Mental Health Ethics NUR1 424 Class 9 PDF

MENTAL HEALTH ETHICS NUR1 424 – Class 9 Marianne Sofronas & Catherine-Anne Miller Structure Today NUR1 - 424 Mental Health Ethics The student will be able to: 1. Explore the contextual factors in mental health in Canada 2. Discuss the main ethical dimensions of mental health nu...

MENTAL HEALTH ETHICS NUR1 424 – Class 9 Marianne Sofronas & Catherine-Anne Miller Structure Today NUR1 - 424 Mental Health Ethics The student will be able to: 1. Explore the contextual factors in mental health in Canada 2. Discuss the main ethical dimensions of mental health nursing practice 3. Reflect on paternalism, coercion and power in mental health nursing 4. Discuss the implications of mental health stigma and link it to ethical nursing practice 5. Reflect on trauma & violence informed care (TVIC) in ethical nursing practice 6. Analyze mental health cases through the lens of ethical theories  01 Context in Canada Introduction to Mental 02 Health Ethics Paternalism, Coercion, CONTENTS 03 & Power in Mental Health 04 Stigma and Nursing – Ethical Implications Trauma and Violence 05 Informed Care – Ethical Implications Reflections  1- Context 1. Context use of restreins: ethical issue, can actually create more agitation two different books/system: physical/mental health (DMS5 for mental health) Some Ethical Questions in Mental Health Resource allocation / Social justice inconceptualize mental health care: often difficult to care outsial of social aspect (financial instability), often mental health= ○ Clinical issues vs. psychosocial needs (Justice) social injustice tx are multisystemic, can take long time, can be relational ○ Treatments are often relational and without “quick fixes” before: MH care in institutional, (psychartric ○ Deinstitutionalization movement (1960-70s) ward), pt stabilize = can live in society, instution closed, good and bad thing (budget, Competence/Capacity and Consent (Autonomy) ressources available) power imbalances already present, amplified ○ MH diagnosis & implication of incompetence +++ in MH ○ Forced treatment & confinement, restraints (coercion)autonomy: looked out differently ; risk analysis (is it Confidentiality and Privacy benificial/ safe for pt to take their onw decision) ○ Can patients with MI have an expectation of P&C? how much do we disclose for pt to have the ressources they need, without saying to much (landlord if pt needs to pay) how much info do you disclose to PAB ect.. what does it means: concept described as (firstly): stigmatized peopl, plp who doesn't have full social acceptance before they hade devalued ideas of themselves and tries to adapt to society -for him stigma= deviency, you are stigmatized because you have a deviant attitude impact of stigma on nurse Perceptions of Mental Illness How is Mental Illness Portrayed in the News? Media? Netflix? https://www.mentalhealthcommission.ca/wp- content/uploads/drupal/Stigma_Press_Releas e_March2012_ENG_0_4.pdf https://www150.statcan.gc.c a/n1/pub/11-627-m/11-627- m2023053-eng.htm Mental Illness in Canada 1 in 5 Canadians will experience mental illness in their lifetime Of these, 20% also have a substance abuse problem 70% of mental health problems have their onset in childhood or adolescence Although mental illness can affect anyone, some are at higher risk: ○ Low income earners, underemployed, single mothers ○ Children & adolescents exposed to violence & aggression ○ Workers who do repetitive work & have little decision-making power ○ Women who have been victims of sexual or domestic violence ○ Frail elderly who live at home (isolated) Source: CAMH  Mental Illness in Canada Indigenous populations are at even higher risk: 30% show symptoms of depression Suicide and self-inflicted injuries are the #1 cause of death in adults under 44 years of age Suicide rates in Indigenous communities are 5-7 times the national average Suicide rate in Inuit communities is 11 times the national average and among the highest in the world 1/3 of people who needs MH care actually receive it, impact by budjet cuts ect.. Source: Health Canada Unmet Health Care Needs Mental Illness in Canada Only 1/3 of those who need mental health services in Canada actually receive them 15% of burden of disease, 5% of health care $ People with serious mental illness