Mental Health Challenges and Ethics
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Questions and Answers

What is a significant challenge associated with the treatment of psychosocial needs?

  • Treatments are primarily relational and not time-sensitive
  • Treatment mainly focuses on individual interventions
  • Quick fixes are often achievable
  • Social injustice issues are multisystemic and complex (correct)
  • What was a key outcome of the deinstitutionalization movement in the 1960s and 70s?

  • An increase in psychiatric ward populations
  • An improvement of institutional care standards
  • Patients stabilized so they could live in society (correct)
  • A total elimination of mental health institutions
  • How does stigma affect individuals with mental illness according to the content?

  • It provides a clear understanding of their condition
  • It encourages stronger relationships within communities
  • It leads to a devaluation of their self-worth (correct)
  • It enhances their social acceptance
  • What aspect of mental health diagnosis is particularly concerning regarding autonomy?

    <p>Power imbalances can be exacerbated in mental health contexts (A)</p> Signup and view all the answers

    What major ethical consideration arises when disclosing information about a patient with mental illness?

    <p>Balancing the need for resources with privacy concerns (A)</p> Signup and view all the answers

    What percentage of Canadians will experience mental illness in their lifetime?

    <p>20% (B)</p> Signup and view all the answers

    Which demographic is NOT identified as being at higher risk for mental illness?

    <p>High-income earners (D)</p> Signup and view all the answers

    What is the predominant cause of death among adults under 44 in Canada?

    <p>Suicide and self-inflicted injuries (B)</p> Signup and view all the answers

    What percentage of individuals with mental health needs actually receive care?

    <p>33% (A)</p> Signup and view all the answers

    Which group has the highest suicide rate in Canada?

    <p>Indigenous communities (B)</p> Signup and view all the answers

    What is the rate of depression symptoms among Indigenous populations?

    <p>30% (D)</p> Signup and view all the answers

    Which of the following is a group that is NOT specifically mentioned as at higher risk for mental health issues?

    <p>High school students (B)</p> Signup and view all the answers

    What ethical dilemma is often associated with forced hospitalization in mental health care?

    <p>Balancing patient autonomy and safety (B)</p> Signup and view all the answers

    What does coercion in mental health care primarily rely on?

    <p>The patient’s experience of pressure (C)</p> Signup and view all the answers

    Which of the following best describes relational autonomy in the context of mental health care?

    <p>Autonomy influenced by the patient's relationships and support systems (B)</p> Signup and view all the answers

    What is the primary difference between formal coercion and perceived coercion in mental health treatment?

    <p>Formal coercion is documented, whereas perceived coercion is subjective and personal. (C)</p> Signup and view all the answers

    In mental health care ethics, what does the term 'moral distress' refer to?

    <p>Conflicts between personal values and professional responsibilities (D)</p> Signup and view all the answers

    What characteristic distinguishes sedative medication in mental health treatment?

    <p>It can lead to dependency if misused. (B)</p> Signup and view all the answers

    What aspect of care delivery in mental health poses a risk of moral distress among providers?

    <p>Power imbalances between providers and patients (A)</p> Signup and view all the answers

    In the context of seclusion in mental health settings, what is a primary ethical concern?

    <p>The impact on the patient's sense of autonomy (A)</p> Signup and view all the answers

    Which of the following best defines coercion as it relates to mental health care?

    <p>Any pressure exerted to make a patient comply with treatment (C)</p> Signup and view all the answers

    Which of the following fundamental freedoms is explicitly mentioned as a right of every person?

    <p>Freedom of opinion (B)</p> Signup and view all the answers

    What must a person maintain while exercising their fundamental freedoms according to Article 9.1?

    <p>A proper regard for democratic values (D)</p> Signup and view all the answers

    What is the primary condition under which force may be used according to Law #2?

    <p>To prevent harm to oneself or others (C)</p> Signup and view all the answers

    Which of the following is NOT mentioned as a requirement for applying measures involving control?

    <p>Notification to the individual's family (B)</p> Signup and view all the answers

    What is explicitly stated as a necessary action for institutions regarding the procedures for the use of control measures?

    <p>They must be consistent with ministerial orientations. (C)</p> Signup and view all the answers

    Which of the following types of restraints is identified in the context of physical control measures?

    <p>Chemical restraints (C)</p> Signup and view all the answers

    How often must institutions evaluate the application of control measures?

    <p>Annually (B)</p> Signup and view all the answers

    What limitation is imposed on the use of force, isolation, or other control measures?

    <p>They must be minimal and exceptional. (C)</p> Signup and view all the answers

    Which of the following freedoms concerns the gathering of individuals?

