Ethical complexities in assessing patients’ insight

2019 ◽  
Vol 45 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Laura Guidry-Grimes
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
Ethical Issues ◽  
Therapeutic Relationships ◽  
Ethical Concerns ◽  
Epistemic Trust ◽  
Contradictory Evidence ◽  
Self Knowledge

The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of clinical insight, which broadly refers to a patient’s awareness of their mental illness. When a patient is described as lacking insight, there are significant implications for patient care and to what extent the patient is trusted as a knower. Insight is currently viewed as a multidimensional and continuous construct, but competing conceptions of insight still lack consensus on the specifics. Studies also give contradictory evidence regarding the frequency and consequences of poor insight. A number of crucial questions remain unanswered. After outlining some of the key theoretical disagreements about what insight means, I highlight ethical issues that have not received much attention in the literature. Given the conceptual ambiguities and the absence of standardised bedside tools, there are significant ethical concerns about insight assessments. I highlight two main ethical concerns, specifically that these assessments risk: (1) marginalising patients by setting unattainable ideals for self-knowledge and (2) minimising the patient’s own perspective on their mental health. I close with recommendations for documenting and responding to concerns about poor insight, so patients who are vulnerable to losing epistemic trust are better supported in their therapeutic relationships.

Mentalising and Epistemic Trust

2021 ◽  
Author(s):  
Robbie Duschinsky ◽  
Sarah Foster
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Context ◽  
The Self ◽  
Disorganized Attachment ◽  
Mental Health And Illness ◽  
Epistemic Trust ◽  
The Social ◽  
Health And Illness ◽  
P Factor

The theory of mentalizing and epistemic trust introduced by Peter Fonagy and colleagues at the Anna Freud Centre has been an important perspective on mental health and illness. This book is the first comprehensive account and evaluation of this perspective. The book explores 20 primary concepts that organize the contributions of Fonagy and colleagues: adaptation, aggression, the alien self, culture, disorganized attachment, epistemic trust, hypermentalizing, reflective function, the p-factor, pretend mode, the primary unconscious, psychic equivalence, mental illness, mentalizing, mentalization-based therapy, non-mentalizing, the self, sexuality, the social environment, and teleological mode. The biographical and social context of the development of these ideas is examined. The book also specifies the current strengths and limitations of the theory of mentalizing and epistemic trust, with attention to the implications for both clinicians and researchers.

Text Messaging and Private Practice: Ethical Challenges and Guidelines for Developing Personal Best Practices

2013 ◽  
Vol 35 (3) ◽  
pp. 211-227 ◽  
Author(s):  
Michael Sude
Keyword(s):  
Mental Health ◽  
Best Practices ◽  
Private Practice ◽  
Text Messaging ◽  
Ethical Issues ◽  
Ethical Challenges ◽  
Ethical Concerns ◽  
Message Service ◽  
Impact Of Technology ◽  
The Impact

The impact of technology on mental health practice is currently a concern in the counseling literature, and several articles have discussed using different types of technology in practice. In particular, many private practitioners use a cell phone for business. However, no article has discussed ethical concerns and best practices for the use of short message service (SMS), better known as text messaging (TM). Ethical issues that arise with TM relate to confidentiality, documentation, counselor competence, appropriateness of use, and misinterpretation. There are also such boundary issues to consider as multiple relationships, counselor availability, and billing. This article addresses ethical concerns for mental health counselors who use TM in private practice. It reviews the literature and discusses benefits, ethical concerns, and guidelines for office policies and personal best practices.

scholarly journals ‘We've got another one for you!’ Liaison psychiatry's experience of stigma towards patients with mental illness and mental health professionals

2012 ◽  
Vol 36 (12) ◽  
pp. 450-454 ◽  
Author(s):  
Jim Bolton
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
General Hospital ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Clinical Communication ◽  
The Impact

Aims and methodTo assess stigmatising attitudes towards mental illness and psychiatric professionals experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital.ResultsOut of 72 multidisciplinary respondents, over three-quarters had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least monthly. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services.Clinical implicationsLiaison psychiatry is well placed to both recognise and combat stigma in the general hospital. This can help to ensure that patient care is comprehensive, safe and respectful.