are disproportionately affected by homelessness 3 people commit suicide and 8 are hospitalized for attempted suicide in Quebec each day 90% of suicide attempts are preceded by Hx of mental illness Source: CAMH, CMHA  Mental Illness & Violence Belief that people living with mental illness are dangerous —> fear, increases stigma People with mental illness comprise a small proportion of perpetrators of violence Most people who are violent do not have a mental illness People living with mental illness are far more likely to be the victims of crime rather than the perpetrators violent behaviours are present are more present when other factors involved, drugs, APA, 2004; Appleby et al., 2011; IOM, 2006  Diagnostic and Statistical Manual-V diagnose has to help you not just for stigma Stein et al., 2010  review of law #2 (PPT) Article 7: Everyone has the right Canadian to life, liberty and security of the Charter of person and the right not to be Rights and deprived thereof except in Freedoms accordance with the principles of fundamental justice. Article 9: Everyone has the right not to be arbitrarily detained or imprisoned. Article 12: Everyone has the right not to be subjected to any cruel and unusual treatment or punishment.  Article 1: Every human being has a right to life, and to personal security, inviolability and freedom. He also possesses juridical personality. Article 3: Every person is the possessor of the fundamental freedoms, including freedom of conscience, freedom of religion, Quebec freedom of opinion, freedom of expression, freedom of peaceful assembly and freedom Charter of of association. Article 4: Every person has a right to the Human Rights safeguard of his dignity, honour and reputation. and Freedoms Article 9.1: In exercising his fundamental freedoms and rights, a person shall maintain a proper regard for democratic values, public Chapter 1 order and the general well-being of the citizens of Québec. In this respect, the scope of the freedoms and rights, and limits to their exercise, may be fixed by law. outlines our legal rights and obligation for people who are presenting a danger to themselves -temporary confiniment -restriction -treatement all different and separate things Review to Content in Law #2 An Act Respecting Health Services and Social Services (Qc, c.S-4.2) legal obligation when using force 118.1. Force, isolation, mechanical means or chemicals may not be used to place a person under control in an installation maintained by an institution except to prevent the person from inflicting harm upon himself or others. The use of such means must be minimal and resorted to only exceptionally, and must be appropriate having regard to the person's physical and mental state. Any measure referred to in the first paragraph applied in respect of a person must be noted in detail in the person's record. In particular, a description of the means used, the time during which they were used and a description of the behaviour which gave rise to the application or continued application of the measure must be recorded. Every institution must adopt a procedure for the application of such measures that is consistent with ministerial orientations, make the procedure known to the users of the institution and evaluate the application of such measures annually.  physical restrains: -holding someone down -wrist/abdo restreins -pinel belt, bedside table ect.. need to be documented and justify as well as checs q h chemical restreins: -medication that later consciousness, sedative properties -only using the amount necessary seclusion: -isolation room -locking the door -separating someone from a group danger to themselves or someone else) https://www.oiiq.org/en/d ecider-d-installer-une- contention 2. Ethics in Mental Health Nursing ‘A Unique Moral Practice’ ‘Unique Moral 1. Forced hospitalization and forced treatment Practice’ 2. Refusal of care 3. Moral dimension due to functional changes caused by mental illness 4. Imbalance of power and institutional history 5. Differences in treatment modalities and ideologies 6. Moral distress Towards viewing autonomy as relational autonomy: in the law: you can take decision for yourself independently, in reality we are impacted by our relationship, patient can be autonomous if we offer relational support Hem, M. H., Gjerberg, E., Husum, T. L., & Pedersen, R. (2018). Ethical challenges when using coercion in mental healthcare: a systematic literature review. Nursing Ethics, 25(1), 92-110. 