Volume 23, Issue 3-4, November - December 2024, Page 219-244.

Background and Aims: The COVID-19 pandemic has led to radical and unexpected changes in everyday life, and it is plausible that people’s psychophysical health has been affected. This study examined the relationship between COVID-19 related knowledge and mental health in a Croatian sample of participants.MethodsAn online survey was conducted from March 18 until March 23, 2020, and a total of 1244 participant responses were collected. Measures included eight questions regarding biological features of the virus, symptoms, and prevention, (...) the Hospital Anxiety and Depression Scale, and Optimism-Pessimism Scale. According to the answers given on the questions on COVID-19 related knowledge, participants were divided in two groups: informed and uninformed on each question. They were then compared in the expressed levels of anxiety, depression, pessimism, and optimism. Full vs. partial mediation models with optimism/pessimism as a mediator in the relationship between anxiety/depression and the accuracy of responses for questions about handwashing and ways of transmission were estimated.ResultsParticipants who responded correctly on the question about handwashing had higher levels of anxiety, depression, and pessimism than those participants whose answer was incorrect, while participants who answered correctly on the question about the percentage of patients who develop serious breathing problems had higher levels of depression than those who answered incorrectly. Lower levels of anxiety and pessimism were observed in the participants who answered correctly about ways of transmission. Higher levels of pessimism were found in participants who scored incorrectly on questions about the efficiency of antibiotics, most common symptoms, and the possibility of being infected by asymptomatic carriers. Higher levels of knowledge about handwashing were predicted by higher levels of anxiety and pessimism. Higher levels of knowledge about ways of transmission were predicted by lower levels of anxiety and lower levels of pessimism. The examined relationships between anxiety/depression and knowledge were mediated by pessimism.ConclusionThe findings of this study suggest that knowledge about COVID-19 may be useful to reduce anxiety and depression, but it must be directed to the promotion of health behaviors and to the recognition of fake news. (shrink)

It is sometimes assumed that when the gospels talk about demon possession they are just using different terminology for what would now be called psychosis or epilepsy. However, these terms come from different discourses that need to be distinguished, but do not need to be kept completely separate. The nature of the relationship between religion and mental health is complex. There is usually a positive correlation, but it is more difficult to be confident about the nature of the (...) causal connection. Poor mental health can become intertwined with religion in a way that drags both down. It is a consistent feature of Jesus' interactions that he encourages people to believe that more is possible than might have been imagined. His impact on the mental health of those around him seems to have been largely a matter of what might now be called positive psychology. (shrink)

In spite of numerous studies of program outcomes finding little or no positive effect on violent behavior, the Duluth model remains the most common program type of interventions with perpetrators of domestic violence. In addition, Duluth model programs often ignore serious mental health and substance abuse issues present in perpetrators. These and other issues of possible threat to mental health professional ethics are reviewed in light of the court-mandated, compulsory nature of most Duluth model programs and (...) client and victim expectations for program efficacy. (shrink)

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This article describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant (...) to encourage increased participation by special populations and narrow the parity gap in effective mental health treatment and services delivery. (shrink)

Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013–2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development (...) Goals (SDGs) of the UN’s 2030 Agenda for Sustainable Development (United Nations, 2015). The WHO’s Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN’s SDGs include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role (...) and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

The discourse surrounding mental health conditions (MHCs) can fluctuate between versions of the medical model, which views such conditions as pathologies requiring clinical intervention, and the ne...

