social determinants impacting mental health (SDIMH) of our resettled Bhutanese refugee population during the pandemic. This second paper details specific barriers to the SDIMH detrimental to the basic human rights and social justice of (...) this population during this pandemic. The SDIMH, as described, further informs the need for social justice measures and cultural humility in mental healthcare, public health, law, and community engagement. This work concludes with a proposed call to action toward mental health improvement and fair treatment for refugee populations in three core areas: communication and education, social stigma and discrimination, and accessibility and availability of resources. (shrink)

The aim of this chapter is to describe a type of law governing involuntary treatment that is based on decision-making capability and not on risk of harm to self or others. It is consistent with the legal and ethical principles followed in general medicine, and non-discriminatory against people with a mental illness. The rationale behind the proposal is outlined, as well as its principles and main features. It is argued that this type of law could be adapted to (...) the needs of low and middle-income countries without sacrificing its underlying principles, and that it lends itself to such adaptation much better than traditional mental health legislation. (shrink)

High quality monitoring of mental health and well-being over an extended period is essential to understand how communities respond to the COVID-19 pandemic and how to best tailor interventions. Multiple community threats may also have cumulative impact on mental health, so examination across several contexts is important. The objective of this study is to report on changes in mental health and well-being in response to the Australian bushfires and COVID-19 pandemic. This study utilized an (...) Experience-Sampling-Method, using the smartphone-based mood monitoring application, MoodPrism. Participants were prompted once a day to complete a brief survey inquiring about symptoms of depression and anxiety, and several well-being indices, including arousal, emotional valence, self-esteem, motivation, social connectedness, meaning and purpose, and control. Participants were N = 755 Australians who downloaded and used MoodPrism, between 2018 and 2020. Results showed that anxiety symptoms significantly increased during the COVID-19 pandemic, but not during the bushfires. This may be explained by concurrent feelings of social connectedness maintained during the bushfires but not during the pandemic. In contrast, depressive symptoms increased significantly during the bushfires, which maintained during the pandemic. Most indices of well-being decreased significantly during the bushfires, and further again during the pandemic. Study findings highlight the unique responses to the bushfire and COVID-19 crises, revealing specific areas of resilience and vulnerability. Such information can help inform the development of public health interventions or individual clinical treatment, to improve treatment approaches and preparedness for potential future community disasters. (shrink)

In recent years there has been considerable discussion and controversy concerning the concepts of mental health and mental illness. The controversy has centered around the problem of providing criteria for an adequate conception of mental health and illness, as well as difficulties in specifying a clear and workable system for the classification, understanding, and treatment of psychological and emotional disorders. In this paper I shall examine a cluster of these complex and important issues, focusing (...) on attempts to define ‘mental health’ and ‘mental illness’; diverse factors influencing the ascription of the predicates ‘is mentally ill’ and ‘is mentally healthy’; and some specific problems concerning these concepts as they appear in various theories of psychopathology. The approach here will be in the nature of a survey, directed at the specification of a number of problems—conceptual, methodological, and pragmatic—as they arise in various attempts to define and to provide criteria for applying the concepts of mental health and mental illness. (shrink)

There are 12 different Mental Health Acts in Canada, all of which provide for the involuntary confinement of the mentally disordered to protect both them from themselves and others from them. The Acts differ in many ways, but three issues stand out above all: involuntary admission criteria, the right to refuse treatment, and who has the authority to authorize treatment. I first describe how the MHAs differ on these issues. I then take up the methodological question (...) of how to select or construct a MHA from the many, all of which have something to be said for them. Finally, I apply this test to the three main issues in dispute and identify which solutions would be in an ideal MHA. My aim in this last is not to settle the issues but to engage with them and so deepen our understanding of what is at stake. (shrink)

In this chapter we outline ethical issues raised by the application of public health approaches to the field of mental health. We first set out some of the basics of public health ethics that are particularly relevant to mental health, with special attention to the ongoing debate over the traditional presumption of non-infringement, increased recognition of the social determinants of health, and the concept of prevention. Then we turn to the moral particularities of (...) mental health, focusing on questions concerning coercion and treatment pressure, personal identity and sociocultural factors (including stigma), and unresolved conceptual and methodological issues in psychiatry that complicate its extension into the domain of public health. (shrink)

