The integration of digital phenotyping in psychiatry promises unprecedented insights into mental health, particularly in college settings where mental well-being is a growing concern. The COVID-19...

From Descartes to designer babies, The Philosophy Gym poses questions about some of history's most important philosophical issues, ranging in difficulty from pretty easy to very challenging. He brings new perspectives to age-old conundrums while also tackling modern-day dilemmas -- some for the first time. Begin your warm up by contemplating whether a pickled sheep can truly be considered art, or dive right in and tackle the existence of God. In this radically new way of looking at philosophy, Stephen Law (...) illustrates the problem with a story, then lets the argument battle it out in clear, easily digestible and intelligent prose. This perfect little mental health club is sure to give each reader's mind a great workout. (shrink)

Physical activity and sedentary behaviour have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students wore accelerometers for 8 days and completed a (...) self-report survey. Mental health was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA, and moderate and vigorous PA were estimated in the time-segments before school, school time, after school, and evenings. Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems. Evening LPA was inversely associated with hyperactivity, while SED was associated with hyperactivity and with peer problems before school, and during school. No associations were observed for MVPA, emotional symptoms, or prosocial behaviour. In conclusion, displacing SED with LPA in some specific periods of the day may benefit the mental health of students; taking this into account could strengthen interventions. (shrink)

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813—1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical ‘antipsychiatric’ communities, the article reveals the myriad forms of activities that have variously been considered fit (...) work for people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work. (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)

Ms. X is a person with cerebral palsy and schizophrenia. She has intractable bedsores that are a result of her immobility and to poor wound care related to her delusional thinking. Despite intensive community support, the wounds have worsened to the point that she has needed multiple hospitalizations to prevent systemic sepsis, a life‐threatening condition. She is capable of placement decisions and wishes for independence at home but is incapable of making wound care decisions and does not appreciate that immediately (...) returning home from the hospital, instead of going into a special care facility, would likely result in sepsis. The resulting dilemma about discharge planning highlights the complexity involved in weighing concerns around mental illness and capacity for treatment and placement of care. The extent of the care that is required and available in a community or health care system and the slow but relatively certain progression of the symptoms also make the decision challenging. Two commentaries take very different approaches in exploring the question whether Ms. X should be supported to go home or to a special care facility. (shrink)

In recent human rights and legal instruments, individuals with impairments are increasingly recognised as agents who are worthy of respect for their inherent dignity and capacity to make autonomous decisions regarding treatment and care provisions. These legal developments could be understood using Stephen Darwall’s normative framework of the second person standpoint. However, this paper draws upon phenomena – both in legal developments and recent court cases – to illustrate theoretical difficulties with the contractualist underpinnings of Darwall’s account if applied to (...) questions of what is owed to individuals with disabilities. I argue that, under Darwall’s framework, whether the threshold for second-personal competence has been met will determine whether respect or rational care is owed to them. This fact distorts our understanding of what we owe to persons with mental impairments—in part because it limits respect to relations that are symmetrical and reciprocal. In light of these challenges the paper offers an account of hermeneutic competency, which can be applied to non-reciprocal and asymmetrical relationships. This alternative account will be of practical import to judicial determinations of best interests under the Mental Capacity Act 2005 in England and Wales. It will also be of broader theoretical interest to any legal system that deals with people with mental disabilities. (shrink)

This article discusses the relationship between stress, physical health, and well-being in cultural context, offers examples of laws, policies, and programs to promote mental health and well-being, and examines how collective impact supports mental health and well-being.

The current state of mental health law in England and Wales exhibits a set of systematic antinomies. This should not be seen as a flaw of the legislation; the antinomies in law reflect an underlying antinomial structure at work where the vocations of care are practiced and regulated in a broadly liberal legal environment. The aim of this paper is to identify these antinomial structures and to deploy resources from the post-Kantian idealist tradition to diagnose them and to (...) consider how they might be managed. (shrink)

When seen in the historical context of psychiatry's relatively recent discovery of violence and risk, along with society's adoption of more risk-averse attitudes, the Mental Health Act 2007 in England and Wales is an ethical and proportionate measure.