    <p>Freedom of peaceful assembly (D)</p> Signup and view all the answers

    What is a significant ethical issue related to the use of restraints in mental health care?

    <p>They can lead to increased agitation in patients. (C)</p> Signup and view all the answers

    Which ethical dimension of mental health nursing emphasizes the role of social justice in resource allocation?

    <p>Social Justice (A)</p> Signup and view all the answers

    Which concept is important for reflecting on the ethical implications of power dynamics in mental health nursing?

    <p>Coercion (C)</p> Signup and view all the answers

    What is a primary focus of trauma and violence informed care (TVIC) within ethical nursing practice?

    <p>To identify and address past traumatic experiences of patients. (D)</p> Signup and view all the answers

    What critical aspect does stigma link to in the context of ethical nursing practice in mental health?

    <p>Therapeutic relationships (D)</p> Signup and view all the answers

    What percentage of individuals with mental illness also have a substance abuse problem?

    <p>20% (C)</p> Signup and view all the answers

    Which demographic is considered at higher risk for mental health issues?

    <p>Single mothers living in low-income conditions (B)</p> Signup and view all the answers

    What is the proportion of people who need mental health care but actually receive it?

    <p>1/3 (D)</p> Signup and view all the answers

    What factor significantly influences the mental health of Indigenous populations?

    <p>High rates of suicide and self-inflicted injuries (C)</p> Signup and view all the answers

    What is the suicide rate among Inuit communities compared to the national average?

    <p>11 times the national average (A)</p> Signup and view all the answers

    Which group shows symptoms of depression among Indigenous populations?

    <p>30% (B)</p> Signup and view all the answers

    Which risk factor is commonly associated with mental illness in children and adolescents?

    <p>Exposure to violence and aggression (C)</p> Signup and view all the answers

    What ethical consideration is emphasized due to the functional changes caused by mental illness?

    <p>Potential for coercion in treatment (A)</p> Signup and view all the answers

    Which of the following best describes informal coercion in mental health care?

    <p>Applying psychological pressure without mandate (C)</p> Signup and view all the answers

    Which of the following statements about relational autonomy in mental health care is accurate?

    <p>Relational support can enhance a patient's autonomy (D)</p> Signup and view all the answers

    What percentage of individuals who need mental health services in Canada actually receive them?

    <p>33% (C)</p> Signup and view all the answers

    What does the term 'moral distress' refer to in the context of mental health nursing?

    <p>The discomfort from making unethical decisions (C)</p> Signup and view all the answers

    Individuals with serious mental illness are most likely to face which of the following issues?

    <p>Higher instances of homelessness (D)</p> Signup and view all the answers

    In mental health settings, what is a primary consideration when using coercive measures?

    <p>The potential for negative psychological impact (A)</p> Signup and view all the answers

    What aspect of coercion differentiates it from voluntary treatment in mental health care?

    <p>The element of choice and consent involved (C)</p> Signup and view all the answers

    What is a common misconception about people with mental illness in relation to violence?

    <p>They have a higher propensity for violent behavior than the general population. (B)</p> Signup and view all the answers

    Which of the following best represents a formal type of coercion in mental health care?

    <p>Using a court order to enforce hospitalization (D)</p> Signup and view all the answers

    According to the Canadian Charter of Rights and Freedoms, which right is explicitly provided to individuals?

    <p>The right to life and personal security (C)</p> Signup and view all the answers

    What percentage of the health care budget is spent on mental health, given that it represents 15% of the burden of disease?

    <p>5% (A)</p> Signup and view all the answers

    What is the primary goal of using seclusion in mental health care?

    <p>To ensure safety of the patient or others (D)</p> Signup and view all the answers

    Which of the following factors is most likely to increase violent behaviors among individuals with mental illness?

    <p>Substance abuse (A)</p> Signup and view all the answers

    What is a common misconception regarding the use of sedative medications in mental health treatment?

    <p>They guarantee immediate recovery of consciousness (D)</p> Signup and view all the answers

    What is the daily statistic for suicides and suicide attempts in Quebec?

    <p>3 suicides and 8 hospitalizations for attempts (A)</p> Signup and view all the answers

    Which of the following articles in the Canadian Charter specifically addresses the prohibition of arbitrary detention?

    <p>Article 9 (A)</p> Signup and view all the answers

    What is a significant issue that often precedes suicide attempts among individuals with mental illness?

    <p>History of mental illness (D)</p> Signup and view all the answers

    Flashcards

    Deinstitutionalization Movement

    A social movement (1960s-70s) focused on moving people with mental health conditions out of institutions and into community settings.