scholarly journals Methodological challenges in the use of focus groups with people with severe mental illness

2017 ◽  
Vol 33 (6) ◽  
Author(s):  
Rosana Teresa Onocko-Campos ◽  
Alberto Rodolfo Giovanello Díaz ◽  
Catarina Magalhães Dahl ◽  
Erotildes Maria Leal ◽  
Octavio Domont de Serpa Junior
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Community Mental Health ◽  
Focus Groups ◽  
Severe Mental Illness ◽  
Ethical Issues ◽  
Collaborative Work ◽  
Mental Healthcare ◽  
Community Mental Health Services ◽  
Ethical Challenges

Abstract: This study addresses the practical, methodological and ethical challenges that were found in three studies that used focus groups with people with severe mental illness, in the context of community mental health services in Brazil. Focus groups are a powerful tool in health research that need to be better discussed in research with people with severe mental illness, in the context of community mental health facilities. This study is based on the authors’ experience of conducting and analyzing focus groups in three different cities - Campinas, Rio de Janeiro and Salvador - between 2006-2010. The implementation of focus groups with people with severe mental illness is discussed in the following categories; planning, group design, sampling, recruitment, group interview guides, and conduction. The importance of connecting mental healthcare providers as part of the research context is emphasized. Ethical issues and challenges are highlighted, as well as the establishment of a sensitive and empathic group atmosphere, wherein mutual respect can facilitate interpersonal relations and enable people diagnosed with severe mental illness to make sense of the experience. We emphasize the relevance of the interaction between clinical and research teams in order to create collaborative work, achieve inquiry aims, and elicit narratives of mental health users and professionals.

scholarly journals Tuberculosis and mental health in the Asia-Pacific

2016 ◽  
Vol 24 (6) ◽  
pp. 553-555 ◽  
Author(s):  
Paul H Mason ◽  
Annika C Sweetland ◽  
Greg J Fox ◽  
Shaun Halovic ◽  
Thu Anh Nguyen ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Asia Pacific ◽  
Culturally Appropriate ◽  
Health Issues ◽  
Tuberculosis Patients ◽  
Ethical Concerns ◽  
Co Morbidity ◽  
Key Issues ◽  
Tuberculosis Care

Objective: This opinion piece encourages mental health researchers and clinicians to engage with mental health issues among tuberculosis patients in the Asia-Pacific region in a culturally appropriate and ethical manner. The diversity of cultural contexts and the high burden of tuberculosis throughout the Asia-Pacific presents significant challenges. Research into tuberculosis and mental illness in this region is an opportunity to develop more nuanced models of mental illness and treatment, while simultaneously contributing meaningfully to regional tuberculosis care and prevention. Conclusions: We overview key issues in tuberculosis and mental illness co-morbidity, highlight ethical concerns and advocate for a regional approach to tuberculosis and mental health that is consistent with the transnational challenges presented by this airborne infectious disease. Integrating tuberculosis and mental health services will go a long way to addressing the needs of vulnerable populations and stopping the transmission of one of the world’s biggest infectious killers.

scholarly journals The Intersection of COVID-19 and Mental Health: What's the Matter with Ethics?

Yuridika ◽  
2021 ◽  
Vol 36 (2) ◽  
pp. 477
Author(s):  
Siti Hafsyah Idris ◽  
Nor Jannah Nasution Raduan ◽  
Nurul Azreen Hashim ◽  
Nadiah Thanthawi Jauhari ◽  
Roslinda Mohd Subbian
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Movement Control ◽  
Emotional Reactions ◽  
Care Providers ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Control Order