Society has historically not taken a benign view of genetic disease. The laws permitting sterilization of the mentally re tarded~ and those proscribing consanguineous marriages are but two examples. Indeed as far back as the 5th-10th centuries, B.C.E., consanguineous unions were outlawed (Leviticus XVIII, 6). Case law has traditionally tended toward the conservative. It is reactive rather than directive, exerting its influence only after an individual or group has sustained injury and brought suit. In contrast, state legislatures have not been (...) inhibited in enacting statutes. Many of their products can be characterized as hasty, unnecessary, ill-conceived, and based on the heart rather than the head. Moreover the lack of expert consultation sought has also been remarkable. One state legislature, for example, has advocated immunization for sickle cell anemia! Many others have enacted laws for the screening of inborn errors of metabolism, e.g., phenylketon uria, but have poorly defined the lines of responsibility to secure compliance. A spate of specific disease-related bills has emerged in the u.S. Congress, each seeking recognition and appropriations. Sickle cell anemia, hemophilia, Cooley's anemia and Tay-Sachs disease have been among the front-runners for support. Finally, in 1975, Congress has begun to examine an omnibus bill concerning all forms of genetic disease. The bill, termed the National Genetic Diseases Act is, however, still far from being enacted. (shrink)

We assessed the attitudes, perceptions, and stereotypes toward Latino immigrants among 247 mental health professionals across 32 U.S. states. We also randomly presented two versions of an attitude measure that varied in their references to immigrants. Participants reported that they did not agree with the anti-immigration law Arizona SB 1070 and other similar bills. Also, greater multicultural awareness was related to positive attitudes and fewer stereotypes toward immigrants. Furthermore, participants who were asked to think about “undocumented immigrants” viewed (...) Latino immigrants more positively than those who were asked think about “illegal aliens.” Findings show the continued need for multicultural awareness and competence training for mental health professionals, which align with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. Limitations and future directions for research are discussed. (shrink)

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an “othered” identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out of its (...) identity‐based understanding and recontextualized as an inferior category of “the human,” circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes‐contradictory nature of the discipline's grappling with identity‐based mental health concepts. We close with several implications for nursing policy, education, and practice. (shrink)

I argue in this essay that the phenomena we classify as "mental illness" result largely from the refusal of socially authorized "experts" to recognize - and thus to constitute - the Other as a subject. I suggest that Institutional Mental Health refuses to do this not merely because it seeks to aggrandize its own power but also because it fears to acknowledge that we are all participants in a process of historical development. It denies this because it (...) is historically conditioned by its own moment of origin in the project of the Enlightenment, It is conseqently wed to an ethos of rationalized order that does not accomodate, much less support, the unpredictable creative power of the Other and that sustains instead the project of mastery, of domination, of disovering eternal laws that will enable Reason to master history and to master the Other. For this reason Institutional Mental Health and its diverse ideologies, ranging from the pyschoanalytic to genetic defect models, constitute a major obstacle to the evolution of humanity. (shrink)

Ethics of Psychiatry addresses the key ethical and legal issues in mental health care. With selections by Paul S. Applebaum, Christopher Boorse, Kerry Brace, Peter R. Breggin, Paula J. Caplan, Glen O. Gabbard, Donald H.J. Hermann, Lawrie Reznek, Thomas Szasz, Jerome Wakefield, Bruce J. Winick, and Robert M. Veatch, among others, this sourcebook offers the latest research in psychiatry, psychology, advocacy, mental health law, social services, and medical ethics relevant to the rational autonomy of psychiatric patients.

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)

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)

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.

Stay up-to-date on the ethical and legal issues that affect your clinical and professional decisions! Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards details the ethical and legal issues that involve mental health professionals. Respected authorities with diverse backgrounds, expertise, and professional experience discuss contemporary theories emphasizing professional ethics, the ramifications of professional actions and decisions, and ethical standards on teaching, training, research, and publication. This informative handbook provides invaluable (...) up-to-date information and guidelines vital for every mental health professional. This book is a thorough examination of ethical behavior which can be used as a reference source for the professional or a textbook for graduate students. The handbook itself is divided into five sections. The first section is a detailed introduction of ethics, law, and licensing. The second section presents general ethical principles like competence, integrity, and respect for individual rights and dignity. The third section examines confidentiality, privilege, consent, and protection. The fourth section focuses on general ethical standards in practice, including sexual contact, multiple relationships, and bartering. The fifth section presents the ethical principles and standards in teaching, training, and research. Appendices include the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002) and the Code of Ethics of the National Association of Social Workers (National Association of Social Workers, 1999). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards discusses: the history of basic approaches and issues in ethical philosophy five fundamental areas in the process of developing competence the necessary ingredients for the mental health professional's practice of integrity aspirational versus enforceable standards of ethics concern for the welfare of others as a core ethical principle the notion of social responsibility in the ethics codes of psychologists and social workers ethical principles, statutes, and case law protecting privacy and confidentiality issues involving the therapist-patient privilege the "duty to protect" doctrine and relevant legal issues the dynamics of multiple relationships and boundary violations sexualized dual relationships between psychologists and patients possible conflict of interest in bartering for services the requirements and implementation of maintaining patient records to avoid ethical and legal problems possible ethical dilemmas involving referrals and fees much, much more This Handbook is an essential resource for all mental health professionals, including psychologists, psychiatrists, social workers, counselors, therapists, and graduate students in mental health and the related fields. Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards is the first of three volumes under this title. The following volumes will focus on forensic settings and special populations/special treatment modalities. (shrink)

