Ethical Issues in Mental Health - Essay Example

Ethical Issues in Mental Health Introduction Ethics is a study of morality; the judgement of right and wrong. The question of right kind of ethics can arise for every piece of research method, conclusions arrived from the research, application of certain kind of theories or study of specific topics. A definition of ethics can be “A set of principles that embody or exemplify what is good or right, or allow us to identify what is bad or wrong” (Hammersley & Traianou, 2012, p.17). In mental health context, the need is to base compulsory treatment on strong ethics in order to prevent distortion of psychiatric practices by societal forces (Szmukler & Holloway, n.d., p.14). Human rights and the treatment of mental health According to WHO reports, 75 to 85 percent of mental patients do not have access to treatments, and almost 90 percent of mental patients remain unemployed. Moreover, they are denied the educational qualifications according to their potential (WHO, 2010). Human rights are the prerogative for every individual irrespective of his or her mental condition. Human rights provide the means of protection for people who suffer from all kinds of mental illness. In the context of human rights, every concerned authority like the government, hospitals and social services need to treat every patient suffering from mental illness with “fairness, equality, dignity and respect” (BIHR, 2006, p.6). Discrimination behaviors towards these people hinder them from getting appropriate treatment and integrating with the society (WHO, n.d.[2]). The general feeling is that human rights is a complex legal matter. However, human rights is matter of consideration in all aspects of human life from everyday events to medical treatment and legal issues. Most of the times, there is no need to find solution by taking the matter to court. Often, solution to a problem can be arrived at by proper discussions outside the court. In order to take full advantage of human rights, it is important to have basic knowledge about how human rights are implemented. The underlying theory is that every individual deserves equal amount of respect and dignity, and should be given fair treatment. The European Convention on Human Rights is one of the most important human rights agreements (BIHR, 2006, p.6). WHO (World Health Organization) helps to promote and implement progressive laws in the context of mental health as a way to protect the human rights of people suffering from mental illness. WHO provides technical help to all countries by setting up training workshops on regional and national level. Also, the organization arranges for distance learning programmes in order to provide all kinds of information and training in international human rights standards concerned with people suffering from mental illness. These programs and workshops also provide the knowledge of practical processes of developing and implementing progressive mental health laws (WHO, n.d.[1]). Mental health treatment and associated controversies It is a common phenomenon that for the treatment of patients suffering from mental illness, they are subjected to restraint and seclusion. Most of the times patients are hospitalized without give any consideration to their consent. The most common reason behind using restraints like “involuntary admission, forced medication, seclusion and restraint” (Kontio et al., 2010, p.66) is aggressive behavior that has the possibility to cause injuries to both the patients and others. Seclusion and restraint are considered as the most inhumane mode of psychiatric treatment available. Moreover, there are no sufficient scientific evidence that proves the medical effectiveness of seclusion and restraint in reducing aggressive behavior in mental patients. On the contrary there have been proofs that indicate the negative effects of seclusion and restrain like having traumatic effects on patients. In most countries, seclusion and restraint are controlled by legal regulations and recommendations. For instance, there are four rules to be complied with – 1) they can be used only when no other alternative treatment is having effect on the patient, 2) every possible safety precautions need to be taken, 3) patient’s dignity and self-respect should be protected in every way, and 4) seclusion and restrain can be used only in the presence of a physician (Kontio et al., 2010, p.66). Using seclusion and restrain on mental patients gives rise to ethical dilemmas for the staff. Firstly, the staffs have to confront their inner conflicts whether or not to subject patients to such harsh treatment. While both the options have pros and cons, the staffs hope for more independence in making choice of treatment rather than practices imposed on them. However, the drawback remains because of their commitment towards the patients on both professional and personal basis. Most staffs hope to establish a therapeutic relationship with patients that can be based on trust and confidence on the part of the patients for the nurses and physicians. Such effort from the staff can easily be neutralized by the practice of seclusion and restrain. Moreover, lack of scientific evidence supporting the ethical and medical effectiveness of such practice causes further ethical and professional conflicts for the staffs. Therefore, such ethical and legal considerations that jeopardize the professional identity of the staffs lead to the need for further research and development of alternative practice of treatment for patients suffering from mental illness in order to curb their aggressive behaviors. In spite of concrete evidence supporting the effectiveness of alternative methods, the major problem is that in most institutions there is technological and awareness deficiency in implementing such methods. Therefore, the focus should be on educating and training the staff so that they can properly use all kinds of treatment processes related to psychiatry. According to Kontio et al. (2010, p.66), for proper education of the staff there can be programmes in “clinical leadership, change management, monitoring of seclusion and restraint episodes, and change to a more therapeutic environment”. A study was conducted on 22 nurses and 5 physicians to learn about their perspectives regarding seclusion and restrain. They expressed their views on management of patients’ aggressive behavior before, during and after seclusion and restrain. In the first phase, i.e. before seclusion and restrain, the staffs prefer to make communication with the patients to understand their perspectives regarding how they should be treated, whether they have displayed aggressiveness before and whether seclusion and restrain had any positive impact on them. Also, the staffs feel most ethical dilemma when they have to simultaneously consider both patients’ and others’ best interests. Often when patients are out of control with their aggressive behavior, the staffs need to make instant decisions without any time to consult with other physicians. During such situations, the staffs often end up feeling guilty for not being able to find any alternative solution. In the second phase, i.e. during seclusion and restrain, the staffs remain close to the patients and ensure that they are subjected to minimum discomfort. This results in giving less attention to other patients which causes