This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care (...) of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed. (shrink)

Ethical dilemmas in community mental health care is the focus of this article. 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. The different stakeholders are confronted with the following dilemmas: community care versus hospital care ; a life with care versus a life without care ; stimulation of the client toward greater responsibility versus protection against such (...) responsibility ; budgetary control versus financial incentives , and respect for the client versus particular private needs . These dilemmas are interpreted against the background of a value based ethical model. This model offers an integral approach to the dilemmas and can be used to determine policy. The dilemmas are discussed here as the result of conflicting values—namely autonomy and privacy, support and safety, justice and participation, and trust and solidarity. (shrink)

Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public (...) policy exceedingly difficult. Referencing a variety of approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, ‘disparity,’ is unjustifiable. (shrink)

In order to be able to provide informed, effective and responsive mental health care and to do so in an evidence‐based, collaborative and recovery‐focused way with those who use mental health services, there is a recognition of the need for mental health professionals to possess sophisticated critical thinking capabilities. This article will therefore propose that such capabilities can be productively situated within the context of the work of the French philosopher Michel Foucault, one (...) of the most challenging, innovative and influential thinkers of the 20th century. However, rather than focusing exclusively upon the content of Foucault's work, it will be suggested that it is possible to discern a general methodological approach across that work, a methodological approach that he refers to as “the history of the present.” In doing so, Foucault's history of the present can be understood as a productive, albeit provisional, framework in which to orientate the purpose and process of critical thinking for mental health professionals by emphasizing the need to both historicize and politicize the theoretical perspectives and therapeutic practices that characterize contemporary mental health care. (shrink)

This paper1 aims to develop a model of practitioner narrative competence specifically for mental health care. I begin by considering the status of narratives as a form of evidence. Following Rita Charon and Cheryl Misak, I claim that there is no distinction to be made between evidence-based medicine and narrative medicine. I then explore Charon’s model of practitioner narrative competence, and suggest that it can be fruitfully adapted for mental health care contexts, a project (...) for which I employ Jennifer Radden and John Z. Sadler’s psychiatric ethics. This project brings together two independently promising accounts to develop what I refer to as the adapted model of... (shrink)

Postdisciplinarity in mental health‐care: an Australian viewpointThis paper outlines some of the powerful forces progressively undermining the conceptual and practical foundations upon which the major disciplines have been established, and dissolving the boundaries which have traditionally distinguished them from each other, particularly those disciplines involved in the healthcare enterprise. It discusses some of the implications of these processes for mental health nursing, and champions a new cadre of ‘postdisciplinary’ staff, comprising a graduate generic mental (...) healthcare worker and a postgraduate clinical specialist. It is argued that such a specialist — a ‘Generic Mental Health Worker’— should be welcomed by all those who want to see improved quality of care in mental health services rather than defend a failing system. (shrink)

Journal of Philosophy of Education, Volume 56, Issue 1, Page 22-28, February 2022.

This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms (...) of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnosis on the essential features of the reformed mental health systems based on the pattern of social inclusion inherent to the new devices and philosophies of care, some major challenges for the future such as the overburdening of services or the overt exclusion of a significant part of potential users are also identified and briefly discussed. (shrink)

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues (...) of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources. (shrink)

The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the ‘experimental’ nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even ‘willfully obstructive’. In an attempt to resist such impressions, this paper will seek to provide an (...) accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a ‘continuity’, rather than as a series of distinct ‘moments’ or ‘events’. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent ‘turn’ to ‘narrative’ as a psychotherapeutic approach and for contemporary mental health care's growing interest in ‘social constructionism’. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing. (shrink)

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers’ perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, (...) and allied mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway. (shrink)

Context: In most jurisdictions where medical-aid-in-dying is available, this option is reserved for individuals suffering from incurable physical conditions. Currently, in Canada, people who have a mental illness are legally excluded from accessing MAiD. Methods: We developed a questionnaire for mental health care providers to better understand their perspectives related to ethical issues in relation to MAiD in the context of severe and persistent suffering caused by mental illness. We used a mixed-methods survey approach, using (...) a concurrent embedded model with both closed and open-ended questions. Findings: 477 healthcare providers from the province of Québec completed the questionnaire. One third of the sample were nurses, one quarter psychologists and one quarter psycho-educators. Nearly half of the respondents considered that people with a severe mental illness should be granted the right to opt for MAiD as a way to end their suffering. Respondents were more likely to feel comfortable listening to the person and participating in discussions related to MAiD for a mental illness than offering care or the means for the person to access MAiD. Most reported that they had not received adequate/sufficient training, education or preparation in order to address ethical questions surrounding MAiD. Conclusions: The findings highlight how extending MAiD to people with a mental illness would affect daily practices for mental healthcare providers who work directly with people who may request MAiD. The survey results also reinforce the need for adequate training and professional education in this complex area of care. (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)

