Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

Background: Coercion is routinely used in psychiatry. Its benefits and drawbacks are controversially debated. In addition, the majority of persons with mental health problems are exposed to stigmatization and are assumed to be dangerous. Stigmatization is associated with negative consequences for individuals with mental illness such as disapproval, social rejection, exclusion, and discrimination. Being subjected to coercive measures can increase the stigmatization of the affected persons, and stigmatization might lead to higher approval for coercion.Aims of the Study: This study aims to examine the approval for coercive measures in psychiatry by the general public, and to explore its relation with person- and situation-specific factors as well as with stigmatization.Method: We conducted a representative survey of the general population (N = 2,207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting psychopathological symptoms of a fictitious character and indicate whether they would accept coercive measures for the person in the vignette. Desire for social distance and perceived dangerousness were assessed as measures of stigmatization.Findings: The person in the case vignette exhibiting dangerous behavior, showing symptoms of a psychotic disorder, being perceived as dangerous, and treatment being understood as helpful increased approval of coercion in general, while familiarity of the respondents with mental illness decreased approval.Conclusions: The public attitude regarding the approval of coercion in psychiatry is highly differentiated and largely follows the current legal framework and medical treatment guidelines. Higher approval occurred in situations of self-harm or harm to others and when coercive measures were thought to have a beneficial effect for the affected persons. A considerable part of the approval for coercion is predicted by stigmatization. With the increasing severity of coercive measures, the influence of person- and situation-specific factors and of familiarity with mental illness decreased and generalizing and stigmatizing attitudes became stronger predictors for the approval of more severe measures.

Interprofessional Education

Interprofessional education (IPE) has emerged as a core educational method among human service and medical educational settings. Research suggests that learners who learn in IPE settings have better transdisciplinary communication skills and are better team members. Unfortunately, competing demands of multiple academic divisions can make facilitating IPE cumbersome. This chapter will describe the processes for developing, implementing, and evaluating an IPE experience drawn from de-identified patient records. The model includes information about incorporating learners from medicine, pharmacy, psychology, social work, and law, but could easily be expanded to include learners from other disciplines. The authors include descriptions of the process of implementing the unfolding case series in both face-to-face and live remote settings. This will include a sample case vignette, a pre-/post-survey, and learning objectives. Finally, the authors include opportunities for expansion and discussion of the challenges of implementing a curriculum targeted toward learners from diverse disciplines.

How can music therapy support family relationships for people living in a long-term care facility with neuro-disabilities, when regular visits can be challenging?

<p>This exegesis will present the findings which emerged from secondary analysis of clinical practice data collected during a music therapy placement. The setting for this research is a long-term residential care facility for people aged 18 to 65 with a variety of physical and neurological conditions, including cerebral palsy, traumatic brain injury, stroke and multiple sclerosis. The aim of the facility is to maximise the quality of life for the residents and support their medical needs. The research aim was developed out of a personal interest regarding how family members might be included in music therapy sessions. The research question evolved into “How can music therapy support family relationships for people living in a long-term care facility with neuro-disabilities, when regular visits can be challenging”. The core themes suggest family relationships can be enhanced through conversations, the gift of music, culture, artefacts, ritual and other activities. The findings include a case vignette to illustrate important points made in the exegesis. Overall, I believe this research will add new insight into the importance of family connections in rehabilitation and overall wellbeing for the residents.</p>

How can music therapy support family relationships for people living in a long-term care facility with neuro-disabilities, when regular visits can be challenging?

<p>This exegesis will present the findings which emerged from secondary analysis of clinical practice data collected during a music therapy placement. The setting for this research is a long-term residential care facility for people aged 18 to 65 with a variety of physical and neurological conditions, including cerebral palsy, traumatic brain injury, stroke and multiple sclerosis. The aim of the facility is to maximise the quality of life for the residents and support their medical needs. The research aim was developed out of a personal interest regarding how family members might be included in music therapy sessions. The research question evolved into “How can music therapy support family relationships for people living in a long-term care facility with neuro-disabilities, when regular visits can be challenging”. The core themes suggest family relationships can be enhanced through conversations, the gift of music, culture, artefacts, ritual and other activities. The findings include a case vignette to illustrate important points made in the exegesis. Overall, I believe this research will add new insight into the importance of family connections in rehabilitation and overall wellbeing for the residents.</p>

