scholarly journals The capacity of people with a ‘mental disability’ to make a health care decision

2000 ◽  
Vol 30 (2) ◽  
pp. 295-306 ◽  
Author(s):  
J. G. WONG ◽  
I. C. H. CLARE ◽  
A. J. HOLLAND ◽  
P. C. WATSON ◽  
M. GUNN
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Mental Illness ◽  
General Population ◽  
Learning Disability ◽  
Comparison Group ◽  
Verbal Ability ◽  
Population Group ◽  
Chronic Schizophrenia ◽  
Mental Disability

Background. Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a ‘mental disability’ (i.e. mental illness (chronic schizophrenia), ‘learning disability’ (‘mental retardation’, or intellectual or developmental disability), or, dementia) and a fourth, comparison group.Methods. The three ‘mental disability’ groups (N = 20 in the ‘learning disability’ group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the ‘general population’ comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability.Results. Compared with the ‘general population’ group, capacity to make the particular decision was significantly more impaired in the ‘learning disability’ and ‘dementia’ groups. Importantly, however, it was not more impaired among the ‘mental illness’ group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the ‘mental disability’ groups, one participant benefited only when responding did not require any expensive verbal ability.Conclusions. Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a ‘mental disability’. The methodology may be extended to assess capacity to make other legally-significant decisions.

scholarly journals Attitudes surrounding the disclosure of mental illness

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S288-S289
Author(s):  
Brishti Sengupta ◽  
Pritha Dasgupta
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
General Population ◽  
Online Survey ◽  
Mental Health Problems ◽  
Population Group ◽  
Medical Professionals ◽  
Health Issues ◽  
Mental Health Issues ◽  
Attitude Shift

AimsTo survey the effect of COVID-19 on mental health of both medical professionals and the general population, as well as attitudes surrounding the disclosure of mental illness.MethodAn online survey comprised of two questionnaires, one for medical professionals and one for the general population, were conducted via social media. Both questionnaires asked respondents of the effect of COVID-19 on their mental health, and the former asked respondents about the effect of COVID-19 on their patient group's mental health. The questionnaires went on to ask respondents about their attitudes to mental health disclosure in various scenarios, to varying groups of people. The general population group was also asked how they would react if someone else disclosed their mental illness to them.ResultThe questionnaire for the medical professionals gained 62 respondents and the one for the general population had 122 respondents, with responses from multiple nations. Overall, COVID-19 has affected everyone's mental health to a degree, and all groups had reservations about disclosing their mental health issues to others. The medical professionals were especially reluctant to disclose mental illness to their patients, but were more comfortable when it came to disclosing mental illness to colleagues. The general population, however, was much more reluctant to disclose mental health issues to their colleagues. The general population were, on the whole, willing to listen to and help anyone who came to them with mental health concerns. Both groups surveyed showed reluctance toward disclosure to the wider community.ConclusionCOVID-19 appears to significantly affect not only physical health, but mental health as well. There is at least some degree of stigma surrounding the disclosure of mental health issues. While most would be happy to help anyone who came to them with their mental health problems, there seems to be an attitude shift when people must contend with mental health issues of their own.

Factors associated with HIV transmission risk in people with a severe mental illness. A narrative review

Salud Mental ◽  
2017 ◽  
Vol 40 (1) ◽  
pp. 29-42 ◽  
Author(s):  
Dulce Galarza-Tejada ◽  
◽  
Ramiro Caballero-Hoyos ◽  
Luciana Ramos-Lira ◽  
◽  
...  
Keyword(s):  
Mental Illness ◽  
General Population ◽  
Severe Mental Illness ◽  
Hiv Transmission ◽  
Population Group ◽  
Narrative Review ◽  
Transmission Risk ◽  
Sociocultural Factors ◽  
Factors Associated ◽  
Hiv Transmission Risk

Background. People with a severe mental illness (SMI) are a highly vulnerable group for the transmission risk of the human immunodeficiency virus (HIV). They have a higher seroprevalence compared with the general population and their life expectancy is shorter than those of people without the disease. This narrative review describes individual factors or those inherent to a person’s characteristics and the sociocultural factors conditioning sexual behaviour and prevention norms. Objective. The purpose of this narrative review is to describe individual and sociocultural factors associated with the risk of HIV in people with a severe mental illness. Method. 82 empirical studies published between 1981 and 2015, addressing HIV transmission risk factors and sociocultural dimensions related to vulnerability were selected. Four indexes were used for this purpose: ISI Web of Knowledge, Redalyc, SciELO, and PUBMED; and four multidisciplinary electronic databases: Ebscohost Web, ProQuest, Sage Publications and ScienceDirect. Results. The analysis based on coding and systematic categorization shows that people with SMI are more vulnerable to risk than the general population, with differentials based on the severity of the disease symptomatology and economic and sociocultural characteristics associated with HIV-related risk practices. Discussion and conclusion. The need to design longitudinal studies with mixed methodology is proposed to attain a deeper understanding of the interaction of factors associated and processes conditioning risk. In this population group, structural preventive programs that take into account social and gender inequality must be implemented.