This paper presents the results of an empirical study among two groups of psychotherapists in the Netherlands. One group works in a mental health institution based on religious principles , and the other group in a general mental health institution . The investigation starts with an overview of the religious background and religious practices of the therapists. Some equations with the average Dutch citizen are made. The next part of the study deals with the perception by (...) psychotherapists of religious issues connected with psycho-social problems. How often in their opinion is there a relation and what kind of relation is at issue? The third part of the study considers the way in which psychotherapists treat these religious issues. Do they attend to them and what kind of interventions are used? Special attention is given to the question of whether there are contacts with the clergy. We conclude that religion should be given a more pronounced place in general mental health care and that Riagg psychotherapists, in particular, should become better equipped to deal with religious issues. (shrink)

Because of the development towards community care, care providers not only exchange information in a team, but increasingly also in networks. This is a challenge to confidentiality. The ethical question is how care providers can keep information about the care receiver confidential, whilst at the same time exchanging information about that care receiver in a team or network? Can shared confidentiality be extended from a team to a network? To clarify this question, the article refers (...) to the advice of an expert ethics committee in mental health care. The advice regards exchange of information in a network as a further step in enhancing collaboration among care providers. Therefore, the good and evident practice of shared confidentiality in a team can be extended to a network if the same conditions are met. First, the care providers participate in a clearly defined and identifiable team or network. Secondly, they have a shared care responsibility. Thirdly, they have a duty of confidentiality. Fourth, they dialogue with the care receiver and obtain his or her consent. Finally, they apply the filter of relevance. Hence, conditional shared confidentiality is an ethical justification for the exchange of information in a team or network. (shrink)

Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately (...) guided by existing rules based on legal precedents, there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most (...) participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated. This article presents a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: formal coercion, informal coercion, uncertainty related to the Norwegian (...) legislation on coercion and professional role and identity. Some ethical challenges did not fit into these categories. Only 36% of the ethical challenges were related to the use of formal coercion or the interpretation of the health law. Conclusion Even within coercion regulated by law, weighing different moral values remains important to reflect upon the appropriateness of the possible use of coercion. (shrink)

The health crisis caused by COVID-19 has resulted in the physical and emotional deterioration of health personnel, especially nurses, whose emotional state is affected by the high risk of contagion, the high demands of health services, and the exhausting working hours. The objective of this research was to determine the relationship between fear, anxiety, and fatigue of nurses caring for patients with COVID-19 in a second level public hospital in Peru. This study presents a quantitative approach and (...) correlational level, cross-sectional, and non-experimental design. The sample consisted of 145 nurses who attended patients with COVID-19 in health care areas. The results show a significant relationship between fear of contagion and physical-cognitive fatigue and a significant relationship between generalized anxiety and physical-cognitive fatigue. It is concluded that in this context, both fear of contagion and generalized anxiety are related to physical-cognitive fatigue. (shrink)

Beyond Clinical Dehumanisation Toward the Other offers a rare and intimate portrayal of the moral process of a mental health clinician that interrogates the intractable problem of systemic dehumanization in community mental health care, and looks to the notion of 'wonder,' and the visionary relational ethics of Emmanuel Levinas, for a possible cure. This book is an ethical primer for mental health professionals, researchers, educators, advocates and service users working to re-imagine and heal (...) a broken system by challenging the underpinnings of entrenched dehumanization and standing with those they "serve". (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role (...) and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

In this paper we develop a hermeneutic approach to the concept of competence. Patient competence, according to a hermeneutic approach, is not primarily a matter of being able to reason, but of being able to interpret the world and respond to it. Capacity should then not be seen as theoretical, but as practical. From the perspective of practical rationality, competence and capacity are two sides of the same coin. If a person has the capacity to understand the world and give (...) meaning to the situation, he or she is able to make decisions, and is thus competent. People can fail in the area of practical rationality. They can feel ill at ease, uncomfortable or not at home in the situation. Under such conditions, they appear as incompetent, and urge caregivers to respond in such a way that their competence can be raised. The issue is not how to measure their incompetence, but how to help them to become more competent, that is to get a practical grip on their situation and to be able to live out their lives in such a way that they develop their identity in relations with others. From a hermeneutic point of view, assessing a patient's capacity implies focusing on the patient's way of meaning making and regarding her behavior from the perspective of practical rationality. The focus should not be on the assessment as a matter of fact, but on improving capacity. This requires allowing the patient to experience the world meaningfully and affording her, in the context of a supportive and trustful institutional environment, the possibility of developing a personal narrative where her choices are expressed verbally or non-verbally. (shrink)

