Human Rights and Mental Health Care Policies: Caregivers and Users - Essay Example

? Human Rights and Mental Health Care Policies: Caregivers and Users Human rights and mental health care policies: caregivers and users Introduction Mental health care and services is a topic that attracts various perspectives (Byrick & Walker-Renshaw, 2012), of course in different circumstances, depending on the kind of the patient or on the kind of mental health/disorder. Mental health care legislation is a health care discipline that assesses the necessary laws, suggests necessary interventions and fosters their implementation. In the health industry, mental health issues often lack static interventional approaches and may lead to breaching of specific rules and policies that medical institution values especially during medication and general handling of a patient (The Carter Center, 2013). Human rights on the patient’s part and on the relatives’ part pose some dilemmatic choices (Bailey, 2004; MindFreedom International [MFI], 2013) during all procedures that are to be carried out on a patient. Similarly, policies governing the medical practitioners’ practices do not always work towards expectations of the medical practitioners, the patients’ and/or the relatives of the patient. Medical practitioners, therefore, may be forced to use instinctual approaches at the cost of breaching the working policies; yet, such policies govern the practices of medical practitioners. Ethical responsibilities too count not to mention the principles that guide the predetermined and the instinctual approaches to mental health attention (Bloch, Chodoff & Green, 2009). While both the caregivers (attending medical practitioners and family members) and the care users (the patients and their family members) are importantly governed by some policies, they too often face dilemmas in making some of the medical decisions. In other words, such among others are the factors that affect health care service legislation. This paper analyses some of these factors and derives a critical analysis of such areas as human rights in health care delivery versus human consent (users and caregivers) (Roberts, 2002), various related Health Acts, implementation of these Acts, their efficacy and suitability, and the other linked-in issues such as mental capacity and the Bournewood Gap. Other issues include stereotypes and stigma (Corrigan & Watson, 2004), which are special cases that are subject to personal opinion. The importance of this study is pinned to the fact that mental illnesses are quite different from other illnesses – mental illnesses are uniquely addressed and treated while mentally ill patients are differently handled. Human rights Overview The mental health issues affect both the caregivers and the users of the health care services (Byrick & Walker-Renshaw, 2012). Health care users are the patients, but can also extend to their family members especially during the making of major health care decisions (Hoop, DiPasquale & Hernandez, 2008). The caregivers are the nurses (medical practitioners) who must determine the best interventional procedures on the mentally ill patients while still abiding by the stipulated mental health policies (Department of Health, 2013), and family members who must follow advices from the responsible medical practitioner. In-between are policies that mostly reflect procedures that manifest best interest in positive health outcome of the patient (The Carter Center, 2013). More often than not, there occur conflicts of interests in handling of the patients, making major decisions regarding the patients’ mental health condition and the general handling of the patients (MFI, 2013). While the responsible medical practitioners’ mission is to ensure the best health outcome of the patient in question, there are some barring or rather binding rules and moral standings that often lead to dilemma in terms of the best step to take (Bailey, 2004). Legal rights According to Bartlett and Sandland (2007), all human beings are entitled to legal rights to refuse various medical procedures potentially to be carried out on their bodies. However, when it comes to mental health, the capacity for the patient with mental health illness to make major decisions derives confusion. It is obvious that, depending on the kind of illness the patient is diagnosed with, mentally ill patients are unstable. A number of authors – Epstein and Simon (1990); Fan (1997); Ernst, Cohen and Stone (2004); Cohen and Kemper (2005) – finds it worth to leave the matter to the discretion of the mental health practitioner responsible. However, for the need to protect the health medical practitioners especially regarding health outcomes, the mental health policies pop in, obviously thwarting the freedom of the medical practitioners to make critical decisions about the patients. Moral rights and moral responsibility The moral responsibility of a medical practitioner and those of the patient are dependent on the existing health care services delivery policy (Byrick & Walker-Renshaw, 2012). The medical practitioner must always work towards the best health outcome of the patient (Department of Health, 2013), however. In the meantime, the dependability of the patients to make moral decisions about is dependent on the kind of illnesses