Explanatory Models of Depression in a Rural Community of Coastal Karnataka, India: A Cross-Sectional Survey

Background: Depression is a major public health problem but there is a huge treatment gap in India. Cultural beliefs influence conception of illness, personal meaning, help-seeking behaviors, and adherence to treatment. Research on explanatory models of depression attempt to explore these unique characteristics in an individual and the community. We set out to examine explanatory models of depression in a rural community of coastal Karnataka and explore the association between sociodemographic variables and explanatory models of depression. Methods: A cross-sectional household survey in the rural community of Harekala village, Mangaluru taluk, Dakshina Kannada district, Karnataka, was done using Kish tables. A total of 200 individuals were interviewed with an adaptation of the Short Explanatory Model Interview in a local language using a case vignette of depression. Results: Around 40% of the individuals perceived the problem as tension/stress/excessive worrying and did not perceive it as mental illness. A scant 10% of the participants recognized some mental illness. Around one-fifth of the individuals attributed the problem to evil spirits and black magic; female participants were more likely to endorse consulting a doctor (P = 0.003**) or a psychiatrist (P = 0.012*). In addition, participants belonging to Islam were less likely to consult a doctor (P = 0.028*) and psychiatrist (P = 0.021*). Also, participants belonging to lower social class were less likely to endorse psychiatric consultation (P = 0.018*) Conclusions: A vast majority of the study subjects failed to identify depression as an illness or acknowledge biomedical causation. Gender, religion, and socioeconomic class may influence help-seeking behavior.

Awareness of obstetric fistula and its associated factors among reproductive-age women in Ethiopia: a multilevel analysis of Ethiopian Demographic and Health Survey data: a cross-sectional study

ObjectiveThis study aimed to determine the magnitude and associated factors of obstetric fistula (OF) awareness among reproductive-age women in Ethiopia.MethodsThis community-based cross-sectional study was conducted among 15 683 reproductive-aged women in Ethiopia. Following the presentation of a case vignette, women’s OF awareness was measured by asking if they had ever heard of OF. A multilevel multivariable logistic regression analysis was employed. A 95% CI and p<0.05 were used to declare statistical significance.ResultThe magnitude of women’s awareness of OF was 38% (95% CI 0.37 to 0.39). Individual level variables including being in the age group of 20–25 (adjusted OR, AOR 1.17; 95% CI 1.02 to 1.35), 26–30 (AOR 1.50; 95% CI 1.27 to 1.76) and >30 (AOR 1.76; 95% CI 1.50 to 2.07), being Muslim (AOR 0.83; 95% CI 0.73 to 0.94), having primary (AOR 1.70; 95% CI 1.53 to 1.89), secondary (AOR 3.43; 95% CI 2.95 to 3.99) and tertiary education (AOR 5.88; 95% CI 4.66 to 7.42), history of pregnancy termination (AOR 1.31; 95% CI 1.13 to 1.51), media exposure (AOR 1.33; 95% CI 1.2 to 1.49), internet use (AOR 2.25; 95% CI 1.84 to 2.75), medium (AOR 1.17; 95% CI 1.02 to 1.34) and rich house hold wealth (AOR 1.50; 95% CI 1.31 to 1.72) and community level factors including high community media exposure (AOR 1.30; 95% CI 1.05 to 1.61), high community antenatal care rate (AOR 1.66; 95% CI 1.37 to 2.02) and low health facility distance problem (AOR 1.49; 95% CI 1.23 to 1.81) were significantly associated with women’s awareness of OF.Conclusions and recommendationsThe magnitude of women’s awareness of OF was very low in Ethiopia. Awareness of OF was influenced by sociodemographic, economic, obstetric and community-related factors. Thus, tailored public health education is required at the national level to enhance women’s awareness of OF.