    Psychosocial Needs (Justice)

    Treatment for social injustices in mental health is complex, relational, and typically requires a longer time frame, unlike quick fixes.

    Competence/Capacity & Consent (Autonomy)

    In mental health, the patient's ability to understand and make decisions is crucial, but power imbalances can magnify problems, increasing the risk of coercion or forced treatment.

    Stigma in Mental Health

    Societal judgments or negative attitudes towards people with mental illness, leading to devaluation of themselves and challenges in social acceptance.

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    Confidentiality & Privacy in MI

    How much personal information about an individual with a mental illness should be shared to provide necessary resources, while respecting patient boundaries and privacy needs.

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    Mental illness prevalence

    1 in 5 Canadians will experience mental illness in their lifetime.

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    Co-occurrence of mental illness & substance abuse

    20% of Canadians with mental illness also have substance abuse problems.

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    Onset of mental health problems

    70% of mental health issues begin in childhood or adolescence.

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    High-risk groups for mental illness

    Groups such as low-income earners, single mothers, exposed children, and specific workers are more vulnerable to mental illness.

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    Indigenous mental health risk

    Indigenous populations have a significantly higher risk of mental health issues, with 30% potentially showing symptoms of depression.

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    Suicide as a leading cause of death

    Suicide and self-harm are the leading causes of death for adults under 44.

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    Indigenous suicide rate

    Suicide rates are 5-7 times the national average in Indigenous communities, and 11 times higher among Inuit communities.

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    Quebec Charter of Human Rights and Freedoms

    A legal document protecting fundamental rights like freedom of conscience, religion, opinion, expression, assembly, and association in Quebec.

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    Dignity, Honour, and Reputation

    The right to be treated with respect and have your good name protected under Quebec law.

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    Limits to Freedoms and Rights

    While the Quebec Charter protects rights, these rights can be limited by law to uphold democratic values, public order, and the well-being of Quebec citizens.

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    Force in Health Services

    Using force, isolation, or restraints in a healthcare setting is only allowed in Quebec to prevent harm to the person or others.

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    Minimal Use of Force

    When using force in a health setting, the use must be minimal, only when necessary, and appropriate to the person's condition.

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    Documentation of Force

    Any use of force, isolation, or restraints in a healthcare setting must be documented in detail in the person's record.

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    Institutional Procedure for Force

    Healthcare institutions must have a procedure for using force, approved by the ministry, and must inform users of the procedure.

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    Annual Evaluation of Force

    Healthcare institutions must evaluate their use of force annually to ensure the procedure is working effectively.

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    Chemical Restraints

    Medications used to reduce a person's level of consciousness or activity. These medications have sedative properties and should only be used when absolutely necessary.

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    Seclusion

    The practice of isolating a person in a designated room, often locking the door, to prevent them from harming themselves or others.

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    Forced Hospitalization

    When a person with a mental illness is admitted to a hospital against their will, typically because they are considered a danger to themselves or others.

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    Refusal of Care

    A patient's right to decline treatment, even if it is deemed necessary by medical professionals.

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    Moral Distress

    A feeling of unease experienced by healthcare professionals when they feel unable to act ethically or when they feel pressured to act in a way that goes against their values.

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    Relational Autonomy

    The idea that our ability to make independent decisions is influenced by our relationships and social contexts.

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    Coercion

    Actions that force someone to do something against their will, often used in a mental health context to encourage compliance with treatment.

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    Formal Coercion

    Coercion that is explicitly sanctioned by law or policy, such as involuntary hospitalization.

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    Informal Coercion

    Coercion that is not explicitly sanctioned by law but occurs through social or interpersonal pressures.

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    Resource Allocation in Mental Health

    The process of distributing limited resources to provide mental healthcare. This involves balancing the needs of individuals with the demands of a broader population.

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    Ethical Questions in Mental Health

    Challenges related to ethical principles like autonomy, beneficence, non-maleficence, and justice when applied to mental health care. These involve patient rights, treatment choices, and societal factors.

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    Trauma and Violence Informed Care (TVIC)

    An approach to healthcare that acknowledges the impact of trauma and violence on individuals and incorporates it into the therapeutic process.

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    Analyzing Mental Health Cases Ethically

    Applying ethical theories like utilitarianism, deontology, and virtue ethics to understand and evaluate situations involving mental health care.

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    Mental Illness & Substance Abuse

    20% of Canadians with mental illness also struggle with substance abuse.

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    Early Onset of Mental Illness

    70% of mental health problems start during childhood or adolescence.

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    Access to Mental Health Care

    Only about 1/3 of people who need mental health care actually receive it, often affected by factors like budget cuts.

