Mental Health Ethics Slides 2024 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 nursin...

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  01 Context in Canada Introduction to 02 Mental Health Ethics CONTENT 03 Paternalism, Coercion, & Power S in Mental Health 04 Stigma and Nursing – Ethical Implications Trauma and 05 Violence Informed Care – Ethical Reflections  1- Context 1. Context Some Ethical Questions in Mental Health Resource allocation / Social justice ○Clinical issues vs. psychosocial needs (Justice) ○Treatments are often relational and without “quick fixes” ○Deinstitutionalization movement (1960-70s) Competence/Capacity and Consent (Autonomy) ○MH diagnosis & implication of incompetence ○Forced treatment & confinement, restraints (coercion) Confidentiality and Privacy ○Can patients with MI have an expectation of P&C? Perceptions of Mental Illness How is Mental Illness Portrayed in the News? Media? Netflix? https://www.mentalhealthcommission.ca/wp-c ontent/uploads/drupal/Stigma_Press_Release _March2012_ENG_0_4.pdf https://www150.statcan.g c.ca/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 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 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 APA, 2004; Appleby et al., 2011; IOM, 2006 Diagnostic and Statistical Manual-V Stein et al., 2010  Article 7: Everyone has the right Canadian to life, liberty and security of the Charter of person and the right not to be Rights deprived thereof except in and accordance with the principles Freedoms 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. Quebec Article 3: Every person is the possessor Charter of of the fundamental freedoms, including freedom of conscience, freedom of religion, freedom of opinion, freedom of Human expression, freedom of peaceful assembly and freedom of association. Rights Article 4: Every person has a right to the safeguard of his dignity, honour and and reputation. Article 9.1: In exercising his Freedoms fundamental freedoms and rights, a person shall maintain a proper regard for democratic values, public order and Chapter 1 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. Review to Content in Law #2 An Act Respecting Health Services and Social Services (Qc, c.S-4.2) 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 https://www.oiiq.org/en/d ecider-d-installer-une-con tention  2. Ethics in Mental Health Nursing ‘A Unique Moral Practice’ ‘Unique 1. Forced hospitalization and forced treatment Moral 2. Refusal of care 3. Moral dimension due to functional changes Practice’ 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 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, & Coercion Defined Formal vs. Informal vs. Perceived Coercion – as a spectrum of pressures 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. 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 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 Understan Create Support Foster C’s d Impact Safety Resilience Understand Create Foster Provide impact of emotionally and opportunities strengths-based trauma and physically safe for: and capacity- violence on environments - Choice building peoples’ lives for both clients approaches to and behaviors and service - Collaboration support client providers - Connection coping and resilience COLLABORATI EMPOWERME TRUST SAFETY CHOICE ON NT (Wathen & Varcoe, 2021) EQUIP Equity Essentials: Trauma- and Violence-Informed Care 6.21 minutes  Case Presentation 37 y.o. Mrs. T. Sought Asylum Gyne issues from Pakistan 5 Depression years ago 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 Underst TVIC Principles Support Create Foster and Resilien Safety C’s Impact ce Understand Create Foster Provide impact of emotionally opportuniti strengths- trauma and and es for: based and violence on physically - Choice capacity- peoples’ safe building lives and environmen - approaches behaviors ts for both Collaboratio to support clients and n client service - coping and providers COLLABORATI Connection EMPOWERME resilience TRUST SAFETY CHOICE ON NT (Wathen & Varcoe, 2021, Kohler et al. 2021 ) Trauma Trauma Awareness and Emphasis on Safety & Trust Opportunity for Choice, Collaboration, Violence- and Connection Strengths-Based and Skill Building Informed 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 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-Spring2 @ CC & Edward Hopper - http://www.artic.edu/aic/collections/artwork/111628  October 26th 2023 Mental6.53Health, Technology, and the epidemic of loneliness Bridge to the Ethics of AI in Healthcare  https://www.hhs.gov/sites/default/files/ surgeon-general-social-connection-ad visory.pdf 7/1/20XX What are words that are contrary to loneliness and isolation? 7/1/20XX Pitch deck title  Link to Mental Health 7/1/20XX 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 Reduces Quality of individuals who are pushed to interactions margins Diminished self-esteem Information/Advice FOMO Emotional Support Online Harassment  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-et hics-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.