Setting Health-Care Priorities

2019 ◽  
Author(s):  
Torbjörn Tännsjö
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Real Life ◽  
Thought Experiments ◽  
Life Extension ◽  
Weighted Sum ◽  
Absolute Priority ◽  
Abstract Thought

The three most promising theories of distributive ethics are presented: Utilitarianism, with or without a prioritarian amendment. The maximin/leximin theory. Egalitarianism. Utilitarianism urges us to maximize the sum-total of happiness. When prioritarianism is added to utilitarianism we are instead urged to maximize a weighted sum of happiness, where happiness weighs less the happier you are and unhappiness weighs more the more miserable you are. The maximin/leximin theory urges us to give absolute priority to those who are worst off. Egalitarianism gives us two goals: to maximize happiness but also to level out differences with regard to happiness between persons. All of these theories are justifiable. In abstract thought experiments they conflict. When applied in real life they converge in an unexpected manner: more resources should be directed to mental health and less to marginal life extension. It is doubtful if the desired change will take place, however. What gets in its way is human irrationality.

Oxford Textbook of Inpatient Psychiatry

2019 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Real Life ◽  
Team Leadership ◽  
Clinical Work ◽  
Well Being ◽  
Legal Aspects ◽  
Traumatic Experience ◽  
Inpatient Psychiatric Care

Acute inpatient mental health care remains an irreplaceable part of some people’s mental health recovery pathway, either through the severity of their difficulties or the associated risks. It can often be a traumatic experience associated with distress and vulnerability both for patients and their relatives. Modern acute inpatient psychiatric care must undoubtedly be truly multidisciplinary and part of a wider community-based system. It must emphasize dignity, compassion, and well-being as well as addressing challenges such as involuntary admissions, cultural diversity, physical comorbidities, and the needs of relatives, just to name a few. The present textbook focuses on these and related issues in a way that is relevant to frontline clinicians dealing with them daily, with medical, nursing, and legal aspects going hand in hand with topics such as team leadership or multidisciplinary work. The textbook describes inpatient services as provided in England, so it describes work that takes place within a national health service free at the point of delivery, carried out by universal primary care as well as secondary mental health care services, both operating within clinical governance structures that seek quality improvement and accountability. Crucially, both the Mental Health Act and the Mental Capacity Act provide unique legal frameworks for the care of mental ill health. The editors hope that for readers in the UK and beyond, the textbook will provide a real-life system which can be questioned and problematized and, in that way, may help to orient clinical work.

Ideal and Nonideal Theory

2019 ◽  
pp. 93-102
Author(s):  
Torbjörn Tännsjö
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
Real World ◽  
Real Life ◽  
Thought Experiments ◽  
Ideal Theory ◽  
Nonideal Theory ◽  
Realistic Situation ◽  
Strict Compliance ◽  
Normative Significance

Time has come to apply the theories in the real world. We have seen that in the metaphysical laboratory, where we put them to crucial tests in our thought experiments, the theories conflict. Now time has come to investigate their implications in real life and to tease out their implications for priority-setting in health care. This task has to be accomplished in steps, however. It is important to distinguish between their implications for priority setting under the assumption of strict compliance (with one or another of the theories), and a realistic situation where it is expected that even people who accept one of the theories will, once their turn to carry the costs has come, try and bend the rules in their favour. Here a simplified notion of ideal and nonideal theory will be developed and put to use. And I will start by looking into the implications of the theories under the assumption of strict compliance (ideal theory), only later to turn to the problems associated with noncompliance (nonideal theory). All this prepares room for a discussion about the normative significance of noncompliance to be undertaken later in this book. The question then is whether the fact that noncompliance with the theories is to be expected spells problems for the theories as such. Does it count against their plausibility that people are not prepared to act in accordance with them?

A Tribute to the Late William J. Curran

1996 ◽  
Vol 24 (3) ◽  
pp. 274-275
Author(s):  
O. Lawrence ◽  
J.D. Gostin
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
United Nations ◽  
Mental Health Care ◽  
Harvard University ◽  
Legal Medicine ◽  
General Assembly ◽  
International Institute ◽  
University Professor

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

Handbook of Person-Centered Mental Health Care

2020 ◽  
Author(s):  
Nosheen Akhtar ◽  
Cheryl Forchuk ◽  
Katherine McKay ◽  
Sandra Fisman ◽  
Abraham Rudnick
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care

Rorschach-CS Scores of Six Groups of Patients

2013 ◽  
Vol 34 (1) ◽  
pp. 24-55 ◽  
Author(s):  
Caspar C. Berghout ◽  
Jolien Zevalkink ◽  
Abraham N. J. Pieters ◽  
Gregory J. Meyer
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Organizations ◽  
Total Sample ◽  
Psychoanalytic Psychotherapy ◽  
Cross Sectional ◽  
Treatment Groups ◽  
Treatment Type ◽  
Psychotherapy Groups ◽  
Cross Sectional Design

In this study we used a quasiexperimental, cross-sectional design with six cohorts differing in phase of treatment (pretreatment, posttreatment, 2-year posttreatment) and treatment type (psychoanalysis and psychoanalytic psychotherapy) and investigated scores on 39 Rorschach-CS variables. The total sample consisted of 176 participants from four mental health care organizations in The Netherlands. We first examined pretreatment differences between patients entering psychoanalysis and patients entering psychoanalytic psychotherapy. The two treatment groups did not seem to differ substantially before treatment, with the exception of the level of ideational problems. Next, we studied the outcome of psychoanalysis and psychoanalytic psychotherapy by comparing the Rorschach-CS scores of the six groups of patients. In general, we found significant differences between pretreatment and posttreatment on a relatively small number of Rorschach-CS variables. More pre/post differences were found between the psychoanalytic psychotherapy groups than between the psychoanalysis groups. More research is needed to examine whether analyzing clusters of variables might reveal other results.

Psychometric Properties of the German Version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR)

2012 ◽  
Vol 28 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Sabine Loos ◽  
Reinhold Kilian ◽  
Thomas Becker ◽  
Birgit Janssen ◽  
Harald Freyberger ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Psychometric Properties ◽  
Therapeutic Relationship ◽  
Internal Consistency ◽  
Convergent Validity ◽  
Community Mental Health Care ◽  
German Version

Objective: There are presently no instruments available in German language to assess the therapeutic relationship in psychiatric care. This study validates the German version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR). Method: 460 persons with severe mental illness and 154 clinicians who had participated in a multicenter RCT testing a discharge planning intervention completed the D-STAR. Psychometric properties were established via item analysis, analyses of missing values, internal consistency, and confirmatory factor analysis. Furthermore, convergent validity was scrutinized via calculating correlations of the D-STAR scales with two measures of treatment satisfaction. Results: As in the original English version, fit indices of a 3-factor model of the therapeutic relationship were only moderate. However, the feasibility and internal consistency of the D-STAR was good, and correlations with other measures suggested reasonable convergent validity. Conclusions: The psychometric properties of the D-STAR are acceptable. Its use can be recommended in German-speaking countries to assess the therapeutic relationship in both routine care and research.

Transforming Mental Health Care for Children and Their Families.

2005 ◽  
Vol 60 (6) ◽  
pp. 615-627 ◽  
Author(s):  
Larke Huang ◽  
Beth Stroul ◽  
Robert Friedman ◽  
Patricia Mrazek ◽  
Barbara Friesen ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care
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