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    Mental Health Services Gap

    Only 1/3 of Canadians needing mental health services receive them, leaving a significant gap in care.

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    Mental Illness & Homelessness

    People with serious mental illnesses are disproportionately affected by homelessness.

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    Mental Illness & Violence

    Individuals with mental illness are more likely to be victims of violence than perpetrators. The belief that they are dangerous increases stigma.

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    Violence & Other Factors

    Violent behaviors associated with mental illness are often linked to substance abuse or other contributing factors.

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    Diagnostic and Statistical Manual-V (DSM-V)

    A guide for mental health professionals to diagnose and classify mental disorders. It aims to reduce stigma and improve understanding.

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    Canadian Charter of Rights and Freedoms (Article 7, 9, 12)

    Protects Canadians' right to life, liberty, security of person, and freedom from arbitrary detention or cruel treatment.

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    Limits to Rights

    Limitations on rights can be enforced by law, to uphold democratic values, public order, and the well-being of Quebec citizens.

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    Force in Health Services (Quebec)

    Using force, isolation, or restraints in a healthcare setting is allowed only to prevent harm to the person or others.

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    What is chemical restraint?

    Medication used to subdue a patient, reducing their level of consciousness for safety. Think sedatives.

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    What is seclusion?

    A safety measure to isolate a patient in a room, sometimes with a locked door, to prevent harm.

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    What is coercion in mental health?

    Actions or pressures that try to force a patient to do something they don't want to do, often related to treatment.

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    What is the key difference between coercion and persuasion?

    Coercion involves pressure that removes free choice, while persuasion allows the patient to independently choose.

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    Formal vs. Informal Coercion

    Formal coercion is sanctioned by law, like forced hospitalization. Informal is pressure that is not legally mandated, like social pressure from loved ones.

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    What is perceived coercion?

    When a patient feels forced to do something, regardless of actual intent. It's about their subjective experience.

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    What is relational autonomy?

    Our choices are influenced by relationships. Individuals can be autonomous if given relational support.

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    What are some ethical challenges in using force in mental health?

    Balancing patient autonomy with safety. It's about using minimal force, only when necessary.

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    Why is documentation of force important?

    It's essential for accountability and transparency. To ensure that force used is appropriate and justifiable.

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    Study Notes

    Mental Health Ethics

    • The course NUR1 424 covers mental health ethics, including coercion, stigma, trauma, and violence-informed care.
    • Learning objectives include discussing ethical dimensions of mental health nursing, identifying risks to autonomy and beneficence (related to paternalism, coercion and power), analyzing the stigma's implications, and describing a trauma-informed approach.
    • Essential readings include "Nursing Ethics in Mental Health Cases," AI ethics online content, a handout on Trauma and Violence Informed Care (TVIC), and Mitchell, V.J. (2017) (prep reading).
    • Assessment includes final exam and case discussions, possibly online surveys in the module.

    Structure Today (Class 9)

    • The class content covers mental health ethics, coercion, stigma, trauma, and violence-informed care in mental health nursing.
    • Key learning objectives include understanding the ethical dimensions of mental health nursing practice, recognizing risks related to paternalism, coercion, and power, appreciating the impact of mental health stigma and how to apply a trauma and violence informed approach to ethical nursing practice, and analyzing mental health cases.
    • Required readings for the class include content relating to mental health ethics and nursing practices and cases.

    Context in Canada

    • The course will explore the contextual factors affecting mental health in Canada.

    Introduction to Mental Health Ethics

    • The introduction to mental health ethics will be covered within the course.

    Paternalism, Coercion, and Power in Mental Health

    • The course analyzes paternalism, coercion, and power dynamics in mental health nursing.

    Stigma and Nursing - Ethical Implications

    • Exploring stigma and its ethical implications in mental health nursing practices is part of this course.

    Trauma and Violence Informed Care - Ethical Implications

    • The course will examine trauma- and violence-informed care (TVIC) in ethical mental health contexts.

    Resource Allocation/Social Justice

    • Resource allocation and social justice in mental health are discussed, along with clinical needs versus psychosocial needs, treatments, deinstitutionalization, capacity and competence, diagnoses, and confidentiality concerns.

    Mental Illness in Canada

    • One in five Canadians experiences mental illness in their lifetime.
    • Twenty percent of those with mental illness also have a substance abuse problem.
    • Seventy percent of mental health issues begin in childhood or adolescence.
    • Mental illness affects all demographics, but some groups (low-income, marginalized, etc.) are at higher risk.
    • Indigenous populations face a disproportionate risk, with 30% showing symptoms of depression, suicide rates 5-7 times the national average, and 11 times higher in Inuit communities.