This unique text is organized around the most current ethical and legal standards as defined by the mental health professionals of psychology, social work, ...

Law and racism are intertwined, with legal tools bearing the potential to serve as instruments of oppression or equity. This Special Issue explores this dual nature of health law, with attention to policing in the context of mental health, schools, and substance use disorders; industry and the environment in the context of food advertising, tobacco regulation, worker safety, and environmental racism; health care and research in the context of infant mortality, bias in medical applications of AI, (...) and diverse inclusion in research; and anti-racist teaching and practice in the context of building an interprofessional curriculum and medical-legal partnerships. (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.

Although nearly 99% of abortions in New Zealand are permitted in order to prevent danger or injury to a woman’s mental health (the ‘mental health exception’), the reasons why mental health considerations should effectively control access to abortion are not altogether clear. This article analyses abortion case law, statutes and debates from New Zealand, the United Kingdom and the United States to attempt to explain the legal connection between mental health considerations and (...) access to abortion. The article argues that the mental health exception evolved in response to a change in the predominant construction of women seeking abortion from ‘selfish’ to ‘desperate’, coinciding with increasing societal subscription to an expanded view of psychological harm. By conceptually accommodating both constructions of women seeking abortion, the article argues that the mental health exception usefully enabled society generally to proscribe the practice of abortion on the basis that it was unnatural and irrational, while nevertheless permitting it in cases considered to be deserving. (shrink)

Purpose of the article American university and college campus law enforcement, like their peers in American munipal law enforcement agencies, find themselves interacting frequently with civilians experiencing mental health disturbances. An innovative model for law enforcement, the Crisis Intervention Team model, has been developed to address the difficulties law enforcement professionals and civilians in mental health crisis face during encounters. This article explores how CIT can enhance police response to mental health crisis on the (...) college campus. Methodology/methods Methods of applied research were conducted, borrowing from a benchmarking model and including interviews with multiple key informants representing law enforcement and mental health. Informants were affiliated with three universities and multiple municipal jurisdictions in Virginia, USA. Scientific goal The goal was to assess the relevance of CIT on the college campus and explore creative approaches to enhancing campus police response to mental health crisis. Findings The results supported the scholarly literature regarding the efficacy of the CIT model. Creative adaptations to the CIT model for campus possibly can be implemented to address concerns of mental health crisis on campus. Conclusions CIT is a highly innovative model requiring extensive collaboration between law enforcement, mental health agencies, and mental health advocates. As standard qualitative research was not conducted, the sample size of key informants may not have reached saturation. However, findings from the interviews support the body of literature on CIT. The implementation of CIT on the college campus could possibly help to alleviate difficulties on campus arising from mental health crisis, including reducing inappropriate arrest or disciplinary action, improving campus safety, addressing concerns related to threat assessment and management, and enhancing collaborative efforts on campus and with resources in the broader community. (shrink)

The Bazelon Center for Mental Health Law, founded as the Mental Health Law Project by a group of attorneys and mental health professionals, has been a major advocacy force promoting the civil rights of persons with mental disabilities since the 1972 New York Willowbrook litigation.Named for D. C. Circuit Court of Appeals Judge David L. Bazelon, whose opinions first articulated the principles that the mentally disabled have a right to treatment in the least (...) restrictive alternative setting, the Center has actively pursued greater rights for the mentally disabled in housing, education, and federal entitlements such as Medicaid, as well as in treatment-related issues. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Mental health professionals rightfully experience significant anxiety regarding their duty to protect when working with potentially dangerous individuals. This work dispels myths and provides readers with a resource addressing the situations where a duty to protect may apply.

Stigma against mental disability within the medical field continues to impose significant barriers on physicians and trainees. Here, we examine several implications of this stigma and propose steps toward greater inclusion of persons with mental disabilities in the physician workforce.

The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.

The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.

Laurence Houlgate's critique of Shuman's "The Right to be Unhealthy" appearing at page 81 of the same issue of the Wayne Law Review.