3. Paternalism, Coercion, & Power in MH different from law P38 cpercion opperates outside of a mandated care plan, any technic that we use to get patient to do what we want them to do, how pt expereince moment that were not meant to be coercion but felt like it for them -relies on the patient experience Coercion Defined Formal vs. Informal vs. Perceived Coercion – as a spectrum of pressures continuum Persuasion Interpersonal Inducements Threats Compulsory Leverage Treatment Szmukler, G., & Appelbaum, P. S. (2008). Treatment pressures, leverage, coercion, and compulsion in mental health care. Journal of Mental Health, 17(3), 233-244. Case Study Szmukler, G., & Appelbaum, P. S. (2008). Treatment pressures, leverage, coercion, and compulsion in mental health care. Journal of Mental Health, 17(3), 233-244.  compulsory threats( last coercive measure) persuation nurse recount how stopping md cause a relapse -explore possible of adjuting dose -reviewed the benefit of medication -appeal to reason interpersonal leverage nurse appears sad , shake her head, looks at the window while pt is talking, nurse is using the trusting relationship to put a pressure pt is gonna continue med to please the nurse not for himself inducement: -nurse gets ticket to canadien gae (which the pt can't afford) and says if you continue tx i will give you tickets threats -nurse reminding pt that he could be elligible to higher amount of financial aids, and nurse need to do paperwork which would take time, and nurse says i m not prepared to do this if you don't take your medicaiton Informal coercion in MHN Nurses' experiences with MH concerns: Impact of stigma, gender, compassion Struggling in silence: hiding suffering, diagnosis, need for leave from colleagues MH concern is a sign of weakness; accessing care in secret Fear of being 'found out' Concerns their competence as a clinician would be questioned Sofronas & McMillan (2025) 5. Trauma and Violence Informed Care  Equity-Oriented Healthcare non maleficience: do no harm, having approach that doesn't further traumatize, do more harm ect.. Trauma & Violence- Informed Care Cultural Harm Safety & Reduction Anti-Racism Image: Adapted from Wathen, C.N. & Varcoe, C. (2021). Trauma- & Violence-Informed Care (TVIC): A Tool for Health & Social Service Organizations & Providers. London, Canada. Retrieved at https://equiphealthcare.ca/files/2021/05/GTV-EQUIP-Tool-TVIC-Spring2021.pdf Trauma and Violence Informed Care Principles Understand Support Create Safety Foster C’s Impact Resilience Understand impact Create emotionally Foster Provide strengths- of trauma and and physically safe opportunities for: based and capacity- violence on environments for - Choice building peoples’ lives and both clients and approaches to behaviors service providers - Collaboration support client - Connection coping and resilience TRUST SAFETY CHOICE COLLABORATION EMPOWERMENT (Wathen & Varcoe, 2021) EQUIP Equity Essentials: Trauma- and Violence- Informed Care 6.21 minutes  Case Presentation 37 y.o. Mrs. T. Sought Asylum from Gyne issues Pakistan 5 years ago Depression Does not work (Case developed in consultation with Joanne Power, Advanced Practice Nurse, Gynecology/Oncology) How would the principles of TVIC inform how you would provide nursing care to Mrs. T? Applying TVIC Principles Understand Create Support Foster C’s Impact Safety Resilience Understand Create Foster Provide impact of emotionally opportunities strengths- trauma and and physically for: based and violence on safe - Choice capacity- peoples’ lives environments building and behaviors for both - Collaboration approaches to clients and - Connection support client service coping and providers resilience TRUST SAFETY CHOICE COLLABORATION EMPOWERMENT (Wathen & Varcoe, 2021, Kohler et al. 2021 ) Trauma and Trauma Awareness Violence- Emphasis on Safety & Trust Opportunity for Choice, Collaboration, and Informed Connection Strengths-Based and Skill Building Care Principles CENTRAL TO Trauma Informed Care Central belief that people can recover Grounded in Hope Deficit to Adaptive http://bccewh.bc.ca/wp- content/uploads/2012/05/ 