Euthanasia in advanced dementia; the view of the general practitioners in the Netherlands on a vignette case along the juridical and ethical dispute

Background In the Netherlands, euthanasia has been regulated by law since 2002. In the past decade, a growing number of persons with dementia requested for euthanasia, and more requests were granted. A euthanasia request from a patient with advanced dementia (PWAD) can have a major impact on a general practitioner (GP). We aimed to get insights in the views of Dutch GPs on euthanasia concerning this patient group. Methods A postal survey was sent to 894 Dutch GPs. Questions were asked about a case vignette about a PWAD who was not able to confirm previous wishes anymore. Quantitative data were analyzed with descriptive statistics. Results Of the 894 GPs approached, 422 (47.3%) completed the survey. One hundred seventy-eight GPs (42.2%) did not agree with the statement that an Advance Euthanasia Directive (AED) can replace an oral request if communication with the patient concerned has become impossible. About half of the respondents (209; 49.5%) did not agree that the family can initiate a euthanasia trajectory, 95 GPs (22.5%) would accept such a family initiative and 110 GPs (26.1%) would under certain conditions. Discussion In case of a PWAD, when confirming previous wishes is not possible anymore, about half of the Dutch GPs would not accept an AED to replace verbal or non-verbal conformation nor consider performing euthanasia; a minority would. Our study shows that, probably due to the public debate and changed professional guidelines, conflicting views have arisen among Dutch GPs about interpretation of moral, ethical values considering AED and PWADs.

Crisis Intervention

Crisis intervention is a major component of school social work practice. This chapter discusses two crises that school social workers may face: suicidal ideation and natural and human-caused disasters. Due to the amount of time children spend at school, schools play an essential component in identifying suicide risk. A case vignette is presented alongside methods that school social workers can use to strengthen suicide prevention. The importance of using methods sensitive to race and ethnicity of diverse student populations is stressed. The second part of the chapter discusses methods to identify and address the multiple needs of the school community after a disaster. Special attention is given to addressing the disproportionate impacts that disasters have on communities of color and those who are economically disadvantaged.

Goal-oriented processes: Exploring the use of goals in music therapy to support young people with autism spectrum disorder

<p>This qualitative research project explored how a student music therapist utilised goal-oriented processes to support young people with autism spectrum disorder throughout their course of music therapy. Inductive thematic analysis of selected literature relating to goals in music therapy developed an initial framework of what goal-oriented processes could include. The student music therapist’s clinical data (including session notes, monitoring sheets, client reports and reflective journal entries) was then coded through deductive secondary analysis, from which five key themes were formed. The findings indicated that clients’ goals were supported by: employing a client-centred philosophical approach; nurturing therapeutic relationships; collaborating with clients and their caregivers; utilising the referral, assessment and review processes; and observing and documenting clients’ development. These goal-oriented processes helped to support goals that were meaningful for the clients and their caregivers. Themes were explored in detail using a case vignette to illustrate and provide a context for the findings. Although the context-bound qualitative nature of this research project limits its generalisability, it attempts to provide insight into what goal-oriented processes in music therapy might include, encouraging other music therapists to consider how they utilise goals in their own practice.</p>

Goal-oriented processes: Exploring the use of goals in music therapy to support young people with autism spectrum disorder

<p>This qualitative research project explored how a student music therapist utilised goal-oriented processes to support young people with autism spectrum disorder throughout their course of music therapy. Inductive thematic analysis of selected literature relating to goals in music therapy developed an initial framework of what goal-oriented processes could include. The student music therapist’s clinical data (including session notes, monitoring sheets, client reports and reflective journal entries) was then coded through deductive secondary analysis, from which five key themes were formed. The findings indicated that clients’ goals were supported by: employing a client-centred philosophical approach; nurturing therapeutic relationships; collaborating with clients and their caregivers; utilising the referral, assessment and review processes; and observing and documenting clients’ development. These goal-oriented processes helped to support goals that were meaningful for the clients and their caregivers. Themes were explored in detail using a case vignette to illustrate and provide a context for the findings. Although the context-bound qualitative nature of this research project limits its generalisability, it attempts to provide insight into what goal-oriented processes in music therapy might include, encouraging other music therapists to consider how they utilise goals in their own practice.</p>