Research has shown that addressing and integrating the existential dimension in treatment settings reduce symptoms like anxiety, depression and substance abuse. Healthcare chaplains are key personnel in this practice. A nationwide, cross-sectional survey influenced by a mixed-methods approach was used to examine the attitudes, practices, understanding and perceptions of mental health professionals, including healthcare chaplains, regarding the value of addressing the existential dimension in treatment programmes. The existential group practice was led by the healthcare chaplains as (...) an integrated part of specialist mental health services. A positive and open attitude towards addressing the existential dimension was identified among the informants. Despite this, a small gap between attitude and practice was reported. Existential, religious and spiritual concerns are reported as part of the existential dimension and as relevant topics to be discussed in specialist mental health services. The findings indicate that the existential group practice could have a positive influence on the co-leaders’ competence to address existential, religious and spiritual concerns; however, this should be further investigated. (shrink)

In the Netherlands, Forensic Flexible Assertive Community Treatment is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life. The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient (...) population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care. (shrink)

Ethics in Mental Health-Substance Use aims to explore the comprehensive concerns and dilemmas occurring from mental health and substance use problems, and to inform, develop, and educate by sharing and pooling knowledge, and enhancing expertise, in this fast developing region of ethics and ethical care and practice. This volume concentrates on ethical concerns, dilemmas, and concepts specifically interrelated, as a collation of problem(s) that directly or indirectly affect the life of the individual and family. Whilst presenting (...) a balanced view of what is ethically best practice today, this title challenges concepts and stimulates debate, exploring all aspects of the development in treatment, intervention and care responses, and the adoption of research-led best practice. (shrink)

This is a response to Professor Fennell's paper on the recent influence and impact of the best interests test on the treatment of patients detained under the Mental Health Act 1983 (MHA) for mental disorder. I discuss two points of general ethical significance raised by Professor Fennell. Firstly, I consider his argument on the breadth of the best interests test, incorporating as it does factors considerably wider than those of medical justifications and the risk of harm. (...) Secondly, I discuss his contention that the apparent permeability of the line between the interests of the patient and the interests of society is something to be concerned about in itself. Since the overarching theme of the paper is the proper place of social and cultural values, my reponse considers the implications of Fennell's arguments in the light of Charlotte Brontë's novel ‘Jane Eyre’, which, through the character of Bertha Mason (the infamous ‘mad woman in the attic’) provides a provocative study of the relationship between mental disorder and society. (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were (...) interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

When clinical services aspire to quality improvement, creative and innovative approaches to old problems are needed to drive such change. Whilst new ef orts should be applauded, information on this topic can be somewhat grey from an ethical and research point of view. Within the mental health profession there is currently an expectation to routinely evaluate care and disseminate i ndings. The notion of service enhancements under the guise of routine practice is an interesting and untested ethical issue. (...) Should clinical innovation continue to enjoy such impunity as patient autonomy is often compromised as they are often compelled to accept treatment under the coercion of mental health legislation? We believe that it should not. All involvement in any form of research is voluntary, thus patients should also have the right to decline participation in quality projects if they wish to do so. (shrink)

Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and (...) psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions, ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment. (shrink)

The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast (...) between categorical and dimensional models, with renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis. (shrink)

With the proviso that Spinoza's concerns were philosophical, not medical, we examine the Ethics with a view to bringing out those aspects of it which are of import for mental health. We find that the Ethics surrounds the idea that man can be egoless in the Buddhist sense of that term. This concept provides a criterion of mental health. Further, according to Spinoza's theory of the Affections, those which are passive include some which are based on (...) pain. These he 'enumerates among the diseases'. And for them he provides, in Part V, specific 'remedies'. This in turn leads him to equate 'Mental Freedom or beatitude' with a 'healthy Mind'. We thus have in Part V additional possible criteria of mental health. Finally, there is the suggestion that philosophy for Spinoza was a kind of therapy.' There is not a philosophical method, though there are indeed methods, like different therapies. — The philosopher's treatment of a question is like the treatment of an illness. — A main cause of philosophical disease — a onesided diet . . . Wittgenstein This doctrine of knowledge first and action later is not a minor disease . . . My present advocacy of the unity of knowledge and action is precisely the medicine for that disease. Wang Yang-ming When asked by two disciples which of the views of each was correct, Wang replied: both are. Which is used depends on the kind of person you are trying to help. Some persons need this one, others that. (shrink)