Background The aim was to explore how the clinical ethics committees in Norway have worked and functioned within mental health care and addiction treatment services. Methods Analysis of 256 annual reports from clinical ethics committees from 2003 to 2012 and a survey to clinicians who had used a clinical ethics committee. Results Dilemmas related to coercion, confidentiality, information, and patient autonomy dominated. The committees established only for psychiatric hospitals, had received more cases from mental health (...) and addiction services than the committees also serving somatic services. Many of the case discussions involved both somatic and mental health care, complicated legal issues as well as ethical dilemmas. Mental health care professionals that have used the clinical ethics committees evaluated the clinical ethics committees deliberation as useful. Conclusion Given the many difficult ethical dilemmas in mental health care ethics work need to be strengthened. The complexity of the cases requires varied and interdisciplinary competence and training among the clinical ethics committee members. (shrink)

Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health care. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a (...) small provider's practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried (...) out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in (...) which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today. (shrink)

This article analyzes doctor–patient communication at admission interviews in an outpatient mental health care service at a public hospital in Buenos Aires, Argentina. These interviews are the first contact between professionals and patients, and they result in the admission or rejection of the latter into the medical institution. In particular, we observe how context, understood as a sociocognitive and scalar concept, is reshaped with gaze direction and agenda-setting through interaction, resulting in three hierarchical spaces which can be (...) represented as degrees in a scale: the public, the private, and the intimate level. This description will allow us to understand a series of communicative difficulties that may result from scale maladjustments, in which professionals interact with patients at different levels and therefore cannot give adequate feedback to satisfy mental health care needs. (shrink)

This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution (...) of scarce resources. These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association. (shrink)

1. Imagine the following hypothetical scenario: Sarah is often called an expert on depression: after all, she graduated from medical school and has a PhD in neuroscience. She knows all theories of...

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. (...) This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities. (shrink)

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)

This article is about the therapeutic use of photography in mental health care. We will first describe the intelligent nature of perception as we understand on the basis of neurobiological research findings. We will link our interpretation of visual perception with the phenomenology of perception from the theory of Merleau‐Ponty.. Then we will discuss how patients in mental health care with mental health problems may profit by an experiential approach that is concomitant (...) with the existential reality described by Merleau‐Ponty. The experiential approach we go into more detail is Focusing. We will demonstrate the limitations and feasibility of Focusing in the procedures of working with photography as a therapeutic medium. (shrink)

Despite changes to research and practice, that, to some degree, acknowledge that people are shaped by their contexts, the treatment of mental illness remains largely focused on interventions that take place at the level of the individual. Conceptualizing mental illness as something that resides in individuals can lead to reliance on neurobiological and psychotherapeutic solutions, and away from conversations about not only contextual causes of mental distress, but also sociopolitical solutions to mental distress. Further, it can (...) lead to the use of mental health interventions that focus on the biology of an individual without a consideration for how those interventions themselves may have psychological, social, or political consequences that act to shape an individual's identity, agency, and relationship to their community. This paper examines one medicolegal intervention, the community treatment order, using the philosophical work of Grosz and Foucault to consider how this intervention affects the experience and construction of identity, and the impact of this on an individual's sense of agential membership in a community. This discussion aims to increase understanding of the individual and social implications of interventions for mental illness, and provide a conceptualization of the relationship between identity, agency, and ethics which can inform critical research and nursing practice more broadly. (shrink)

This book takes Edmund Husserl's phenomenology and applies it to help psychotherapy practitioners formulate complex psychological problems. The reader will learn about Husserl's system of understanding and its concepts that point to first-person lived experience, and about the work of Husserl scholars who have developed a way to be precise about the experiences that clients have. Through exploring the connection between academic philosophy of consciousness and mental health, themes of biopsychosocial treatment planning, psychopathology of personality and psychological disorders, (...) and the treatment of complex psychological problems become clear. The author shows that Husserlian phenomenology can be used in the design of interventions for clients in a process called formulation. Once the intentionality of consciousness is understood, by asking simple questions, it becomes possible to define problematic experiences. This is a means of creating informed consent for treatment and it makes it clear to clients what is happening for them, so helping them understand themselves and how they see the world. We also see how Husserl's phenomenology is a vehicle for psychotherapists to present their knowledge about the research literature of what has been found to be effective care. This volume applies the concepts and practices of phenomenology in a concrete way, relating them to the practice of therapy and showing the value of a qualitative approach to understanding mental processes and the nature of human beings as motivated by values, meanings and other conscious experiences. This is a readable text in simple language that condenses key aspects of Husserl's thinking in relation to the theory and practice of psychotherapy, and it is suitable for philosophers and practitioners of psychology, psychiatry, and the psychotherapies, including psychoanalysis. (shrink)

Background Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. Aim This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. Research design This study (...) had a cross-sectional, descriptive-correlational survey design. Participants and method Nurses ( N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. Ethical considerations Ethical approval for the study was obtained from the relevant ethics committee. Findings Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = −0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (β = −0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18). Discussion and conclusion Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected. (shrink)