Psychologists' courtroom involvement and testimony should not be dictated solely by what the judge or court allows but also require the application of personal or professional standards. This article explores various standards that might be used to determine whether psychological evidence is ready for courtroom application, whether or which evaluative procedures should be performed prior to courtroom use, and the potential tensions between personal validation or impression and formal scientific evidence. Although determining just how tough our professional standards ought to (...) be involves complex issues, the field should take a strong stance against testimony that is based largely on personal validation and that lacks scientific support or conflicts with research evidence. Much of current testimony violates this minimal standard. (shrink)

Waiting lists are a standard approach to managing excess demand in elective health care. While waiting times are an important policy issue, the ethical validity of the first come, first served (FCFS) principle as such is rarely questioned. Presenting a psychiatric day hospital where all eligible patients have roughly equal claims as a case study, we criticize the reflex use of FCFS for allocation of elective psychiatric care, consider conditions under which this may not be the optimal strategy, and (...) discuss alternatives. We conclude that in our example prioritizing more recent referrals (last come, first served [LCFS]) makes more sense, clinically and ethically. Where several referrals arrive (near-)simultaneously under LCFS, we propose that a higher level of scrutiny be applied to detect possible good reasons for prioritizing one of them. We believe that our observations can be applied to other health care settings that share relevant characteristics with our case. (shrink)

Acting on what started as a hunch, Dr. Francis Martin has cataloged well over 20,000 distinct approaches to counseling and psychotherapy that are advertised on the webpages of licensed, practicing mental health providers. No doubt some portion of them are harmful, but the sheer volume of advertised practices and techniques, often with names deceptively similar to actual evidence-based practices, should be cause for concern among all stakeholders in the helping professions - from educators and researchers to policy makers (...) and insurance companies and, especially, consumers. Based on this significant original study, and drawing from other research and supports, Therapy Thieves describes a near-universal crisis in the field and recommends ways to rescue mental health care from itself. The crisis is caused by declining competence among counselors and psychotherapists who have failed to regulate themselves and who, therefore, deliver inadequate - if not harmful - services. In presenting a simple, yet powerful indictment of the field, Dr. Martin advocates for major reforms in several areas of mental health care, including how prospective licensees are trained, supervised and licensed, a major reworking of professional ethics, and the need to establish regulations for mental health care providers. In short, the book calls for major, specific, and urgently needed reforms. (shrink)

IntroductionGratitude is commonly known as a positive emotion, but it can also be understood as a disposition—one’s inherent quality that includes being grateful for the positive aspects of one’s life and appreciating altruistic gifts. A growing body of research suggests that having a disposition of gratitude is positively related to wellbeing and psychological adjustment. The present study examined the extent to which acceptance of illness—a measure of adjustment to a distressing condition—mediated relationships between dispositional gratitude and wellbeing among women who (...) had elevated levels of depressive symptoms.MethodsParticipants were 131 women who, based on scores on the Center for Epidemiological Studies Depression scale, were at-risk for experiencing clinical depression. Thirty-five of these participants had been diagnosed as depressed at some point in their lives and 96 had not. Participants completed measures of dispositional gratitude, wellbeing, anxiety, and acceptance of illness.ResultsDispositional gratitude was positively correlated with wellbeing and was negatively correlated with depression and anxiety. Dispositional gratitude was also positively correlated with acceptance of illness. Mediational analyses found that acceptance of illness mediated relationships between dispositional gratitude and wellbeing, between dispositional gratitude and anxiety, and between dispositional gratitude and depression. Moreover, such mediation varied as a function of whether women had ever been diagnosed as depressed. Acceptance of illness was related more strongly to wellbeing for women who had been diagnosed as depressed at some time in their lives than it was for women who had never been diagnosed as depressed.ConclusionWomen with elevated depressive symptoms who were more grateful were more accepting of their condition, which was related to increased wellbeing and decreased feelings of depression and anxiety. (shrink)