guilt among the staff. In the final phase, i.e. after seclusion and restrain, the staffs usually feel exhausted and helpless, but have to overcome those feelings to concentrate on more urgent issues like writing reports. The staffs also, at this stage, feel the need to discuss seclusion and restrain situations with multidisciplinary teams and managers (Kontio et al., 2010, pp.68-69). Therefore, there is much need of care for mental patients where the staff learns the reasons behind the aggressiveness of the patients, and accordingly discusses alternative methods of treatments with the patients. Patients’ rights when being treated for mental illness in UK In UK, there is a law that allows “detention and compulsory treatment” of patients with mental illness. By detention, it means a patient is forcefully admitted to a hospital without taking his or her concern. According to the European Convention on Human Rights, all people with mental disorder have three human rights – 1) the patients cannot be treated in cruel and inhuman manner under any circumstances, 2) the patients should have the right to maintain family and private life, and can maintain contact with family and friends, 3) the patients have the right to liberty (BIHR, 2006, p.12). In general people with serious mental disability are subjected to inhuman treatments. However, the seriousness of mental illness depends on the circumstances of the concerned patient which means factors like age, gender, condition of health and time phase of the treatment are taken into consideration. For instance, there is a difference between forcing an old and frail person to stand against a wall for several hours and forcing the same on a young and healthy person. Although both cases are considered as unacceptable, the impact will be more adverse for the old person. In other cases, the staffs’ treatment may not be deliberate like not changing sheets or keeping the patient under sedation due to lack of staff. Such treatments, although intentional, are considered as inhuman or degrading treatment, as this causes violation of human dignity. Then there is the issue of treatment without consent which is not considered as inhuman under circumstances where there is legal evidence that the concerned patient does not have the mental capacity to make any kind of decisions (BIHR, 2006, pp.13-15). Also, all mental patients have the right to maintain family life, i.e. their rights are violated if they are separated from their children or other family members. In cases whether the mother is suffering from a mental illness that can cause harm to her new born baby, it is not legal to separate the baby from the mother since it violates the right of the mother to take care of her baby. In such a case, the Court’s instruction is to find other mitigating course of action like keeping the mother and baby under constant supervision. Therefore, it is the responsibility of public authorities like government agencies and social services departments to consider actions that are less restrictive for the patients before interfering with their family life (BIHR, 2006, pp.19-20). Ethical theories Situation ethics In situation ethics, the judgement process of right and wrong depends on the specific situation. Since, in case of mental health patients, each patient is unique therefore there cannot be any universal moral rules and rights. For mental health professionals, there are certain ethical codes to be followed that are compatible with their principles and values related to their profession. However, such ethical codes can be difficult to maintain since each mental patient can have unique problem that cannot be solved by conventional methods. Therefore, in situation ethics it is not always possible to come up with a logical solution to ethical dilemmas. Although feelings of love and care are also important while dealing with mental patients, these are nevertheless abstract concepts. Therefore, a mental health professional needs to provide valid reasons that support his ethical judgements (Ford, 2000, p.76). However, one weakness of this theory is that since the final outcome cannot be predicted, therefore it is not possible to determine whether the action taken will have positive consequences. Utilitarianism According to utilitarianism, “what is good is that which promotes the happiness of the greatest number of people” (Gould, 2010, p.61). In the field of mental health, this can be problematic as it may indicate forceful treatments for the betterment of the society resulting in violating the civic liberties of the patients. In an economist’s perspective, mental disorders like depression and anxiety can have negative financial impact on the society. Therefore, the need is to design programs that will relief patients from depression and anxiety and enhance their happiness. However, the programs need to be designed to produce economic benefits for the broader society. The drawback of this is that by making economic utility a condition, such programs tend to create class differentiations among mental health service users (Gould, 2010, p.61). Conclusion Often a mental health professional is confronted with ethical dilemmas during the course of his career. The problem lies in making decisions regarding own conduct or the conduct of the patient. It is necessary that any ethical problems be identified at an early stage so that such problems do not rise to the point of having harmful impacts. Often the problem is unintentional but for professionals it becomes inevitable to deal with the problem. For a mental health professional, his future career prospects depend largely on how he tackles ethical problems. To make effective response the factors required are “developed skills, planned resources, the right information, and a preestablished ethical awareness” (Koocher & Keith-Spiegel, 2007, p.4). References BIHR (2006). Your Human Rights: A Guide for people living with mental health problems, BIHR, retrieved on June 24, 2014 from: http://www.bihr.org.uk/sites/default/files/bihr_mental-health_guide.pdf Ford, G.G. (2000). Ethical Reasoning in Mental Health Professions, CRC Press Gould, N. (2010). Mental Health Social Work in Context, N.Y.: Routledge Hammersley, M. & Traianou, A. (2012). Ethics in Qualitative Research: Controversies and Contexts, London: SAGE Publications Kontio, R. et al. (2010). Patient restrictions: Are there ethical alternatives to seclusion and restraint? Nursing Ethics, 17(1), 65-76 Koocher, G.P. & Keith-Spiegel, P. (2007) Ethics in Psychology and the Mental Health Professions: Standards and Cases, Oxford Univ. Press Szmukler, G. & Holloway, F. (n.d.). Mental Health Law: Discrimination or Protection? King’s College London, retrieved on June 24, 2014 from: http://admin.iop.kcl.ac.uk/maudsley-publications/maudsley-discussion-papers/mdp10.pdf WHO (2010). People with mental disabilities cannot be forgotten, WHO, retrieved on June 24, 2014 from: http://www.who.int/mediacentre/news/releases/2010/ mental_disabilities_20100916/en/ WHO (n.d.[1]). Mental Health, Human Rights and Legislation, WHO, retrieved on June 24, 2014 from: http://www.who.int/mental_health/policy/legislation/policy/en/ WHO (n.d.[2]). WHO Mental Health and Human Rights Project, WHO, retrieved on June 24, 2014 from: http://www.who.int/mental_health/policy/mental_health_and_ human_rights_october_2006.pdf?ua=1 Read More