Learning disability, autism and the Criminal Procedure (Scotland) Act

2020 ◽  
Vol 14 (5) ◽  
pp. 149-167
Author(s):  
Fionnuala Williams ◽  
Mike Warwick ◽  
Colin McKay ◽  
Callum Macleod ◽  
Moira Connolly
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Personality Disorder ◽  
Learning Disability ◽  
Design Methodology ◽  
Medication Use ◽  
Criminal Procedure ◽  
Content Type ◽  
Scottish Government

Purpose This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA. Design/methodology/approach All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use. Findings Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%). Originality/value The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.

Informed consent in a vulnerable population group: supporting individuals aging with intellectual disability to participate in developing their own health and support programs

2017 ◽  
Vol 41 (4) ◽  
pp. 436 ◽  
Author(s):  
Stuart Wark ◽  
Catherine MacPhail ◽  
Kathy McKay ◽  
Arne Müeller
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Intellectual Disability ◽  
Informed Consent ◽  
Health Management ◽  
Case Study Research ◽  
Population Group ◽  
Complex Needs ◽  
Care Plans ◽  
Capacity For Consent

Objective The aim of the present study was to explore the use of complementary consent methodologies to support a potentially vulnerable group of people, namely those aging with intellectual disability, to provide personal input. It was premised on the view that processes to determine capacity for consent, appropriately modified to account for individual capabilities and current circumstances, could facilitate meaningful participation in the development of personal health care plans of people previously excluded from contributing. Methods The present descriptive case study research was undertaken in New South Wales, Australia. A seven-step process for determining capacity for consent was developed, and 10 participants aged between 54 and 73 years with lifelong intellectual disability and health comorbidities were involved. A variety of assistive communication tools was used to support individuals to demonstrate their capacity for giving informed consent. Results After being provided with tailored support mechanisms, seven participants were considered to meet all seven components for determining capacity for consent. Three participants were deemed not to have capacity to give consent regardless of the type of support provided. Conclusions Three critical factors for facilitating personal involvement in decision making for individuals with an intellectual disability were identified: (1) defining consent specifically for the target outcome; (2) outlining the criteria needed for consent to be obtained; and (3) using appropriately modified alternative communication mechanisms as necessary. What is known about the topic? Self-determination is one of the fundamental principles of human rights legislation around the world and, as such, it is considered desirable to have personal input by individuals into the development of their own health care plans. However, this is not always considered feasible if the person comes from a group in the community perceived to be vulnerable to exploitation and viewed as lacking capacity to give informed consent. This results in the use of proxy respondents, who may not accurately represent the desires and life aspirations of the individual. What does this paper add? This paper examines the development and implementation of a targeted program to support individuals aging with lifelong intellectual disability to demonstrate their capacity to provide informed consent. Specifically, it outlines how alternative communications methods, tailored to personal needs and capacity, can assist an individual to both understand and then confirm their understanding of consent in order to participate in developing health care plans. What are the implications for practitioners? People with intellectual disability are now living longer and are increasingly at risk of serious health conditions. The development of long-term health management plans has traditionally not included individuals with more complex needs and moderate intellectual disability, but the present study shows that members of this cohort can successfully understand and consent to participate in health care decision making. By proactively supporting this process, community and healthcare settings may be able to directly facilitate contribution from more individuals, therefore better meeting the goal of person-centred support.

Mental Health and Empathy: Do Nursing Students Have Better Attitudes to Psychiatric Patients?

2016 ◽  
Vol 33 (S1) ◽  
pp. S520-S520
Author(s):  
M. Pascucci ◽  
F. Capobianco ◽  
M. La Montagna ◽  
E. Stella ◽  
A. Ventriglio ◽  
...  
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Nursing Students ◽  
General Population ◽  
University Students ◽  
Psychiatric Patients ◽  
Significant Difference ◽  
Stigmatizing Attitudes ◽  
The Difference ◽  
Students Attitudes