they are suffering from. For mentally unstable patients who are unable to make vital decisions, or are not old enough to make vital decisions such as refusal to medication, the medical practitioner may be entitled to make the right decision on behalf of the patient. The service user movements and stakeholder participation The Mental Health Service User Movement is a group of individuals in the UK who have previously been diagnosed with mental illnesses and who fight discrimination of the mentally ill people. They are the end users of the medical interventions various health institutions resort to. They find, for instance, various Mental Health Acts wanting and discriminating. For example, according to Wallcraft and Bryant (2003), under the Mental Health Act 2007, they discover racial favoritism in the England. The prevalence of such a movement suggests, among other things, one major concern: health care services policies do not completely mean proper health care (National Institute of health and Clinical Excellence [NICE], 2011) and the society depends on the pressure groups in this context. Surely, mental health care policy has graduated to becoming a matter of public attention (Hoop, DiPasquale & Hernandez, 2008). The public (the receiving end) forms the users who, upon realization of their rights, have engaged the planners and/or the policy makers in their appraisals (The Carter Center, 2013) – it is all about the entire affected stakeholders’ participation. In their study, Doel, Carroll, Chambers et al (2007) underpin the necessity of participation of all the stakeholders in health policy making processes – they indicate a number of benefits to the society in terms of health outcome trends and the awareness of the public (Doel et al, 2007). Bournewood Gap Related to a case between a patient with autism and the Bournewood hospital presented to the European Court of justice (The College of Social Work, 2013), Bournewood gap is the incapacity to determine the liberty of a patient (SourceUK, 2006). The liberty of the patient so referred to herein is that of movement and that of the patient’s relatives to visit or see the patient (SourceUK, 2006). This reverts back to the issue of rights of the patient (SourceUK, 2006; The College of Social Work, 2013) as discussed above. The efforts of movements such as the England’s Users Movement and the Mental Health Act 2007 (Mind, 2013) are geared towards closing Bournewood gap; that is, making a once and all statement about the liberty of a patient in this context. Labor In labor, the determination as to whether a mentally ill person may be allowed to work in a particular industry – that is, determining whether a supposedly mentally unstable patient can work without causing losses or endangering his or her life (Surgeon General of the United States, 1999) – is another bone of contention mental health issues. Department of Labor (DOL) (2012) emphasizes on the need to ensure that each patient gets enough medications and consumer advice especially when mentally ill engage in some economic activities. According to DOL (2012), group health plans and health insurances issuance and benefits, as suggested by the Mental Health Parity and Addiction Equity Act 2008, must be closely governed to ensure mentally unstable people get maximum and timely care (Department of Health, 2013). Shared responsibility Most of the time, the care and the health outcomes of the mentally ill patients are left on the shoulders of the medical practitioners. The various psychotherapies required for such patients, according to the American Psychiatric Association (APA) (2003) and Gelder, Lopez-Ibor and Andreasen (2009), require a shared responsibility among the patient, the medical practitioner and the patient’s relatives. The relatives often provide moral and nursing support to the patients and sometimes they make major decisions (Gelder, Lopez-Ibor & Andreasen, 2009). In other words, there has to be a concrete coordination among the three arms of the patient’s care. Stereotypes and stigma on the patient, which often results from family members and the society, are only unfortunate endings (Corrigan & Watson, 2004; Doel et al, 2007). Inhumane as such ordeals are, according to Corrigan and Watson (2004), there are no viably concrete legislative means to deal with stigma and stereotypes because they are mostly stealthy. Patient’s and family members’ consent The medical practitioner’s must seek patient’s consent before major decisions on his or her health (Department of Health, 2013). The patient may be represented by the family members. Both Mental Capacity Act 2005 (Mental Health Foundation [MHF], 2013) and Mental Health Act 2007 support this patient’s protection and too, unbind the attending medical practitioner from the blame and/or incrimination for the health outcomes of the patient (Roberts, 2002; Mind, 2013). However, the beneficence rule may apply because the best health outcome of the patient makes the complete objectives of the responsible physician’s mission. Health Acts Health Acts are (assemblages of) law statements meant to be references and guides for the medical practitioners. They serve to protect the caregivers and the care service users. Mental Capacity Act 2005 and the Mental Health Act 2007 The Mental Capacity Act 2005 