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Mental health, mental capacity and human rights: a practitioner’s guide
- Author:
- BRITISH INSTITUTE OF HUMAN RIGHTS
- Publisher:
- British Institute of Human Rights
- Publication year:
- 2016
- Pagination:
- 28
- Place of publication:
- London
This booklet provides information about human rights values and approaches for practitioners working in services supporting people with mental health or mental capacity issues. It looks at how the Human Rights Act work, legal duties under the Human Rights Act, and provides information about the key rights which are most relevant to practice in mental health and/or mental capacity settings. Human rights discussed include: right to life; right not to be tortured or treated in an inhuman or degrading way; right to liberty; right to respect for private and family life, home and correspondence; and right not be discriminated against in relation to any of the human rights. For each human right, the booklet outlines how practitioners might encounter this rights in their work, their practitioner duties, whether practitioners are able to restrict this right, and provides a short example. The booklet also includes a flowchart to help identify human rights issues in practice. It is the first of eight booklets developed as part of the British Institute of Human Rights (BIHR) project ‘Delivering Compassionate Care: Connecting Human Rights to the Frontline’, which aims to ensure that staff have the knowledge and skills uphold the dignity and human rights of the people using their services. It has been produced alongside seven issue-specific resources. (Edited publisher abstract)
How included are mental health service users in decisions about their medication?
- Author:
- HOLTTUM Sue
- Journal article citation:
- Mental Health and Social Inclusion, 20(3), 2016, pp.141-148.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services. Design/methodology/approach: One article describes conversations between a psychiatrist and service users about medication. The second paper describes a study in which young people were supported with the aim of developing their confidence to challenge medication decisions. The third paper reports on interviews with both professionals and service users about medication decisions. The fourth paper presents a theory of how the wider context can affect medication decision making in mental health. Findings: The first paper shows how a psychiatrist can persuade service users to accept medication decisions. The second paper shows how some young people can challenge medication decisions if they have the right support. The third paper illustrates how both professionals and service users may doubt service users’ ability to decide about medication, and pessimistically suggests that shared decision making may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are organised in order to enable service users to be more empowered about medication decisions. Originality/value: A model of shared decision making is being imported into mental health from physical health. These four papers illustrate problems with a simple transfer from physical to mental health. The present paper points to differences in apparent awareness of different clinical researchers of the need to tackle service users’ disempowerment in mental health care, showing how some researchers are tackling this. (Publisher abstract)
Factors that influence decision making by 8-12 year olds in child and adolescent mental health services (CAMHS): a systematic review
- Authors:
- COX Annette, et al
- Journal article citation:
- Research Policy and Planning, 31(3), 2016, pp.195-209.
- Publisher:
- Social Services Research Group
There is significant legal guidance and case law available to support clinicians in assessing whether young people aged over 13 years are able to make informed decisions about their own healthcare; however when working with children aged 8-12 years, the guidance is unclear. In order to assess whether 8-12 year olds are able to make decisions in their own healthcare, we first need to understand the factors that influence this process. A systematic literature review of five electronic databases (PsycINFO, EBSCO, Science Direct, Science Full Text, Web of Science All Databases) was conducted. The search identified 12 studies and one piece of government guidance. The studies were identified from a variety of health and social research journals. The six factors that were identified were: 1) consent, competence and capacity, 2) best interests, 3) communication, 4) risks and conflicts, 5) legal frameworks, and, 6) parental role. The review concludes that it is possible for some children 8-12 years of age to make decisions regarding their own healthcare. The necessary conditions are that age specific language is used through a variety of mediums which will include risks, benefits and options for the proposed interventions. Clinicians need to be skilled in the assessment of the child’s ability to make decisions and be effective communicators with a commitment to children’s involvement. Further research in both these areas is needed. (Edited publisher abstract)
Adults’ perceptions about whether children should disclose their mental illness
- Authors:
- CORRIGAN Patrick, et al
- Journal article citation:
- Journal of Public Mental Health, 15(4), 2016, pp.200-208.
- Publisher:
- Emerald
Purpose: Disclosure of mental illness is a key ingredient in contact-based public stigma change strategies. Adults who disclose their personal recovery story experience greater empowerment and heightened quality of life. Qualitative research suggests youth may similarly benefit, but also have unique benefits and costs associated with disclosure. The purpose of this paper is to examine adults’ perceived costs and benefits of mental illness disclosure for middle and high school students with a new measure, the Coming Out with Mental Illness Scale for Children (COMIS-Child). Design/methodology/approach: In total, 300 adult participants from Amazon’s MTurk completed the COMIS-Child, the Beliefs about Disclosure Scale (BDS), assessing perceptions about child disclosure, and the Attribution Questionnaire, assessing public stigma. Findings: Principal component analyses of the COMIS-Child yielded one factor representing disclosure costs and two factors for benefits (changing pubic stigma; person-defined benefits). Internal consistencies of the COMIS-Child factors were strong. Parents with children with mental illness endorsed more costs and fewer benefits from the changing public stigma factor than other respondents. Regression analyses showed decisions about youth disclosing mental illness from the BDS were associated with perceived costs, perceived benefits as personally defined, and public stigma. Disclosure beliefs were also inversely associated with public stigma. Social implications: Adults who identify more costs and fewer benefits were less likely to believe youth should disclose, favouring a more conservative approach to youth disclosure. This highlights the importance of participating in self-stigma interventions that guide an individual’s decision making about disclosure. Originality/value: To the author’s knowledge, this is the first study examining adults’ perceptions of youth disclosure of mental illness. (Publisher abstract)
Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis
- Authors:
- STOVELL Diana, et al
- Journal article citation:
- British Journal of Psychiatry, 209(1), 2016, pp.23-28.