BackgroundStigma towards mental illness has a major impact on the quality of life and the health care of psychiatric patients. Several studies have reported that health professionals have more negative attitudes than general population.AimsTo explore empathy and attitudes towards mental illness in nursing students (NS) and non-health university students. Our purpose is to see how NS have more empathic and less stigmatizing attitudes towards psychiatric patients, compared to other university students.MethodsWe tested 96 university students (50 NS and 46 non-health university students), with the following questionnaires anonymously filled out:– Community attitudes towards mental ill (CAMI), to evaluate the different students’ attitudes towards mental illness;– Empathy quotient (EQ), to assess empathy.ResultsNS differs from the other group in 5 items of CAMI (P < 0.05 in 3 items and P < 0.01 in 2 items), and Authoritarianism subscale (P = 0.023). This shows that NS have a greater general awareness and less stigmatizing attitudes about the need to hospitalize the mentally ill, the difference between psychiatric patients and general population, the wrong need of segregation and the real causes of mental illness. There is also a significant difference in EQ (items 6, 21, 25, 44, 59): future nurses seem to have a slightly higher empathy, even though the EQ total score does not differ in the two groups.ConclusionsThese results suggest that there is a difference with respect to the attitudes towards psychiatric patients in NS and students who do not follow health-care courses: NS have more empathetic and less stigmatizing attitudes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric assertive outreach and learning disability services

2003 ◽  
Vol 9 (5) ◽  
pp. 368-373 ◽  
Author(s):  
Angela Hassiotis ◽  
Peter Tyrer ◽  
Patricia Oliver
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Learning Disabilities ◽  
Learning Disability ◽  
Service Provision ◽  
Disability Services ◽  
Established Method ◽  
Assertive Outreach ◽  
Limited Application

Assertive outreach is a well-established method of managing patients with severe mental illness in the community. However, there is limited application and evidence of its efficacy in services for people with learning disabilities who also have mental illness. This paper elucidates current service provision for this group of patients and illustrates the pathways to mental health care available to them.

scholarly journals The Scottish Health Advisory Service visit

1999 ◽  
Vol 23 (9) ◽  
pp. 547-548
Author(s):  
Shiona Macdonald
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Learning Disability ◽  
The Elderly ◽  
Health Board ◽  
Health Advisory ◽  
England And Wales ◽  
Advisory Service ◽  
Secretary Of State ◽  
High Standards

The Scottish Health Advisory Service (SHAS) was established in 1970 to provide information to the Secretary of State for Scotland and the Health Board on the management and running of hospitals for the elderly and for patients with mental illness and learning disability. The Health Advisory Service serves a similar purpose in England and Wales. The purpose of SHAS is to promote high standards of health care for these patients. The SHAS achieves this in different ways, but one of their main functions is to visit the hospitals regularly to assess the quality and effectiveness of the service.

scholarly journals An Irish perspective on patients who lack the capacity to consent to treatment

1999 ◽  
Vol 23 (9) ◽  
pp. 522-524 ◽  
Author(s):  
John Hillery ◽  
David Tomkin ◽  
Adam McAuley
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Learning Disability ◽  
Dual Diagnosis ◽  
Legal System ◽  
Health Care Professionals ◽  
Service Provision ◽  
Consent To Treatment ◽  
Health Trust

Health care professionals in Ireland are concerned about the effect of L v. Bournewood Community and Mental Health Trust ex parte L (1998). Despite Ireland's distinct legal system and different service provision, this case has highlighted existing concerns about the treatment of patients with a dual diagnosis of learning disability and mental illness.

scholarly journals Of Minors and the Mentally Ill: Re-positioning Perspectives on Consent to Health Care

2011 ◽  
Vol 29 ◽  
pp. 107 ◽  
Author(s):  
Mona Pare
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Mental Illness ◽  
Mentally Ill ◽  
The Other ◽  
Legal Capacity ◽  
Prise De Décision ◽  
Soins De Santé ◽  
Decision Making Model ◽  
Domestic Law

Recognition of people’s right to consent to health care is linked to legal capacity and to respect for physical and mental integrity. Traditionally, children and persons with mental illness have been denied this right and substitute decision-making systems have been used for their protection. Today, respect for rights and freedoms forces courts and legislators to find a balance between autonomy and protection. However, domestic law lacks vision and objectives, often ending up breaching both protection and autonomy rights, or prioritizing one to the detriment of the other. One should turn to the supported decision-making model, which addresses protection concerns while respecting people’s integrity and autonomy.La reconnaissance du droit à consentir ou non à des soins de santé est liée à la question de la capacité juridique ainsi qu’à celle du respect de l’intégrité physique et mentale de la personne. Traditionnellement, les enfants et les personnes atteintes de maladie mentale se sont vu nier ce droit, et des systèmes de prise de décision au nom d’autrui ont été utilisés pour les protéger. Aujourd’hui, le respect des droits et des libertés oblige les tribunaux et les législateurs à trouver un équilibre entre autonomie et protection. Cela dit, la vision et les objectifs inscrits dans le droit interne présentent des carences; et il arrive souvent que l’on porte atteinte à la fois au droit à la protection et au droit à l’autonomie, ou que l’on accorde priorité à l’un de ces droits au détriment de l’autre. Nous devrions nous tourner vers le modèle de l’aide à la prise de décision, qui satisfait aux nécessités reliées à la protection de la personne tout en respectant l’intégrité et l’autonomie de celle-ci.

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