was established to determine the conditions that permit the patient to make sound decisions (National Health Service [NHS], 2013). The major determinants are age, level of illness and resilience (in learning and retention of what is learned) (MHF, 2013; NHS, 2013). The Mental Capacity Act 2005 emphasizes on own decision making as much as possible where the patient is helped by all means possible (NHS, 2013) in this context. The Mental Health Act 2007 is an improvement of Mental Health Act 1983 and a complement to the Health Capacity Act 2005 (Mind, 2013). It was created to protect the patients who lack the capacity to make rational decisions about their health including prevention of suicidal decisions. It also defines limits for both the medical practitioner and the patients in making major decisions about the patient’s health care proceedings (Gabbard & Lester, 2008). Aforementioned, it provides a solution to Bournehood gap by providing patients liberty privileges and the physician’s freedom of discretion (Smith-Bell & Winslade, 1994; Roberts, 2002). Ethical dilemmas While the Mental Health Act 2007 allows the medical practitioner freedom to make particular decisions without seeking the patient’s consent (the beneficence rule), the liberty of the patient pops in to contradict the efforts (Roberts, 2002). It may become necessary to lock down a patient who may endanger his or her life if discharged and set free but then the patient’s liberty and rights are breached (Bailey, 2004). In the meantime, the relatives may file a petition if a bad health outcome is realized. From such a confusion matrix, the end decision determines the health outcome of the patient anyway – this is gambling with the patient’s health. Health policies implementation Similar dilemmas occur during implementation of mental health laws. There is a matrix of confusion caused by disagreements regarding who decides what – is it the physicians, patients, the family members or what combination? Implementation of mental health policies inherently becomes difficult because of the tension between the rights of the patients and the limits to the physicians, yet, it is the patient that suffers poor health outcomes in the long run (Bailey, 2004). So such mental health acts as indicated above plus the user movements have not been able to find a completely fitting law. Reaching a consensus will require all stakeholders’ participation in decision making so as to redefine the existing mental health laws. Conclusion Policy makers in the mental health window have a hard task to involve the quite alarmed societies following the prevalence in health care disparity (Hoop, DiPasquale & Hernandez, 2008; NICE, 2011). The establishment of groups such as the England service user movement only depicts a problem in the society in this context. Similarly, the proposal of multilateral participation of all affected stakeholders is quite congruent to the presupposition of such movements such as the service user movement as depicted above. Mental health issues are not a one-man matter to consider. First is the understanding that the health welfare of a patient attracts multilateral attentions; the patient, the health physician responsible, the family members affected, the immediate society and the government developmental agenda regarding mental health trends. The previous statement underpinning the necessity of coordination among the roles of the key affected stakeholders is fundamental to the health care services delivery system in operation (Simon, 1992; NICE, 2011). The public awareness does not deter the attending physician to do the right thing (Bloch, Chodoff & Green, 2009) but it enhances easy mental health care delivery (Simon, 1992). After all, various ordeals that patients are prone to such as stigma, racial bias (Gbadegesin, 1998; APA, 2003) and stereotypes are easily overcome. Mental health awareness among the general public must be emphasized as effective approaches to mental health care service delivery – mental illnesses are multifaceted. They are functions of physical, psychological and sociological disorientations (Gbadegesin, 1998; Gelder, Lopez-Ibor & Andreasen, 2009). The fight to protect the service user probably exceeds that aimed at protecting the medical practitioner. There are suggestions that, for instance, there must be a continued supply of quality medicine to the mentally ill. However, the protection of the medical health practitioners and their respective professions is so feeble and sometimes they are barred from doing the right thing (making the right decision concerning the health of the patient). Bournewood hospital is an example of an institution sued for supposedly doing the right thing about the illness of a particular patient. Mental health Act 2007 perhaps offers the best tool so far; however, the prevalence of such pressure groups as the service user movement and others depict a problem in the mental health scope. There exists a boundary line between the legal rights of the patients and the limits to the freedom of the physician involved (Gabbard & Lester, 2008). A good example is the legal rights of a patient to refuse medication whereof the physicians perceive all needs for such a medication for the sustenance of the health of a patient. Mental health illnesses present a