Supported Decision-Making: Emerging Paradigm in Research, Law, and Policy

2021 ◽  
pp. 104420732110231
Author(s):  
Peter Blanck
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Lived Experience ◽  
Comparative Law ◽  
Self Determination ◽  
Special Issue ◽  
Persons With Disabilities ◽  
Law And Policy ◽  
United Nations Convention ◽  
Research And Policy

Supported decision-making (“SDM”) is an emerging paradigm in which people use friends, family members, and professionals to help them understand and address the situations and choices they encounter in everyday life. The aim of SDM is to empower individuals to make their own decisions to the maximum extent possible to increase self-determination. SDM is an alternative to overly restrictive guardianship or substitute decision-making regimes to which persons with cognitive and mental health disabilities historically have been relegated in law and policy. This special issue examines emergent issues involving SDM in areas of research, law, and policy. It examines SDM from American and comparative law, research, and policy perspectives, as recognized in Article 12 of the United Nations Convention on the Rights of Persons with Disabilities, and from the perspective of the lived experience.

A new United Nations ‘disability’ convention

2017 ◽  
Author(s):  
George Szmukler
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
United Nations ◽  
Involuntary Treatment ◽  
Persons With Disabilities ◽  
United Nations Convention ◽  
The United Nations

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) presents in a tailored form the rights of such persons. Mental health disabilities are included. While the Convention is most welcome, it is hugely challenging when it comes to involuntary treatment. Important authorities have interpreted it as excluding all forms of ‘substitute decision-making’. The Convention demands ‘respect for the rights, will and preferences’ of persons with disabilities. This chapter examines the meaning of ‘will’ and of ‘preference’. A problem arises when a person’s currently expressed ‘preference’ (or desire or wish) diverges from the person’s ‘will’ (taken to mean a person’s relatively enduring and deeply held value commitments). Both cannot be respected at the same time. Which should have precedence? The method of ‘interpretation’ discussed in Chapter 7 allows such a determination to be made, and aligns the ‘fusion law’ proposal with the objectives of the Convention.

The impact on clinical practice of the 2015 reforms to the New South Wales Mental Health Act

2016 ◽  
Vol 25 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Christopher James Ryan ◽  
Sascha Callaghan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Practice ◽  
Persons With Disabilities ◽  
Mental Health Act ◽  
Recovery Movement ◽  
South Wales ◽  
Management Plans ◽  
Decision Making Model ◽  
The Impact

Objectives: The Mental Health Act 2007 (NSW) ( MHA) was recently reformed in light of the recovery movement and the United Nations Convention on the Rights of Persons with Disabilities. We analyse the changes and describe the impact that these reforms should have upon clinical practice. Conclusions: The principles of care and treatment added to the MHA place a strong onus on clinicians to monitor patients’ decision-making capacity, institute a supported decision-making model and obtain consent to any treatment proposed. Patients competently refusing treatment should only be subject to involuntary treatment in extraordinary circumstances. Even when patients incompetently refuse treatment, clinicians must make every effort reasonably practicable to tailor management plans to take account of any views and preferences expressed by them or made known via friends, family or advance statements.

scholarly journals Consumer-run services research and implications for mental health care

2016 ◽  
Vol 25 (5) ◽  
pp. 410-416 ◽  
Author(s):  
S. P. Segal ◽  
S. L. Hayes
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Self Determination ◽  
Functional Improvement ◽  
Way Of Life ◽  
Services Research ◽  
Self Help ◽  
Mental Health Consumers ◽  
The Individual ◽  
The Impact

Mental health consumers/survivors developed consumer-run services (CRSs) as alternatives to disempowering professionally run services that limited participant self-determination. The objective of the CRS is to promote recovery outcomes, not to cure or prevent mental illness. Recovery outcomes pave the way to a satisfying life as defined by the individual consumer despite repetitive episodes of disorder. Recovery is a way of life, which through empowerment, hope, self-efficacy, minimisation of self-stigma, and improved social integration, may offer a path to functional improvement that may lead to a better way to manage distress and minimise the impact of illness episodes. ‘Nothing about us without us’ is the defining objective of the process activity that defines self-help. It is the giving of agency to participants. Without such process there is a real question as to whether an organisation is a legitimate CRS or simply a non-governmental organisation run by a person who claims lived experience. In considering the effectiveness of CRSs, fidelity should be defined by the extent to which the organisation's process conveys agency. Unidirectional helping often does for people what they can do for themselves, stealing agency. The consequence of the lack of fidelity in CRSs to the origins of the self-help movement has been a general finding in multisite studies of no or little difference in outcomes attributable to the consumer service. This, from the perspective of the research summarised herein, results in the mixing of programmatic efforts, some of which enhance outcomes as they are true mutual assistance programmes and some of which degrade outcomes as they are unidirectional, hierarchical, staff-directed helping efforts making false claims to providing agency. The later CRS interventions may provoke disappointment and additional failure. The indiscriminate combining of studies produces the average: no effect.

scholarly journals Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units

2014 ◽  
Vol 11 (02) ◽  
pp. 105-118 ◽  
Author(s):  
Karleen Gwinner ◽  
Louise Ward
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Intensive Care ◽  
Lived Experience ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Review Of Literature ◽  
Psychiatric Distress ◽  
Nurse Knowledge

AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.

scholarly journals Mental health legislation in Botswana

2018 ◽  
Vol 16 (03) ◽  
pp. 68-70
Author(s):  
J. Maphisa Maphisa
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Mental Disorders ◽  
United Nations ◽  
Persons With Disabilities ◽  
Mental Health Legislation ◽  
United Nations Convention ◽  
The United Nations ◽  
Health Legislation

The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.

Human rights in community psychiatry

2016 ◽  
Author(s):  
Genevra Richardson
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Global Mental Health ◽  
Mental Health Policy ◽  
European Convention ◽  
Health It ◽  
Persons With Disabilities ◽  
United Nations Convention

This chapter examines the increased concern for human rights within the global mental health policy agenda and considers what value human rights might add in relation to the use of coercion in community mental health. It describes the position underlying the European Convention on Human Rights (ECHR) and compares it with the more radical approach of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). While the CRPD might be more challenging to mental health professionals, it contains within its principles that the wishes and preferences of the person be centre stage and as such deserve to be taken seriously in the provision of community mental health care.

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