ObjectiveThe study aimed to assess the level of disease acceptance as well as the wellbeing and emotions that accompany cancer patients during the COVID-19 pandemic.Materials and MethodsThe study involved 1,000 patients of the oncology centers. The following questionnaires were used for the study: WHO-5–Well-Being Index, BDI–Beck Depression Inventory, disease acceptance scale, and proprietary multiple-choice questions regarding the impact of the epidemic situation on the respondents’ lives so far. The questionnaire study was conducted twice: in March-October 2020 and March-October 2021. The (...) differences between the given periods were statistically analyzed.ResultsAt the time of the study, the respondents felt mainly anxiety related to the possibility of contracting COVID-19, the possibility of infecting a loved one, or staying in quarantine. Anxiety was also caused by the vision of poorer access to health services. Along with the duration of the epidemic, the acceptance of neoplastic disease has decreased and the incidence of depressive symptoms has increased.ConclusionThe wellbeing of the respondents deteriorated significantly during the pandemic. The respondents, in their daily functioning, were mainly accompanied by anxiety. The risk of depression has increased and the acceptance of the disease has decreased significantly. (shrink)

Scholarship in neuroethics and related disciplines has long reflected on the value of different conceptual models of disability and impairment. While this theoretical work is valuable, centering the voices of people with mental health conditions in neuroethics research can help us better understand how such models apply in everyday people’s lives. Drawing on qualitative data from a study on mental health peer providers’ lived experiences of recovery, this paper will demonstrate that peers borrow from both a (...) neurodiversity framework and the medical model of disability, though their feelings toward the two models were often complex and ambivalent. These findings advance neuroethics by indicating that future research and clinical practice should take a nuanced approach to responding to the needs of people with mental health conditions and turn to peers as experts, honoring their values and recognizing both the promise and pitfalls of living with a mental health condition. (shrink)

High quality monitoring of mental health and well-being over an extended period is essential to understand how communities respond to the COVID-19 pandemic and how to best tailor interventions. Multiple community threats may also have cumulative impact on mental health, so examination across several contexts is important. The objective of this study is to report on changes in mental health and well-being in response to the Australian bushfires and COVID-19 pandemic. This study utilized an (...) Experience-Sampling-Method, using the smartphone-based mood monitoring application, MoodPrism. Participants were prompted once a day to complete a brief survey inquiring about symptoms of depression and anxiety, and several well-being indices, including arousal, emotional valence, self-esteem, motivation, social connectedness, meaning and purpose, and control. Participants were N = 755 Australians who downloaded and used MoodPrism, between 2018 and 2020. Results showed that anxiety symptoms significantly increased during the COVID-19 pandemic, but not during the bushfires. This may be explained by concurrent feelings of social connectedness maintained during the bushfires but not during the pandemic. In contrast, depressive symptoms increased significantly during the bushfires, which maintained during the pandemic. Most indices of well-being decreased significantly during the bushfires, and further again during the pandemic. Study findings highlight the unique responses to the bushfire and COVID-19 crises, revealing specific areas of resilience and vulnerability. Such information can help inform the development of public health interventions or individual clinical treatment, to improve treatment approaches and preparedness for potential future community disasters. (shrink)

Global Mental Health is a field of research and practice that addresses the expansion of universal and equitable mental health care worldwide. This article explores the ways the concept of culture is employed in Global Mental Health literature. Global Mental Health advocates and critics assume an ontological separation between ‘nature’ and ‘culture’ to typify mental illness, linking it predominantly to one or the other of these two categories. Advocates of Global (...) class='Hi'>Mental Health view mental disorders as a nature–culture hybrid, while critics see them as typically cultural phenomena. The cultural critique of Global Mental Health can be strengthened by a sociological approach to both the role of critique and the uses of the concept of culture within social sciences. As an alternative to the ontologization of culture, we propose a different theoretical approach to the social issues involved in the expansion of international public health care in mental health: Arthur Kleinman's and Didier Fassin’s moral anthropological approaches. (shrink)

How are we to make sense of madness and psychosis? For most of us the words conjure up images from television and newspapers of seemingly random, meaningless violence. It is something to be feared, something to be left to the experts. But is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs, but is this actually so? There is no convincing evidence that the brain is (...) disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. So, how do we make sense of this situation? Postpsychiatry addresses these questions. It involves an attempt to rethink some of the fundamental assumptions of mental health work, showing how recent developments in philosophy and ethics can help us to clarify some of the dilemmas and conflicts around different understandings of madness. Throughout, the authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice. This new direction emphasises the importance of cultural contexts in understanding madness, placing ethics before technology in responding to madness, and minimising 'therapeutic' coercion. (shrink)

Central to ethical debates in contemporary mental health research are the rhetoric of parity of esteem, challenges underpinned by the social construct of vulnerability and the tendency to homogenis...