    Perceptions of Mental Illness (Media Representation)

    • Canadian news media often stigmatize people with mental illness.
    • A symposium targets journalism students to improve news coverage.

    Unmet Mental Health Care Needs

    • Over one-third (36.6%) of individuals with mental health disorders report partially or fully unmet healthcare needs.
    • This includes unmet needs for medication, information, counseling, and overall care.

    Mental Illness in Canada (Statistics)

    • Only one-third of those needing mental health services in Canada actually receive them.
    • Mental illnesses account for 15% of the disease burden and 5% of healthcare costs.
    • People with severe mental illness are disproportionately affected by homelessness.
    • Three (3) people commit suicide, and eight (8) are hospitalized for attempted suicide daily in Quebec.
    • Ninety percent (90%) of suicide attempts are preceded by a history of mental illness.

    Mental Illness & Violence

    • A belief that people with mental illness are dangerous increases stigma.
    • A small percentage of those with mental illness commit violent acts.
    • Most violent people do not have mental illness.
    • People living with mental illness are more likely to be victims of crime.

    Diagnostic and Statistical Manual V

    • Provides principles for diagnosing mental disorders, focusing on behavioral and psychological symptoms, outcomes, and the link to improved treatment.

    The Canadian Charter of Rights and Freedoms

    • Fundamental freedoms are enumerated, including freedom of conscience, religion, thought, belief, opinion, expression, peaceful assembly, and association.
    • The right to life, liberty, and security of person, the prohibition against arbitrary detention, and cruel and unusual treatment are guaranteed.
    • Additional details, rights, and specifics are provided for particular cases and circumstances, such as minority language rights, equality rights, and application.

    Quebec Charter of Human Rights and Freedoms

    • Every individual has a right to life, personal security, inviolability, freedom, and juridical personality.
    • Fundamental freedoms, such as conscience, religion, opinion, expression, peaceful assembly, and association are guaranteed to all.
    • The safeguard of dignity, honor, and reputation are also enshrined rights.
    • There's also a regard for democratic values, public order, and general well-being.

    An Act Respecting Health Services and Social Services (Quebec)

    • Addresses the legal obligations regarding the use of force, isolation, and mechanical/chemical means for controlling a person in a health institution, only to prevent self-harm or harm to others.
    • These measures must be minimal, exceptional, and appropriate to the person's physical and mental state.
    • Record keeping is mandatory, documenting the measures, timeframe, and behaviors.

    Ethics in Mental Health Nursing

    • Mental health nursing practice is unique and morally complex, impacted by forced hospitalization, refusal of care, functional changes due to mental illness, power imbalances, institutional histories, treatment ideologies, and moral distress. Relational autonomy is about considering real world considerations when patients make choices.

    Trauma and Violence Informed Care Principles

    • Trauma-informed care (TVIC) principles are grounded in understanding the impact of trauma and violence on individuals, creating safe environments, fostering opportunities for choice, collaboration, and connection, and supporting strengths-based coping and resilience strategies.
    • TVIC principles are central to recovery and aim at minimizing retraumatization through safety, choice, collaboration, and empowerment.

    The Loneliness Epidemic & Technology

    • Technology supports staying connected and social participation, but can also displace in-person engagement, reduce interaction quality, and potentially diminish self-esteem or cause online harassment.

    Artificial Intelligence

    • Artificial intelligence (AI), especially generative AI, is discussed in the context of mental health prevention and implementation in healthcare.
    • Potential ethical concerns, equity issues, and issues relating to academic integrity are discussed in the context of AI.

    Mental Health and Well-being: A Socio-Ecological Model

    • This model illustrates the interplay of personal, familial, and socio-cultural factors affecting mental health and well-being.

    Lack of Social Connection

    • Lack of social connection has substantial negative health effects (as significant as smoking 15 cigarettes a day)

    How Does Social Connection Influence Mental Health?

    • Social connection is significantly linked to mental health via biological, psychological, and behavioral factors.

    Learning Objectives

    • Specific learning objectives are provided, outlining the course's focus on AI characteristics, capacities, applications in healthcare, ethical considerations, and integration with personal, academic, and professional contexts related to ethics, equity, and academic integrity.

    References, including specifics for certain studies

    Additional information about different perspectives and definitions of coercion is provided.

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    Description

    Test your knowledge on the psychosocial challenges in mental health treatment, the impact of stigma, ethical considerations in patient care, and statistics surrounding mental illness in Canada. Engage with critical questions that delve into the historical context of deinstitutionalization and current demographic issues.

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