The burdens of mental illnesses and substance use disorders do not lie merely with the individuals who suffer from these conditions but affect, and are affected by, their families, communities, cities and countries. The ethical and political challenges that arise in the treatment of mental illnesses and substance abuse disorders are, therefore, challenges that affect both individuals and communities.

Following the tragic shootings in Newtown, Aurora, Isla Vista and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking.

Identifying biomarkers of developing mental disorder is crucial to improving early identification and treatment—a key strategy for reducing the burden of mental disorders. Cross-frequency coupling between two different frequencies of neural oscillations is one such promising measure, believed to reflect synchronization between local and global networks in the brain. Specifically, in adults phase–amplitude coupling (PAC) has been shown to be involved in a range of cognitive processes, including working and long-term memory, attention, language, and fluid intelligence. Evidence (...) suggests that increased PAC mediates both temporary and lasting improvements in working memory elicited by transcranial direct-current stimulation and reductions in depressive symptoms after transcranial magnetic stimulation. Moreover, research has shown that abnormal patterns of PAC are associated with depression and schizophrenia in adults. PAC is believed to be closely related to cortico-cortico white matter (WM) microstructure, which is well established in the literature as a structural mechanism underlying mental health. Some cognitive findings have been replicated in adolescents and abnormal patterns of PAC have also been linked to ADHD in young people. However, currently most research has focused on cross-sectional adult samples. Whereas initial hypotheses suggested that PAC was a state-based measure due to an early focus on cognitive, task-based research, current evidence suggests that PAC has both state-based and stable components. Future longitudinal research focusing on PAC throughout adolescent development could further our understanding of the relationship between mental health and cognition and facilitate the development of new methods for the identification and treatment of youth mental health. (shrink)

The position concerning the mental health of black and minority ethnic women in Britain is closely linked to that of their respective communities in general. Issues concerning inappropriate care and treatment; lack of access to services; and service delivery based on assumptions and stereotypes govern the way in which black women and men experience mental health care and treatment. This article discusses the specific nature of black women's position, within the wider context of black (...) communities’ experience as a whole. While the term ‘black and minority ethnic communities’ covers a range of differing communities, the focus here is on the experiences of women from African, African-Caribbean and Asian communities. In relation to women in these communities, reference is made to issues concerning: (1) older women; (2) women of mixed heritage; (3) women's roles as care-givers; and (4) the position of refugees and asylum seekers. The article also explores and outlines the importance of self-help strategies including, e.g. befriending and counselling and the role of religion and spirituality in enabling many black people to manage their mental distress. (shrink)

Originally published in 1967 Medieval Minds looks at the Middle Ages as a period with changing attitudes towards mental health and its treatment. The book argues that it was a period that that bridged the ancient with the modern, ignorance with knowledge and superstition with science. The Middle Ages spanned almost a millennium in the history of the humanities and provided the people of this period with the benefit of this knowledge. The book looks at the promise (...) and progress which was reflected by thinkers such as Augustin and Aurelianus, Alexander of Tralles and Paul of Aegina. The book also looks at martyrs like Valentine and Dympna, and the patrons of those afflicted with illnesses such as epilepsy and insanity. Written by the psychologist Thomas Francis Graham, this book provides a distinct and unique insight into the mind of those living in the medieval period and will be of interest to academics of history and literature alike. (shrink)

Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients (...) to harm and force psychologists to make disclosures that violate patients’ rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards. (shrink)

Simonet, Emanuel Nicolas Cortes Victoria's new Mental Health Act 2014 came into operation on 1st July 2014. Corresponding with international standards, the new Act aims to strengthen the human rights of persons with mental illness. This is supported by the inclusion of a recovery framework which promotes a collaborative treatment approach, procedures that reduce the duration of compulsory treatment, as well as better mental health service oversight and safeguards. This article analyses and highlights (...) these reforms from a human rights perspective. (shrink)