2013_TIP-Guide.pdf adapting our language LANGUAGE MATTERS Wathen, C.N. & Varcoe, C. (2021). Trauma- & Violence-Informed Care (TVIC): A Tool for Health & Social Service Organizations & Providers. London, Canada. References Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care. BMC medical ethics, 15(1), 82. Hem, M. H., Gjerberg, E., Husum, T. L., & Pedersen, R. (2018). Ethical challenges when using coercion in mental healthcare: a systematic literature review. Nursing Ethics, 25(1), 92-110. Mitchell, V.J. Ethics and Mental Health Nursing in Chambers, M. (Ed.). (2017). Psychiatric and mental health nursing: the craft of caring. CRC Press. Mohr, W. K. (2010). Restraints and the code of ethics: An uneasy fit. Archives of Psychiatric Nursing, 24(1), 3-14. Norvoll, R., Hem, M. H., & Pedersen, R. (2017, March). The role of ethics in reducing and improving the quality of coercion in mental health care. In HEC forum (Vol. 29, No. 1, pp. 59-74). Springer Netherlands. Szmukler, G. (2008). Treatment pressures, coercion and compulsion in mental health care. Journal of Mental Health. References 2 Hall, A., McKenna, B., Dearie, V., Maguire, T., Charleston, R., & Furness, T. (2016). Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: A pilot study. BMC nursing, 15(1), 1-8. Kohler, R. E., Roncarati, J. S., Aguiar, A., Chatterjee, P., Gaeta, J., Viswanath, K., & Henry, C. (2021). Trauma and cervical cancer screening among women experiencing homelessness: A call for trauma-informed care. Women's Health, 17, 17455065211029238. Elizabeth Reeves (2015) A Synthesis of the Literature on Trauma-Informed Care, Issues in Mental Health Nursing, 36:9, 698-709, DOI: 10.3109/01612840.2015.1025319 Wathen, C.N. & Varcoe, C. (2021). Trauma- & Violence-Informed Care (TVIC): A Tool for Health. Retrieved at https://equiphealthcare.ca/files/2021/05/GTV- EQUIP-Tool-TVIC-Spring2021.pdf @ CC & Edward Hopper - http://www.artic.edu/aic/collections/artwork/111628  October 26th 2023 Mental Health, 6.53 Technology, and the epidemic of loneliness Bridge to the Ethics of AI in Healthcare 47 https://www.hhs.gov/sites/default/files /surgeon-general-social-connection- advisory.pdf 7/1/20XX What are words that are contrary to loneliness and isolation? 49 51 7/1/20XX Pitch deck title 52 Link to Mental Health 7/1/20XX Pitch deck title Technology Please fill in the survey ⓘ Start presenting to display the poll results on this slide.  THE LONELINESS EPIDEMIC & TECHNOLOGY + - Staying in touch Displaces in-person Social Participation engagement Finding community – Monopolized attention especially for individuals who are Reduces Quality of interactions pushed to margins Diminished self-esteem Information/Advice Emotional Support FOMO Online Harassment Pitch deck title 56 Artificial Intelligence What now? 7/1/20XX David is 35, lives alone and uses the app Sovie which allows one to monitor one’s mental health. David was curious about the app, so he decided to download it to his phone. Sovie collects various information, such as medication, diagnosed disorders, medical records, regular physical activities, daily teleworking activity, sleep time, meals, time spent for online entertainment and socialization, web browsing and viewing of online programming. With the use of high- performance algorithms, the app can assign a mood level and depression tendency to the user. Then, when necessary, the app alerts the user’s contacts as well as suicide prevention help lines. Lately, David has been feeling the need to seclude and has been ignoring the notifications sent by Sovie. A few days later, Sovie sends out an alert concerning David’s mental health to many of his friends as well and the suicide help line SOS Suicide. They decide to pay him a visit, leaving David perplexed. https://montrealdeclaration-responsibleai.com/integrating-the- ethics-of-ai-in-higher-education-a-toolkit/ Link To Online Content  Learning Objectives Describe the main characteristics and capacities of Artificial intelligence (AI), especially generative AI. Identify possible ways that AI is and will be implemented in healthcare. Recognize Articulate ethical considerations with AI in health care and in education. Reflect on personal, academic, and professional uses of AI as it relates to ethics, equity, and academic integrity.