Involuntary Treatment of Adolescents in Psychiatric and Social Care

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Kaltiala-Heino
Keyword(s):  
Decision Making ◽  
Psychiatric Care ◽  
Social Care ◽  
Psychiatric Treatment ◽  
Ethical Problem ◽  
Self Determination ◽  
Involuntary Treatment ◽  
Medical File ◽  
Involuntary Care ◽  
Disruptive Behaviours

Background:Little is known about use of coercion on minors in psychiatric care. Questions of coercion, self-determination and competence are more complicated in minors than in adults. Choice between psychiatric and child welfare care is not always clear.Objective:To present findings in Finnish studies on involuntary treatment of adolescents.Methods:Register data, medical file data and interviews with the young people, their parents, and professionals participating in decision-making are used in an ongoing series of studies.Results:Involuntary psychiatric treatment and taking into care of adolescents has vastly increased since mid 1990's. Their use varies greattly within the same legislation. Involuntary care is more common in socially deprived ares. Involuntary treatment takes place justified by paternalistic motivations. Girls are more easily committed due to disruptive behaviours than boys.Conclusion:Involuntary care of minors is a sizeable and ignored ethical problem.

‘Voluntary’ and ‘involuntary’ child welfare: Challenging the distinction

2016 ◽  
Vol 18 (3) ◽  
pp. 253-272 ◽  
Author(s):  
Tarja Pösö ◽  
Elina Pekkarinen ◽  
Susanna Helavirta ◽  
Riitta Laakso
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Child Welfare ◽  
Critical Points ◽  
Family Life ◽  
Self Determination ◽  
Involuntary Care ◽  
Decision Making System

Summary Finnish child welfare divides care orders into voluntary and involuntary care orders, based on the consent or objection of different parties. When giving consent to a care order, the parties allow their rights to family life and self-determination to be restricted. This article examines how the voluntary care order differs in practice from the involuntary one and how voluntarism and involuntarism are represented in these two types of care order. Findings The analysis of 37 care orders highlights different shades of voluntarism and involuntarism as well as formal and informal spheres of consent and objection. The binary distinction between voluntarism and involuntarism becomes problematic. Instead, new forms and arenas for consent and objection, e.g., resistance, become topical in child welfare. Applications The spectrum of voluntarism and involuntarism should be recognised in every type of child welfare. The study points out several critical points in the dual decision-making system in Finland, in particular informed consent.

scholarly journals To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden

Dementia ◽  
2016 ◽  
Vol 15 (3) ◽  
pp. 343-357 ◽  
Author(s):  
Ann-Charlotte Nedlund ◽  
Annika Taghizadeh Larsson
Keyword(s):  
Decision Making ◽  
Social Care ◽  
Welfare System ◽  
The Self ◽  
Self Determination ◽  
People With Dementia ◽  
Taking Charge ◽  
Institutional Contexts

Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia.

Involuntary hospitalization

2021 ◽  
pp. 279-298
Author(s):  
Christopher James Ryan ◽  
Jane Bartels
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Clinical Features ◽  
Real World ◽  
Inpatient Treatment ◽  
Psychiatric Treatment ◽  
Ethical Question ◽  
Involuntary Treatment ◽  
Involuntary Hospitalization ◽  
Decision Making Capacity

The chapter outlines a series of arguments designed to answer possibly the most important ethical question in psychiatry: under what circumstances, if any, is it ethically justifiable to treat people with clinical features of mental illness, despite their objection? We argue that involuntary inpatient treatment is ethically justified, but only in circumstances where: the objection to treatment was made without decision-making capacity; there is no reason to believe that the person would have objected had he or she been competent; the treatment will protect the person from serious harms (when balancing these with any harms associated with the treatment); and involuntary treatment represents the avenue for protection least restrictive of the person’s freedom. Having established a model for ethically justified involuntary inpatient psychiatric treatment, we examine how it can be applied to two real-world cases.

scholarly journals Retrospective views of psychiatric in-patients regaining mental capacity

2009 ◽  
Vol 195 (5) ◽  
pp. 403-407 ◽  
Author(s):  
Gareth S. Owen ◽  
Anthony S. David ◽  
Peter Hayward ◽  
Genevra Richardson ◽  
George Szmukler ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Psychiatric Treatment ◽  
Treatment Decisions ◽  
Mental Capacity ◽  
Self Determination ◽  
Surrogate Decision Making ◽  
People With Mental Illness ◽  
Surrogate Decision ◽  
Few Data