As the coronavirus (COVID-19) pandemic rapidly sweeps across the world, despite the measure taken to contain the spread of the disease through quarantine, it induces a considerable degree of fear, worry and concern in the population at large. Health care providers, older people and people with underlying health conditions are the most vulnerable to the pandemic. Nations, even countries with advanced medical sciences and resources, have underestimated the perils of the pandemic. Efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of COVID-19 disease. One aspect overlooked is the mental health crisis underpinning the effects of self-isolation/ quarantine and the deaths of loved ones—the number of positive cases in Malaysia at an exponential growth rate each day. With strict preventive measures and restrictions by the Malaysian Government in the form of nationwide Movement Control Order (also known as MCO), the citizens are going through a range of psychological and emotional reactions and fear and uncertainty of being one of the infected. Many studies have been conducted to identify the state of mental health of people during this calamity. This raises ethical concerns and legal issues with regards to the rights of individuals enduring mental illness. This paper explores the ethical issues about the research on mental health during Covid-19 pandemics and the regulatory mechanisms which protect the rights of the persons who have the symptoms of mental illness.

What Genetic Advances Might Mean for the Consumer in Mental Illness

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A198-A200 ◽  
Author(s):  
Marilyn Mitchell
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Mental Illness ◽  
Young People ◽  
Ethical Issues ◽  
Psychotic Illness ◽  
Ethical Concerns ◽  
Personal Experiences ◽  
Screening Procedures

Objective Increased research efforts into screening young people at risk of schizophrenia is anticipated. The aim of the present paper is to consider the ethical concerns raised by this research from a consumer's perspective. Method Insights into relevant ethical concerns obtained from personal experiences of psychotic illness are described. Results A range of salient ethical issues were identified that need to be addressed in research proposals regarding the screening of people for schizophrenia risk factors. Conclusions The importance of research into the development of screening procedures for schizophrenia risk factors suggests that the ethical issues identified need urgent attention. Consumer input is essential in this endeavour.

First, do no harm: Confronting the myths of psychiatric drugs

2012 ◽  
Vol 19 (4) ◽  
pp. 451-463 ◽  
Author(s):  
Phil Barker ◽  
Poppy Buchanan-Barker
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Ethical Issues ◽  
Mental Disease ◽  
Mental Health Policy ◽  
Policy And Practice ◽  
Psychiatric Drugs ◽  
The People ◽  
Problems In Living ◽  
Health Policy And Practice

The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with ‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drug-focused research, much of this funded by the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care.

Diagnosis and Serious Mental Illness

1996 ◽  
Vol 30 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Donald C. Grant ◽  
Edwin Harari
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
Serious Mental Illness ◽  
Psychiatric Diagnosis ◽  
Clinical Skills ◽  
Clinical Encounter ◽  
Psychiatric Practice ◽  
Health Reforms ◽  
Mental Health Reforms

We examine some limitations of the psychiatric diagnosis, particularly in the assessment of the seriousness of a patient';;s mental illness. The bureaucratic or technocratic use of the concept ‘serious mental illness’ is contrasted with the perspective of the clinician who provides ongoing patient care. A decline in the clinical skills of psychiatrists is likely if proposed mental health reforms regulate psychiatric practice according to bureaucratic and technocratic definitions of serious mental illness rather than the realities of the clinical encounter between patient and doctor.

scholarly journals Role of risk assessment in reducing homicides by people with mental illness

2000 ◽  
Vol 176 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Eileen Munro ◽  
Judith Rumgay
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Mental Illness ◽  
The Public ◽  
Ethical Concerns ◽  
People With Mental Illness ◽  
Substantial Risk

BackgroundImproved risk assessment has been stressed as the way to reduce homicides by people with mental illness. The feasibility of predicting rare events needs examining.AimsTo examine the findings of public inquiries into homicides by people with mental illness to see if they support the claim that better risk assessment would have averted the tragedy.MethodAnalysis was made of the findings of the public inquiries between 1988 and 1997 in relation to the predictability and preventability of the homicides.ResultsOf the homicides considered by the inquiry panels, 27.5% were judged to have been predictable, 65% preventable and 60% of the patients had a long-term history containing violence or substantial risk factors for violence.ConclusionsImproved risk assessment has only a limited role in reducing homicides. More deaths could be prevented by improved mental health care irrespective of the risk of violence. If services become biased towards those assessed as high risk, then ethical concerns arise about the care of both violent and non-violent patients.

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