The Ethics of Mental Health

HCR 210 Ethics for the Healthcare Professional The Ethics of Mental Health Learning Objectives: • Summarize the ethical principles of human dignity and personal autonomy underlying the health care system's response to mental illness and disability • Understand the unique ethical issues related to pediatric and adolescent health care • Apply ethical decision-making models and principles to the issues surrounding vulnerable members of society Vulnerable Populations Vulnerable populations: populations that are more likely to experience health inequities Vulnerable populations Physical Psychological Social History of Mental Health Stigma • In the Middle Ages, people who suffered from mental illness were thought to be “punished by God” or “possessed by devils” • People with mental illnesses have been subjected practices that we would now consider to be cruel and unusual: o Forced sterilization o Insulin coma therapy (1930s-1960s) – used for schizophrenia o Involuntary, unregulated electroshock therapy • One of the most heavily stigmatized mental health illnesses is schizophrenia Mental Health Stigma Public stigma: Stereotypes, discrimination, and prejudice • “People with mental health disorders are dangerous” or “People with mental health disorders are weak and can’t take care of themselves.” • Can affect job and housing opportunities Mental Health Stigma Self-stigma: Diminished self-esteem and confidence due to internalization of public stigma • “My mental health makes me a dangerous person.” • “That’s right, I am weak and I can’t take care of myself.” Mental Health Stigma Label avoidance: Avoidance of mental health services due to fear of being labelled and categorized • “If I go to the doctor, they’ll just say that I’m crazy.” DSM - 5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition • Published in 2013 by the American Psychiatric Association • Standard for the clinical diagnosis of mental illnesses Why do we diagnose and categorize mental health disorders? • Ease of communication, expected course and prognosis, patterns of family history Example DSM-V criteria for major depressive disorder Mental Health Stigma What are the potential pitfalls of diagnosis? • Creates sense of groupness/otherness “Schizophrenics aren’t like us.” • Creates sense of homogeneity “Schizophrenics are all the same.” • Creates sense of stability “Schizophrenics are always like this.” Mental Health Stigma The voices in my head by Eleanor Longden Instead of saying: “This patient is a schizophrenic.” Say this instead: “___________________________ ___________________________.” Autonomy + Mental Health What do you do if someone if suffering from a mental health illness but does not want to seek medical treatment? Can you force someone to undergo medical treatment? What if that person was threatening to harm themselves or others? Mental Health Case Studies Andrew is a psychiatric nurse practitioner who has been studying Native American culture and recently got a job working with the Indian Health Service. One day, Andrew has a patient who claims that she has been having “visions” (visual hallucinations) of her now-deceased father. Andrew considers multiple differential diagnoses such as acute psychosis due to other general medical conditions or substance abuse, depression with psychotic features, and early symptoms of schizophrenia. However, Andrew does not seriously consider these diagnoses as he feels like this would be culturally incompetent and could possibly pathologize what he believes is his patient’s cultural way of expressing hope and connection to the dead. He is also worried about stigmatizing his patient by giving her a diagnosis of a mental illness. Andrew reassures the patient that everything is fine. Do you agree with Andrew’s actions? Mental Health Case Study Jennifer is a psychiatric physician assistant who is currently taking care of a 25year-old male Indian-American patient with anxiety/depression. After several weeks of treatment, the patient opens up about his sexuality and his fears of not being accepted by his parents. Some time later, the patient’s mother calls to ask how therapy is going and requests that his medical records be sent to her. Jennifer explains that she cannot do this without the patient’s consent. Privately, she is also worried given that she had taken extensive notes including documentation of the patient’s strained relationship with his parents and his sexuality. When Jennifer brings this up to her patient, he agrees that it would be devastating to have his parents read his medical chart. However, he feels like he has a duty to his parents and signs the medical release form. What should Jennifer do? Mental Health Resources If you are struggling with mental health issues, please seek assistance. Questions?