BackgroundAn individual's right to self-determination in treatment decisions is a central principle of modern medical ethics and law, and is upheld except under conditions of mental incapacity. When doctors, particularly psychiatrists, override the treatment wishes of individuals, they risk conflicting with this principle. Few data are available on the views of people regaining capacity who had their treatment wishes overridden.AimsTo investigate individuals' views on treatment decisions after they had regained capacity.MethodOne hundred and fifteen people who lacked capacity to make treatment decisions were recruited from a sample of consecutively admitted patients to a large psychiatric hospital. After 1 month of treatment we asked the individuals for their views on the surrogate treatment decisions they received.ResultsEighty-three per cent (95% CI 66–93) of people who regained capacity gave retrospective approval. Approval was no different between those admitted informally or involuntarily using Mental Health Act powers (χ2 = 1.52, P = 0.47). Individuals were more likely to give retrospective approval if they regained capacity (χ2 = 14.2, P = 0.001).ConclusionsMost people who regain capacity following psychiatric treatment indicate retrospective approval. This is the case even if initial treatment wishes are overridden. These findings moderate concerns both about surrogate decision-making by psychiatrists and advance decision-making by people with mental illness.

scholarly journals 6 The Intersection of Human Rights and Decision Making Capacity Legislation with Person Centred Approaches

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Amanda Phelan ◽  
Patricia Rickard Clarke
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
United Kingdom ◽  
Social Care ◽  
Self Determination ◽  
Cognitive Capacity ◽  
Risky Decision ◽  
Support Person ◽  
Decision Making Capacity ◽  
Health And Social Care

Abstract Background A major focus on decision making capacity (as opposed to cognitive capacity and competence) legislation in many Western countries is the integration of a human rights approach focused on self-determination and autonomy. This paper examines modern day concepts of personhood and person centred care and presents Irish and United Kingdom legal commentaries which focus on health services’ and society's approaches to risky decision making. Integrating human rights into decision making capacity legislation has been central in contemporary discourses on health and welfare. Methods A literature review was undertaken charting the emergence of personhood, person centred care and human rights. Case studies of influential legal commentaries in Ireland and the United Kingdom where decision-making capacity was addressed were mapped to person centred care principles. Results Findings point to a convergence of discourses of human rights in contemporary approaches to health and social care as well as the evolution of legislation to support person centredness in fostering safeguarding and promoting autonomy and self-determination. Specific legal commentaries point to the need of health and social care to be mindful of paternalism and to conceptualise the concept of ‘risk’ with a particular emphasis on the inclusion and defence of the voice of the older or vulnerable person. Conclusion The intrinsic worth of each human is articulated through an implicit and explicit vindication of their human rights. The emergence of the third generation of human rights has argued the value of self-determination and autonomy, articulated through robust national legislation on decision-making capacity based on the core principles of person centred care approaches. This move from paternalism is imperative and is imbued in contemporary legislation and legal commentaries, which has noted the need for revisions in health and social care case management perspectives.

Scham und Autonomie

2012 ◽  
Vol 2012 (1) ◽  
pp. 163-192
Author(s):  
Sonja Rinofner-Kreidl
Keyword(s):  
Decision Making ◽  
Social Dynamics ◽  
Self Esteem ◽  
Self Determination ◽  
Intentional Content ◽  
Conceptual Clarification ◽  
The Social ◽  
Conventional Behavior ◽  
And Control

Autonomy is associated with intellectual self-preservation and self-determination. Shame, on the contrary, bears a loss of approval, self-esteem and control. Being afflicted with shame, we suffer from social dependencies that by no means have been freely chosen. Moreover, undergoing various experiences of shame, our power of reflection turns out to be severly limited owing to emotional embarrassment. In both ways, shame seems to be bound to heteronomy. This situation strongly calls for conceptual clarification. For this purpose, we introduce a threestage model of self-determination which comprises i) autonomy as capability of decision-making relating to given sets of choices, ii) self-commitment in terms of setting and harmonizing goals, and iii) self-realization in compliance with some range of persistently approved goals. Accordingly, the presuppositions and distinctive marks of shame-experiences are made explicit. Within this framework, we explore the intricate relation between autonomy and shame by focusing on two questions: on what conditions could conventional behavior be considered as self-determined? How should one characterize the varying roles of actors that are involved in typical cases of shame-experiences? In this connection, we advance the thesis that the social dynamics of shame turns into ambiguous positions relating to motivation, intentional content,and actors’ roles.