- Publisher:
- Cambridge University Press
Background: In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed. Aims: To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis. Method: A systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161) was conducted. Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship. Results The authors identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09–0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI 0.35–1.02), with a number needed to treat of approximately 10 (95% CI 5–∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous. Conclusions: For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required. (Edited publisher abstract)
Living a meaningful life with serious mental illness: defining and understanding personal medicine
- Author:
- RADOHL Tamara
- Journal article citation:
- Journal of the Society for Social Work and Research, 7(2), 2016, p.345–369.
- Publisher:
- Society for Social Work and Research
Objective: Shared decision making (SDM) is an approach adapted from the health care field for use in mental health treatment because SDM promotes collaborative decision making of providers and consumers regarding treatment options and goals. Personal medicine, defined as “self-initiated, non-pharmaceutical self-care activities that serve to decrease symptoms, avoid undesirable outcomes such as hospitalisation, and improve mood, thoughts, behaviours, and overall sense of well-being” (Deegan, 2005, p. 31), has been incorporated into SDM when applied in mental health settings. This exploratory, qualitative study investigates how mental health consumers define and use personal medicine. Method: A sample of 14 consumers with severe and persistent mental illness were selected from a local community mental health agency using purposeful sampling. Participants used Common Ground, a software programme that formalises SDM and uses the concept of personal medicine. Participants were interviewed using a naturalistic inquiry approach and a semi-structured interview protocol of open-ended questions. Interviews were transcribed and coded, and findings were corroborated with consultant panels. Comprehensive member checks ensured trustworthiness. Results: Personal medicine might be a larger concept than can be explained by any single modality. Several factors contribute to the use of personal medicine, including the individualisation of personal medicine by consumers, how consumers define the concept of personal medicine, and the purposes and benefits of personal medicine. Conclusions: Participants report personal medicine to have benefit, value, and purpose that impact recovery. These findings support current literature and practical implications that might inform the ways in which professionals use personal medicine. (Edited publisher abstract)
Recovery versus risk? from managing risk to the co-production of safety and opportunity
- Authors:
- PERKINS Rachel, REPPER Julie
- Journal article citation:
- Mental Health and Social Inclusion, 20(2), 2016, pp.101-109.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to propose a recovery-focused approach to risk and safety and what this might look like in practice. Design/methodology/approach: Review of recovery approaches and the ways in which traditional approaches to risk might hinder people in their recovery journey. Consideration of the principles of a recovery-focused approach to safety. Findings: A recovery-focused approach to risk based on co-produced safety plans that enable people to do the things they value as safely as possible and shared responsibility for safety. Four key principles of a recovery-focused approach to promoting safety, autonomy and opportunity are proposed. Originality/value: A recovery-focused approach to risk and safety is central to the development of recovery-focused practice within services. This paper outlines such an approach. (Publisher abstract)
A critical narrative analysis of shared decision-making in acute inpatient mental health care
- Author:
- STACEY Gemma
- Journal article citation:
- Journal of Interprofessional Care, 30(1), 2016, pp.35-41.
- Publisher:
- Taylor and Francis
Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place. (Publisher abstract)
Constructing parental problems: the function of mental illness discourses in a child welfare context
- Author:
- KEDDELL Emily
- Journal article citation:
- British Journal of Social Work, 46(7), 2016, pp.2088-2103.
- Publisher:
- Oxford University Press
Understanding how social workers and parental service users construct the meanings of parental problems in the child protection context is important, as ultimately this affects decision making. Using qualitative methods, this study elicited social workers' and parental service users' perceptions of decision reasoning and analysed them from a discursive constructionist perspective. By completing secondary analysis of social worker–parental service user pairs, this article describes patterns in how the causes of family problems were constructed by social workers and parental service users. It was found that explanations of poor mental health and lack of supports for initial family problems were used to emphasise a lack of parental culpability by both parties, particularly through a narrative of separating one's ‘authentic self’ from the impacts of mental illness on parenting. This convergence of explanations helped to maintain fragile parental identities, assisted with relationship maintenance, and allowed both social workers and parents to acknowledge harm to children. However, an individualised view of problems promoted by mental illness discourses was unable to account for the impact of domestic violence and poverty on parental life experiences, and thus sometimes over-emphasised parental responsibility. (Publisher abstract)