Engagement without entanglement: a framework for non-sexual patient–physician boundaries

2021 ◽  
pp. medethics-2021-107580
Author(s):  
Jacob M Appel
Keyword(s):  
Mental Health ◽  
Conflict Of Interest ◽  
Mental Health Setting ◽  
Operational Model ◽  
Professional Boundaries ◽  
Sexual Boundaries ◽  
The Subject ◽  
Physician Relationship ◽  
General Guidance

The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance.

The future role of the psychiatrist in Europe – a UEMS perspective

2014 ◽  
Vol 11 (01) ◽  
pp. 35-42
Author(s):  
M. Hermans
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
General Interest ◽  
Future Role ◽  
Personal Opinion ◽  
The Future ◽  
The Subject ◽  
The Many

SummaryThe author presents his personal opinion inviting to discussion on the possible future role of psychiatrists. His view is based upon the many contacts with psychiatrists all over Europe, academicians and everyday professionals, as well as the familiarity with the literature. The list of papers referred to is based upon (1) the general interest concerning the subject when representing ideas also worded elsewhere, (2) the accessibility to psychiatrists and mental health professionals in Germany, (3) being costless downloadable for non-subscribers and (4) for some geographic aspects (e.g. Belgium, Spain, Sweden) and the latest scientific issues, addressing some authors directly.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

The Feasibility of Using Body Worn Cameras in an Inpatient Mental Health Setting

2017 ◽  
Vol 13 (01) ◽  
Author(s):  
Hardy S ◽  
Bennett L ◽  
Rosen P ◽  
Carroll S ◽  
White P ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Setting ◽  
Inpatient Mental Health

Principles of capacity management, applied in the mental health context

2018 ◽  
Vol 42 (4) ◽  
pp. 438
Author(s):  
Kathryn Zeitz ◽  
Darryl Watson
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Average Length ◽  
Patient Flow ◽  
Waiting Times ◽  
Capacity Management ◽  
Mental Health Setting ◽  
Mental Health Consumer ◽  
Mental Health Consumers ◽  
Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

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