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Ethical dilemmas of practicing social workers around psychiatric medication: results of a national study
- Authors:
- WALSH Joseph, et al
- Journal article citation:
- Social Work in Mental Health, 1(4), 2003, pp.91-105.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Describes the results of a national survey of practicing social workers in the USA regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. Presents implications of these findings for social work practice and further research. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Secret practices: interdisciplinary work in child welfare
- Author:
- TAYLOR Alexis A
- Publisher:
- Upfront
- Publication year:
- 2003
- Pagination:
- 202p.,bibliog.
- Place of publication:
- Leicester
This ethnographic study presents a different perspective on Child and Adolescent Mental Health Services: that of the child’s. The author argues that the rights of children encountering this service are as seriously compromised as those of adult mental health service users once were. The evidence challenges the quality of assessments, and shows the powerful influence of technical language and power mongering on constructing realities. Professional work can be self-serving rather than ‘in the best interests of the child’. Some of the fundamental tensions in inter-disciplinary work and ‘joined up thinking’ are exposed. Novel ways of exploring critical decision points and working effectively in groups are presented. There are salutary messages for child welfare practitioners and policy makers, and compelling reasons for radically altering the child welfare system in the UK in order to meet the needs of distressed children. A new ‘architecture of care’ must replace the current monolithic institutions and professional tribes.
Ethical decision making: pressure and uncertainty as complicating factors
- Author:
- HEALY Tara
- Journal article citation:
- Health and Social Work, 28(4), November 2003, pp.293-301.
- Publisher:
- Oxford University Press
This American qualitative study examines social workers' ethical tension as they evaluate decisional capacity of elderly individuals experiencing some degree of cognitive impairment. An interview guide of open-ended questions was used with a convenience sample of 17 home health care social workers. Three areas emerged as highly relevant to participants ethical decisions: clinical uncertainty, pressure from other professionals, and a combination of pressure from other professionals and clinical uncertainty. Clinical uncertainty was influenced by partial cognitive impairment, mental health problems, the interplay of health and mental health and unclear etiology of poor decisional capacity. Pressure from other professionals typically involved issues of compliance and medical safety.
Gatekeepers, proxies, advocates?: the evolving role of carers under mental health and mental incapacity law reforms
- Author:
- KEYWOOD Kirsty
- Journal article citation:
- Journal of Social Welfare and Family Law, 25(4), December 2003, pp.355-368.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article explores the potential impact of the mental health and mental incapacity law reforms on carers. The reform proposals anticipate a number of overlapping and at times conflicting roles for carers (including those of gatekeeper, decision-making proxy and advocate), which is suggestive of an ongoing ambivalence toward the caring role at the level of ethics, policy and strategic planning.
The development of potential models of advance directives in mental health care
- Authors:
- ATKINSON Jacqueline M, et al
- Journal article citation:
- Journal of Mental Health, 12(6), December 2003, pp.575-584.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The review of mental health law in the UK has involved consideration of mechanisms for advance directives in mental health care. The aim was to develop potential models of advance directives based on the views of stakeholders in mental health services in Scotland. Focus groups and individual interviews were conducted with service users, professionals and carers who had an interest in advance directives. Leaflets and policy documents from campaign groups and voluntary organisations were collected and along with data generated in interview and group discussion were analysed for themes. Six potential models were developed that highlighted the overarching themes of co-operation versus autonomy and the legal status of any directive. There is a wide variety of opinion about what advance directives could or should bring to mental health care, they are not all achievable through the use of any one model.
Making Decisions Alliance campaign pack
- Author:
- MAKING DECISIONS ALLIANCE
- Publisher:
- Making Decisions Alliance
- Publication year:
- 2003
- Pagination:
- 17p.
- Place of publication:
- London
The Making Decisions Alliance brings together a wide range of organisations and groups working with people who may, for a range of different reasons, have difficulty in making our communicating decisions. The two broad aims of the Alliance are to lobby the Government to introduce mental capacity legislation in the next Queen's speech by November 2003 and to increase awareness of the need for new legislation. After more than a decade of promising to act, the Government has not introduced legislation. This pack sets out the reasons why this situation cannot go on.
The handbook of community mental health nursing
- Editors:
- HANNIGAN Ben, COFFEY Michael
- Publisher:
- Routledge
- Publication year:
- 2003
- Pagination:
- 427p.,bibliogs.
- Place of publication:
- London
This text covers a range of topics, from the history of the profession to current approaches to specific client groups, organized around three linked themes:professional context, practice issues, as well as education and research. The book reflects the diversity and scope of the role of the CMHN and recognizes the multidisciplinary and service user context in which nurses work. is intended forr CMHNs and mental health nurse educators, and allied professionals
Who says?
- Author:
- -
- Journal article citation:
- Mental Health Today, March 2003, pp.10-11.
- Publisher:
- Pavilion
- Place of publication:
- Hove
Discusses pressure from the Making Decisions Alliance, on the government to do more in its legislation to govern decision making and mental incapacity.
Survey of expert second opinions in a tertiary psychiatric out-patient clinic in the Yorkshire region between 1988 and 2000
- Authors:
- NIRODI Pratibha, et al
- Journal article citation:
- Psychiatric Bulletin, 27(10), November 2003, pp.416-420.
- Publisher:
- Royal College of Psychiatrists
A medical second opinion is an expert clinical case evaluation requested by a colleague for a patient already under specialist care. There is no literature on the provision for second opinions in psychiatric practice other than those relating to the Mental Health Act 1983, and the availability of clinics offering second opinions varies greatly from one area to another. The authors undertook a survey of an expert second opinion service in Leeds over the period 1988-2000 and examined the case notes of 103 referred patients, of whom 71 were included in the analysis data. In the majority of cases diagnoses were not changed, but alternative treatment strategies were suggested. The exception was for patients with a diagnosis of personality disorder, in whom neither a new diagnosis nor alternative management was commonly suggested. Half of the assessments were completed in a single visit, but a substantial minority required further evaluation as outpatients, close follow-up or even hospital admission for detailed review. The authors believe that a second opinion service offers clinicians valuable support and expertise, especially in sector psychiatry. Evidence presented suggests that further therapeutic options are available for many patients regarded as 'difficult to treat'. In some cases this may involve a period of observation free of all psychotropic medication. As in other specialities, psychiatrists should be aware of the value of further advice for patients with particularly refractory or unusual disorders.
Issues in the development of advance directives in mental health care
- Authors:
- ATKINSON Jacqueline, et al
- Journal article citation:
- Journal of Mental Health, 12(5), October 2003, pp.463-474.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Interest in advance directives in mental health care is growing internationally. There is no clear universal agreement as to what such an advance directive is or how it should function. The aim was to describe the range of issues embodied in the development of advance directives in mental health care. The literature on advance directives is examined to highlight the pros and cons of different versions of advance directive. Themes emerged around issues of terminology, competency and consent, the legal status of advance directives independent or collaborative directives and their content. Opinions vary between a unilateral legally enforceable instrument to a care plan agreed between patient and clinician. There is immediate appeal in a liberal democracy that values individual freedom and autonomy in giving weight to advance directives in mental health care. They do not, however, solve all the problems of enforced treatment and early access to treatment. They also raise new issues and highlight persistent problems.