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental (...) health are aimed just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view from this (...) position, although not without challenge and internal discipline dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

Global mental health in a changing world -- Contemporary humanitarianism -- Humanitarian ethics -- Professional and personal challenges in humanitarian work -- Managing ethical challenges in global mental health -- Aspirational guidance : principles of humanitarian assistance -- Operational guidance : IASC guidelines -- Ethical dilemmas : damned if you do and damned if you don't -- Ethically questionable practices -- Safety imperative and self-care -- Values-based ethical framework and core competencies in global mental (...) class='Hi'>health -- Ethical considerations for refugee mental health providers in the United States -- Conclusion and future directions. (shrink)

Shortly following the Second World War, and under the medical direction of ex-army psychiatrist T. F. Main, the Cassel Hospital for Functional Nervous Disorders emerged as a pioneering democratic ‘therapeutic community’ in the treatment of mental illness. This definitive movement away from conventional ‘custodial’ assumptions about the function of the psychiatric hospital initially grew out of a commitment to sharing therapeutic responsibility between patients and staff and to preserving patients’ pre-admission responsibilities and social identities. However, by the mid-1950s, hospital (...) practices had come to focus pre-eminently on patients’ relationships with family members, and staff had developed a social model of mental health that focused on the family as the irreducible unit of mental treatment. By the late 1950s, this culminated in the in-patient admission of entire families for mental treatment, even when only one family member was exhibiting symptoms. At the heart of this growing post-war social-psychiatric preoccupation with the family was a new emphasis on the close relationship between mental health and individuals’ successful development toward mature responsible adulthood. The family came to be conceived as the quintessential space where both were forged. This article examines the process through which the Cassel’s social-psychiatric commitment to ‘therapeutic community’ became focused on the family as a key therapeutic site. While the family had become a central point of focus in social, political and psychological discussions of the foundation for stable democratic culture and political peace in post-war Britain, the Cassel Hospital actively experimented with these connections in therapeutic practice. This article thus illuminates the important, but frequently overlooked, role of psychiatric practices in the development of a post-war psychopolitics that established important links between the nuclear family, mental health and democratic social life. (shrink)

Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent preventive (...) models: those aiming to avert subsequent mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions. (shrink)

This article offers a narrative analysis of the contributing factors of moral distress (MD) and moral injury (MI) among mental health clinicians working amidst humanitarian crises. It discusses the impact of moral stress on therapeutic relationships in mental health trauma. The article originated from the author's experience developing a peer-to-peer support program at a nongovernmental organization (NGO) and conducting peer-to-peer support for mental health clinicians and healthcare providers in Ukraine and Turkey. A significant amount (...) of literature has documented the detrimental effects of MD and MI on mental health, job sustainability, and resilience of healthcare providers and first responders. The negative effects of MD and MI are particularly relevant in trauma counseling, where clinicians must draw upon the use of self to develop therapeutic relationships with their clients. This process demands a high level of moral reasoning and self-awareness, which can be severely tested under the morally challenging conditions of a humanitarian crisis. There is an imperative need to deepen our understanding and to swiftly address the factors that precipitate MD and MI in mental health clinicians working in crisis zones. By doing so, we aim to bolster their resilience and the enduring nature of their commitment to help and save others. This, in turn, will not only contribute to saving more lives but also enable those who are affected by trauma to flourish in the aftermath of their experiences. (shrink)

In this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National (...) Statement on Ethical Conduct in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings. (shrink)

