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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Newton-Howes G, Walker S, Pickering NJ. Epistemic problems with mental health legislation in the doctor-patient relationship. JOURNAL OF MEDICAL ETHICS 2023; 49:727-732. [PMID: 36697216 DOI: 10.1136/jme-2022-108610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Mental health legislation that requires patients to accept 'care' has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislation that creates an environment that fundamentally unbalances the doctor-patient relationship. Significant positive reasons to counterbalance this are needed to justify the continuation of such legislation.
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Affiliation(s)
- Giles Newton-Howes
- Department of Psychological Medicine, University of Otago Medical School, Wellington, New Zealand
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McCusker P, Gillespie L, Davidson G, Vicary S, Stone K. The United Nations Convention on the Rights of Persons with Disabilities and Social Work: Evidence for Impact? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6927. [PMID: 37887665 PMCID: PMC10606596 DOI: 10.3390/ijerph20206927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
The United Nations Convention on the Rights of Persons with Disabilities (hereafter CRPD) has provided a radical imperative for the reform of mental health and capacity legislation around the world. The interpretation of the CRPD has been controversial, ranging from the complete abolition of detention, forcible treatment, and substitute decision-making to accepting that elements of these measures need to be retained based on non-discriminatory criteria, additional safeguards, and a comprehensive shift towards supported decision-making. While the potential effects of the CRPD on mental health social work and social work generally are considerable given their shared commitment towards social justice, to date there has been no review of research evidence exploring their relationship. In addressing this knowledge gap, this study held a preliminary discussion with practitioners and academics at the European Association of Social Work Mental Health Special Interest Group in Amsterdam 2022, followed by a scoping literature review on the question: What impact, if any, has the CRPD had on social work practice? The review produced four main findings: impact on legislation; positive impact on practice; limited impact on practice; and impact on social work education and research. In sum, while there were some positive indications of social work and mental health social work practice being influenced by the CRPD, these were scant. Barriers to change included tendencies among some social workers to practise substitute decision-making, in part related to resourcing and policy contexts, and understandings of disability aligned to individualised/medical rather than social perspectives. The results indicate that legal reform on its own is insufficient to impact social work practice, and that realising the potential of the CRPD will necessitate good quality training, as well as improving social workers' knowledge of the human rights of people with mental impairment.
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Affiliation(s)
- Pearse McCusker
- School of Social and Political Science, The University of Edinburgh, Edinburgh EH8 9LD, UK; (P.M.); (L.G.)
| | - Lauren Gillespie
- School of Social and Political Science, The University of Edinburgh, Edinburgh EH8 9LD, UK; (P.M.); (L.G.)
- Advanced Care Research Centre, The University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Gavin Davidson
- School of Social Sciences Education and Social Work, Faculty of Arts, Humanities and Social Sciences, Queens University Belfast, Belfast BT7 1NN, UK
| | - Sarah Vicary
- School of Health Wellbeing and Social Care, Faculty of Wellbeing Education and Languages, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK;
| | - Kevin Stone
- Centre for Lifelong Learning, The University of Warwick, Coventry CV4 7AL, UK;
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Berring LL, Georgaca E. A Call for Transformation: Moving Away from Coercive Measures in Mental Health Care. Healthcare (Basel) 2023; 11:2315. [PMID: 37628513 PMCID: PMC10454462 DOI: 10.3390/healthcare11162315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Coercion is common practice in mental health care [...].
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Berring LL, Bak J, Hvidhjelm JC. National Strategies to Reduce the Use of Coercive Measures in Psychiatry in Denmark - A Review of Two Decades of Initiatives. Issues Ment Health Nurs 2023; 44:35-47. [PMID: 35849544 DOI: 10.1080/01612840.2022.2089788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Coercive measures are a major infringement of the autonomy of psychiatric patients and no medical justification exists for applying mechanical restraint (MR) to these patients currently. Knowledge regarding how preventive strategies affect the use of MR is limited. This paper aimed to understand the link between the initiatives taken by national authorities and the practical implications to MR reduction. Policy texts and the number of coercive measures used in two decades were reviewed. Trends were discussed with five experts with real-life experience and suggestions were obtained regarding how to end the use of mechanical restraint in mental health care settings.
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Bak
- Clinical Mental Health and Nursing Research Unit, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services in the Capital Region of Denmark, Roskilde, Denmark
| | - Jacob Christian Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services in the Capital Region of Denmark, Roskilde, Denmark
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Høyer G, Nyttingnes O, Rugkåsa J, Sharashova E, Simonsen TB, Høye A, Riley H. Impact of introducing capacity-based mental health legislation on the use of community treatment orders in Norway: case registry study. BJPsych Open 2022; 8:e22. [PMID: 34991772 PMCID: PMC8811783 DOI: 10.1192/bjo.2021.1073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2017, a capacity-based criterion was added to the Norwegian Mental Health Act, stating that those with capacity to consent to treatment cannot be subjected to involuntary care unless there is risk to themselves or others. This was expected to reduce incidence and prevalence rates, and the duration of episodes of involuntary care, in particular regarding community treatment orders (CTOs). AIMS The aim was to investigate whether the capacity-based criterion had the expected impact on the use of CTOs. METHOD This retrospective case register study included two catchment areas serving 16% of the Norwegian population (aged ≥18). In total, 760 patients subject to 921 CTOs between 1 January 2015 and 31 December 2019 were included to compare the use of CTOs 2 years before and 2 years after the legal reform. RESULTS CTO incidence rates and duration did not change after the reform, whereas prevalence rates were significantly reduced. This was explained by a sharp increase in termination of CTOs in the year of the reform, after which it reduced and settled on a slightly higher leven than before the reform. We found an unexpected significant increase in the use of involuntary treatment orders for patients on CTOs after the reform. CONCLUSIONS The expected impact on CTO use of introducing a capacity-based criterion in the Norwegian Mental Health Act was not confirmed by our study. Given the existing challenges related to defining and assessing decision-making capacity, studies examining the validity of capacity assessments and their impact on the use of coercion in clinical practice are urgently needed.