No known cure exists for COVID-19, and medical practitioners are exhausted and at their wits’ end trying to find treatments that prevent patients from ending up in hospital or intensive care, or even dying. A variety of treatments tried by medical practitioners include standard registered medicine, investigational or so-called experimental, unapproved or preapproved medicines, emergency or compassionate-use authorised medicine and pre-market approved medicine. However, the medicines that can be accessed via each of these categories are at different stages of efficacy (...) testing and knowledge about adverse effects, dosages and risks. To obtain ethical and legal informed consent, medical practitioners must deal with a lot of medical uncertainty, and care must be taken to ensure that the patient understands the difference in risks they may be willing to take depending on the medicine’s stage of development. Often additional information is required to obtain ethical consent as opposed to legal consent. A purely legal approach to informed consent, especially when dealing with the medical uncertainties of health emergencies and pandemics, may lead to patients’ consent lacking in enough substance to be truly considered legal and ethical. Informed consent as respect for autonomy in this sense requires more than the patient’s explicit agreement or compliance with a certain treatment proposal. This article explains the difference in consent content attached to each different stage of a medicine’s development, especially considering the additional difficulties posed by obtaining truly informed consent during a pandemic with uncertain characteristics, treatment and solutions. (shrink)

Background Maternal mental health during the peripartum period is critically important to the wellbeing of mothers and their infants. Numerous studies and clinical trials have focused on various aspects of interventions and treatments for perinatal mental health from the perspective of researchers and medical health professionals. However, less is known about women’s experiences of participating in perinatal mental health research, and the ethical issues that arise. Aim To systematically review the literature on the (...) ethical issues that emerge from pregnant and/or postpartum women’s experiences of taking part in perinatal mental health-related research. Methods Systematic review of nine bibliographic databases, from inception to July 2021. Qualitative, quantitative and mixed method studies were included if they reported on ethical issues experienced by perinatal women. Research ethical issues encompassed any issue relating to women’s experiences of being offered study information, recruitment, consent, retention and respect for autonomy. Titles, abstracts and full text screening, appraisal of the methodological quality of included studies, and data extraction, were conducted independently by two reviewers. Ethical considerations Ethical approval was not required for this systematic review. Findings A total of 9830 unique citations was retrieved. Six studies met the inclusion criteria. Studies were clinically and methodologically heterogenous, and only one was purposively designed to explore women’s experiences. The key finding was the establishment of trust between the researcher and participant in all stages of the research process. Findings are presented according to recruitment and consent processes, participation and retention, and study follow-up and completion. Conclusion The establishment of trust between the researcher and perinatal women leads to a dynamic with research ethical implications relevant to all stages of perinatal mental health-related research. Further research on the research ethical issues experienced by perinatal women is required because of the limited literature. (shrink)

Background Improving the ways in which routinely-collected mental health data are shared could facilitate substantial advances in research and treatment. However, this process should only be undertaken in partnership with those who provide such data. Despite relatively widespread investigation of public perspectives on health data sharing more generally, there is a lack of research on the views of people with mental illness. Methods Twelve people with lived experience of mental illness took part in semi-structured (...) interviews via online video software. Participants had experience of a broad range of mental health conditions including anxiety, depression, schizophrenia, eating disorders and addiction. Interview questions sought to establish how participants felt about the use of routinely-collected health data for research purposes, covering different types of health data, what health data should be used for, and any concerns around its use. Results Thematic analysis identified four overarching themes: benefits of sharing mental health data, concerns about sharing mental health data, safeguards, and data types. Participants were clear that health data sharing should facilitate improved scientific knowledge and better treatments for mental illness. There were concerns that data misuse could become another way in which individuals and society discriminate against people with mental illness, for example through insurance premiums or employment decisions. Despite this there was a generally positive attitude to sharing mental health data as long as appropriate safeguards were in place. Conclusions There was notable strength of feeling across participants that more should be done to reduce the suffering caused by mental illness, and that this could be partly facilitated by well-managed sharing of health data. The mental health research community could build on this generally positive attitude to mental health data sharing by following rigorous best practice tailored to the specific concerns of people with mental illness. (shrink)