Does community psychiatry treat severely mentally ill?

Objective: The aim of this paper is to clarify the ethical challenges resulting from new models of community psychiatry and to examine practical approaches aimed at meeting them. Method: Review of the literature and observations both as clinician and medical director of community services. Results: Assertive community treatment presents ethical dilemmas relating to privacy, confidentiality, ‘coercion’ and conflicts of duty to the patient versus others, including carers and the wider community. Their acuity is influenced by the context in which services are provided, especially community fears of the consequences of care in the community for the severely mentally ill. Approaches to resolving ethical problems include increasing patient involvement in their care, clarifying the grounds for ‘paternalistic’ interventions, and re-examining grounds for acting to reduce the risk of harm to others. Conclusions: The ethical dilemmas are not new, but they present in sufficiently different guises to warrant reconsideration in their new context. There has been a reluctance to face them, but if community psychiatric practice is to survive, it must rest on a sound ethical base.

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Breaking Down Stereotypes in Graduate Students: An Integrated Approach to a Practicum Experience---Linking Training With Severely Mentally Ill Clients With Advocacy Through the National Alliance on Mental Illness

PsycEXTRA Dataset ◽

10.1037/e637862010-001 ◽

2010 ◽

Author(s):

Diana J. Semmelhack ◽

Karen E. Farrell ◽

Diana Uchiyama

Keyword(s):

Mental Illness ◽

Graduate Students ◽

Mentally Ill ◽

Integrated Approach ◽

Severely Mentally Ill ◽

Practicum Experience ◽

National Alliance

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Adverse Events Medication Treatment Costs in a Chronically, Severely Mentally Ill Forensics Population

Clinical Schizophrenia & Related Psychoses ◽

10.3371/csrp.2.2.6 ◽

2008 ◽

Vol 2 (2) ◽

pp. 158-162 ◽

Cited By ~ 1

Author(s):

Alexandria Fagan ◽

Julie Kissack ◽

Bruce Augustin

Keyword(s):

Adverse Events ◽

Mentally Ill ◽

Treatment Costs ◽

Medication Treatment ◽

Severely Mentally Ill

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Counselling the Relatives of the Long-Term Adult Mentally Ill

The British Journal of Psychiatry ◽

10.1192/bjp.154.6.775 ◽

1989 ◽

Vol 154 (6) ◽

pp. 775-782 ◽

Cited By ~ 27

Author(s):

Liz Kuipers ◽

Brigid MacCarthy ◽

Jane Hurry ◽

Rod Harper ◽

Alain LeSage

Keyword(s):

Family Relationships ◽

Mentally Ill ◽

Expressed Emotion ◽

Realistic Model ◽

Education Session ◽

Term Care ◽

Interactive Education ◽

Severely Mentally Ill ◽

Group Facilitators

A psychosocial intervention is described geared to the needs of carers of the long-term mentally ill, which is feasible for a busy clinical team to implement: relatives were not selected for the group by patient diagnosis or motivation and little extra staff input was required. An interactive education session at home was followed by a monthly relatives group which aimed to reduce components of expressed emotion (EE) and to alleviate burden. The group facilitators adopted a directive but non-judgemental style, and constructive coping efforts were encouraged. The intervention was effective at reducing EE and improving family relationships. The study offers a realistic model of how to offer support to people providing long-term care for the severely mentally ill.

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