rather dramatic scenario in which the patient is in no position to make a decision. Most patients with dementia, for instance, may not be better placed to make decisions even if they are the main beneficiaries in the bargain. The legal rights of the patient are in league with the freedom of the physician to impose whatever medical and other therapeutic procedures he or she may deem necessary. They are two parallel needs that many health policies have not been able to merge into a concrete solution. The Mental Health Act 2007 provides for the application of the beneficence rule in which the attending physician have all the rights to impose any medical procedure he deems necessary at which point the patient is unable to make sensible decisions about his or her own life. At the same time, the study on the Bournewood gap depicts a possible breach of common law that works with the legal rights of the patient (as in the court of law) by denying the patient’s liberty and comfort of movement say. Such scenarios bring into being the culture of ethical dilemma among medical practitioners (Surgeon General of the United States, 1999) which alters the attention and focus of the attending physician to the health welfare of the patient. There has to be a complete redefinition of the mental health-related laws that allows for compromises between the health care delivery channels and the user (NICE, 2011). References American Psychological Association (APA). 2003. Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, pp.377-402. Bailey, S. B. 2004. Approaching ethical dilemmas. Monitor on Psychology, 35, p.9. Bartlett, P. & Sandland, R. 2007. Mental Health Law: Policy and Practice. 3rd ed. Oxford, NY: Oxford University Press. Bloch, S., Chodoff, P. & Green, S.A. (Eds.). 2009. Psychiatric Ethics. 3rd ed. New York: Oxford University Press. Byrick, K. & Walker-Renshaw, B. 2012. A Practical Guide to Mental Health and the Law in Ontario. Accessed on 04/05/2013 from Cohen, M.H. & Kemper, K.J. 2005. Pediatric use of complementary therapies: Ethical and policy choices. Pediatrics, 116: 4, pp.568-75. Corrigan, P.W. & Watson, A.C. 2004. Stop the stigma: Call mental illness a brain disease. Schizophrenia Bulletin, 30: 3, pp.477-79. Department of Health. 2013. Policy – Making mental health services more effective and accessible. Accessed on 02/05/2013 from Department of Labour (DOL). 2012. DOL FAQs Address MHPAEA Compliance. Accessed on 04/05/2013 from Doel, M., Carroll, C., Chambers, E. et al. 2007. Developing measures for effective service user and carer participation – Stakeholder Participation Position Paper 09. United Kingdom: Social Care Institute for Excellence. Epstein, R.S. & Simon, R.I. 1990. The Exploitation Index: An early warning indicator of boundary violations in psychotherapy. Bulletin of the Menninger Clinic, 54, pp.450-65. Ernst, E.E., Cohen, M.H. & Stone, J. 2004. Ethical problems arising in evidence-based complementary and alternative medicine. Journal of Medical Ethics, 30, pp.156-9. Fan, R. 1997. Self-determination vs. family-determination: Two incommensurable principles of autonomy – A report from East Asia. Bioethics, 11: 3-4, pp.309-22. Gabbard, G.O. & Lester, E.P. (Eds.). 2008. Boundaries and boundary violations in psychoanalysis. New York: Basic Books. Gbadegesin, S. 1998. Bioethics and cultural diversity. In H. Kuhse & P. Singer (Eds.), A companion to bioethics. Oxford, UK: Blackwell. Gelder, M., Lopez-Ibor, J.J. & Andreasen, N. (Eds.). 2009. New Oxford textbook of psychiatry. Cambridge, UK: Oxford University Press. Hoop, J.G., DiPasquale, T. & Hernandez, J.M. 2008. Ethics and Culture in Mental Health Care. Ethics & Behaviour, 18: 4, p. 353-72. Mental Health Foundation. (MHF). 2013. The Mental Act 2005. Accessed on 04/05/2013 from Mind. 2013. Mental Health Act. Accessed on 04/05/2013 from MindFreedom International (MFI). 2013. MindFreedom - Stop Human Rights Abuses in the Mental Health System. Accessed on 04/05/2013 from National Health Service (NHS). 2013. Managing someone's legal affairs – Mental Capacity Act. Accessed on 04/05/2013 from National Institute of health and Clinical Excellence (NICE). 2011. Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services. NICE Clinical Guideline 136. p.4-40. Roberts, L.W. 2002. Informed consent and the capacity for voluntarism. American Journal of Psychiatry, 159: 5, pp.705-12. Simon, R.I. 1992. Treatment boundary violations: Clinical, ethical, and legal considerations. The Bulletin of the American Academy of Psychiatry Law, 20: 3, pp.269-88. Smith-Bell, M. & Winslade, W.J. 1994. Privacy, confidentiality, and privilege in psychotherapeutic relationships. American Journal of Orthopsychiatry, 64: 2, pp.180-93. SourceUK. 2006. Closing the Bournewood Gap. Accessed on 01/05/2013 from Surgeon General of the United States. 1999. Mental health: A report of the surgeon general. Washington, DC: U.S. Department of Health and Human Services. The Carter Center. 2013. Mental Health Program. Accessed on 04/05/2013 from The College of Social work. 2013. Mind the Bournewood Gap - the story of the deprivation of liberty safeguards (DoLS). Accessed on 30/04/05 from Wallcraft, J. & Bryant, M. 2003. The mental health service user movement in England – Policy Paper 2. London, UK: The Sainsbury Centre for Mental Health. Read More