Purchasing Power and Self-Determination: Social Worker Perspectives

2021 ◽  
Author(s):  
Charlotte Bailey ◽  
Debbie Plath ◽  
Alankaar Sharma
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Social Workers ◽  
Work Practice ◽  
Social Work Practice ◽  
Self Determination ◽  
Purchasing Power ◽  
Service Users ◽  
Structured Interviews ◽  
Management Approaches

Abstract The international policy trend towards personalised budgets, which is designed to offer people with disabilities purchasing power to choose services that suit them, is exemplified in the Australian National Disability Insurance Scheme (NDIS). This article examines how the ‘purchasing power’ afforded to service users through individualised budgets impacts on social work practice and the choice and self-determination of NDIS service users. Social workers’ views were sought on the alignment between the NDIS principles of choice and control and social work principles of participation and self-determination and how their social work practice has changed in order to facilitate client access to supports through NDIS budgets and meaningful participation in decision-making. A survey was completed by forty-five social workers, and in-depth semi-structured interviews were conducted with five of these participants. The findings identify how social workers have responded to the shortfalls of the NDIS by the following: interpreting information for clients; assisting service users to navigate complex service provision systems; supporting clients through goal setting, decision-making and implementation of action plans; and adopting case management approaches. The incorporation of social work services into the NDIS service model is proposed in order to facilitate meaningful choice and self-determination associated with purchasing power.

Eupsychian Versus Authoritarian Leadership: Existential–Humanistic Underpinnings and Empirical Support

2021 ◽  
pp. 002216782110106
Author(s):  
Andrew M. Bland ◽  
Brett A. Swords
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Perspective Taking ◽  
Empirical Support ◽  
Self Determination ◽  
Practical Implementation ◽  
Applied Psychology ◽  
Authoritarian Leadership ◽  
Cultural Conditions ◽  
Psychology Literature

This article surveys Maslow’s views on eupsychian leadership and how his vision of eupsychia may be regarded as a contemporary expression of the Greek philosophical notion of the Good. This involves actively and ongoingly cultivating cultural conditions that promote awe-based creative living in accordance with human nature, authentic freedom, and social justice in the interest of developing character via self-determination. Then we outline essential qualities of Maslow’s notion of eupsychia as they have been empirically validated by Rego et al.’s qualitative study of the characteristics and outcomes of eupsychian (humanistic) versus antieupsychian (authoritarian) leadership. The findings thereof also provide a heuristic framework for integrating the results of numerous quantitatively-based research studies in recent international applied psychology literature. This applied leadership literature both (a) satisfies Maslow’s call for empirical research to guide perspective-taking and decision-making when considering the possible practical implementation of a eupsychian society and (b) provides empirical support for his dynamic systemic and synergistic theorizing on leadership.

scholarly journals Implementing evidence-based assessment and selection in organizations: A review and an agenda for future research

2020 ◽  
pp. 204138662098341
Author(s):  
Marvin Neumann ◽  
A. Susan M. Niessen ◽  
Rob R. Meijer
Keyword(s):  
Decision Making ◽  
Self Determination Theory ◽  
Assessment Methods ◽  
Self Determination ◽  
Future Research ◽  
Assessment Instruments ◽  
Evidence Based ◽  
Assessment Practice ◽  
Outcome Feedback ◽  
Evidence Based Decision Making

In personnel- and educational selection, a substantial gap exists between research and practice, since evidence-based assessment instruments and decision-making procedures are underutilized. We provide an overview of studies that investigated interventions to encourage the use of evidence-based assessment methods, or factors related to their use. The most promising studies were grounded in self-determination theory. Training and autonomy in the design of evidence-based assessment methods were positively related to their use, while negative stakeholder perceptions decreased practitioners’ intentions to use evidence-based assessment methods. Use of evidence-based decision-making procedures was positively related to access to such procedures, information to use it, and autonomy over the procedure, but negatively related to receiving outcome feedback. A review of the professional selection literature showed that the implementation of evidence-based assessment was hardly discussed. We conclude with an agenda for future research on encouraging evidence-based assessment practice.

scholarly journals Psychiatric Services in Saskatchewan under Medicare*

1970 ◽  
Vol 15 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Wilfred A. Cassell ◽  
Colin M. Smith ◽  
Maggie Grandy Rankin
Keyword(s):  
Private Practice ◽  
Urban Areas ◽  
Psychiatric Care ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Treatment Session ◽  
Psychiatric Services ◽  
Treatment Services ◽  
Hospital Visits ◽  
To Receive

This study has examined the nature and extent of services provided to psychiatric patients under ‘Medicare’. An analysis of the records of 864,128 residents of Saskatchewan revealed that in 1965, 13,950 males and 27,009 females received a psychiatric diagnosis from physicians in private practice. Psychoneurotic conditions were frequent. General practitioners provided the majority of treatment services for this group. Physicians practising in urban areas were found to complete more psychiatric treatment than their rural counterparts. Female patients were found to receive relatively more psychiatric care than males. The latter obtained more consultations, hospital visits and somatic investigations. Lastly, the rate of service was infrequent, averaging less than one treatment session per patient.

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