Brussen, Kerri Anne Adolescence and young adulthood are a time of change. It is also a time where there is an increased chance of being diagnosed with a mental illness. Professor Patrick McGorry has driven the agenda to transform the approach to youth mental health. This article is a review of the recommendations of McGorry and others within the mental health field on how best to care for our youth with a mental illness. We (...) also briefly look at some of the services offered by a Catholic agency. (shrink)

BackgroundThe positive component of Mental Health Literacy refers to a person’s awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners.AimTo identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications.MethodsLiterature search and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach.ResultsPositive component of Mental Health (...) Literacy is considered one component of MHL, integrating positive mental health. The concept’s attributes include: competence in problem-solving and self-actualization; personal satisfaction; autonomy; relatedness and interpersonal relationship skills; self-control; and prosocial attitude. Four case scenarios were used to clarify the antecedents and consequences of PMeHL.ConclusionPositive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families. (shrink)

This work provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in ...

Plato, Aristotle, and the Stoics identify mental health with moral virtue. Are they right? We might be inclined to disagree with him if we believe that mental health is good for the agent, whereas virtues of character are good for other people. These philosophers answer that the mental features of the virtues of character are also features of a person's good. Still, their demands for psychic unity and cohesion might appear to exaggerate reasonable conditions on (...) mental health. In the view of these philosophers, our conception of mental health should make us aware of the aspects of agency that we value. We do not refer to different characteristics when we think of mental health and when we think of moral virtue. The main question is not about whether we choose to confine the expression "mental health" to the minimal condition, but about what makes the minimal condition valuable. It turns out to be difficult to explain why the minimal condition is valuable without also endorsing the moral virtues. (shrink)

Social theory has much to gain from taking up the challenges of conceptualizing ‘mental health’. Such an approach to the stunting of human mental life in conditions of adversity requires us to open up the black box of ‘environment’, and to develop a vitalist biosocial science, informed by and in conversation with the life sciences and the neurosciences. In this paper we draw on both classical and contemporary social theory to begin this task. We explore human inhabitation (...) – how humans inhabit their ‘ecological niches’ – and examine a number of conceptual developments that ‘deconstruct’ the binary distinction between organism and environment. We argue that we must understand the neurological, ecological and social pathways and mechanisms that shape human (mental) life if we are to address the central concerns of our discipline with inequity and injustice as these are inscribed into the bodies and souls of human beings. (shrink)

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. (...) Ethics of service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public policy (...) exceedingly difficult. Referencing a variety of approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, ‘disparity,’ is unjustifiable. (shrink)

This book is a penetrating analysis of the forensic mental health system - how it operates, the people involved, the problems inherent in the system, and the huge ethical dilemmas. It brings together a range of specialists, who describe the processes involved in dealing with a mentally disordered offender - from their own unique perspective.

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the (...) whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed. (shrink)

The aim of this chapter is to describe a type of law governing involuntary treatment that is based on decision-making capability and not on risk of harm to self or others. It is consistent with the legal and ethical principles followed in general medicine, and non-discriminatory against people with a mental illness. The rationale behind the proposal is outlined, as well as its principles and main features. It is argued that this type of law could be adapted to the (...) needs of low and middle-income countries without sacrificing its underlying principles, and that it lends itself to such adaptation much better than traditional mental health legislation. (shrink)

ConclusionA map of mental health is admittedly the vaguest of speculations at the moment. It is nowhere near as precise as anything presently seen through the mental health microscope. Indeed it may well turn out to offer nothing at all. On the other hand, the truth remains that unless we beat our addiction to microscopes we will never get even a glimpse of mental health: you can’t read a map with a microscope.

After nearly three decades of scientific research, digital mental health (DMH) is having its moment. Millions of dollars of venture capital funding are entering this space (Shah and Berry 2021; Wan...

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with (...) the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a (...) transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments. (shrink)