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Affiliation(s)
- Georg Høyer
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Norway; and Department of Community Medicine, UiT The Arctic University of Norway, Norway
| | - Olav Nyttingnes
- Health Services Research Unit, Akershus University Hospital, Norway; and R&D Department, Division of Mental Health Services, Akershus University Hospital, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Norway; and Centre for Care Research, University of South-Eastern Norway, Norway
| | | | | | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway, Norway; and Division of Mental Health and Substance Abuse, University Hospital of North Norway, Norway
| | - Henriette Riley
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Norway; and Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
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Corcuff M, Routhier F, Paquette-Raynard E, Gagnon M, Battalova A, Mwaka C, Lamontagne ME. Organizations strategies to improve implementation of universal accessibility principles: protocol of a scoping review (Preprint). JMIR Res Protoc 2021; 11:e33641. [PMID: 35816367 PMCID: PMC9315903 DOI: 10.2196/33641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Maëlle Corcuff
- Département de réadaptation, Université Laval, Québec, QC, Canada
| | | | | | | | | | - Claudel Mwaka
- Département de réadaptation, Université Laval, Québec, QC, Canada
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Steinert T, Götzl S, Flammer E. [Participation in Road Traffic and Mobility in People with Alcohol Dependency and Mental Disability]. PSYCHIATRISCHE PRAXIS 2021; 48:324-327. [PMID: 34015849 DOI: 10.1055/a-1490-8027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inclusion in terms of personal mobility (§ 20 of the UN Convention on the Rights of Persons with Disabilities) should be investigated in a sample of people with alcohol dependency and additional mental disability. METHODS Interviews with N = 153 individuals, recruited from specific community services for people with alcohol-related disorders and co-morbidity of mental disorders, patients in in-patient treatment, day clinics, and in out-patient treatment. RESULTS 54.1 % reported loss of their driver's licence due to alcohol, 43.3 % indicated to own a motor vehicle. Personal mobility was realized much more frequently by bicycle or on foot than in the general population. CONCLUSION The expansion of public transport and the bicycle network is desirable not only on the background of climate change but also in favour of the inclusion of people with mental disability.
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Affiliation(s)
- Tilman Steinert
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau)
| | - Stefan Götzl
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau)
| | - Erich Flammer
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau)
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Rangarajan SK, Muliyala KP, Jadhav P, Philip S, Angothu H, Thirthalli J. Reasonable Accommodation at the Workplace for Professionals with Severe Mental Illness: A Qualitative Study of Needs. Indian J Psychol Med 2020; 42:445-450. [PMID: 33414591 PMCID: PMC7750859 DOI: 10.1177/0253717620939771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Professionals with Severe Mental Illness (PwSMI) often face challenges in obtaining and retaining employment. For equal and effective participation, they may require reasonable workplace adjustments. The recently legislated Rights of Persons With Disabilities Act 2016 in India defines such adjustments as reasonable accommodations. METHODS In-depth qualitative interviews were conducted with 15 consenting PwSMI availing psychiatric rehabilitation services at a tertiary mental health institute in India, five mental health professionals, and five employers. The audio-recorded interviews were transcribed and coded manually by two independent investigators. Inductive content analysis approach was used for qualitative analysis. RESULTS The detected themes included modifications in work schedule, supports to improve work efficiency, modifications in the work environment, modifications in the work-related appraisal, supportive employer policy, and integration of services. The participants described the term "undue burden" to be ambiguous. CONCLUSIONS The reported reasonable accommodations are non-structural and mainly dependent on human assistance. Vocational rehabilitation and job reintegration efforts can focus on guided negotiations between employers and PwSMI. This is dependent on at least some degree of disclosure. Awareness regarding reasonable accommodation and stigma reduction is necessary for successful implementation.
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Affiliation(s)
- Subhashini K Rangarajan
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Krishna Prasad Muliyala
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhu Jadhav
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sharad Philip
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hareesh Angothu
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Gómez LE, Monsalve A, Morán ML, Alcedo MÁ, Lombardi M, Schalock RL. Measurable Indicators of CRPD for People with Intellectual and Developmental Disabilities within the Quality of Life Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5123. [PMID: 32679924 PMCID: PMC7400318 DOI: 10.3390/ijerph17145123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
This article proposes the quality of life (QOL) construct as a framework from which to develop useful indicators to operationalize, measure, and implement the Articles of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the scientific literature on people with intellectual and developmental disabilities (IDD) was carried out, with the aim of identifying personal outcomes that can be translated into specific and measurable items for each of the CRPD Articles aligned to the eight QOL domains. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the systematic review was conducted across the Web of Science Core Collection, Current Contents Connect (CCC), MEDLINE, KCI-Korean Journal Database, Russian Science Citation Index and SciELO Citation Index, for articles published between 2008 and 2020. A total of 65 articles focusing on people with IDD were selected. The results were grouped into four broad categories: conceptual frameworks used to monitor the CRPD; instruments used to assess the rights set out in the CRPD; recommendations on the use of inclusive research; and indicators or personal outcomes associated with specific rights contained in the CRPD.
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Affiliation(s)
- Laura E. Gómez
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Asunción Monsalve
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Mª Lucía Morán
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
| | - Mª Ángeles Alcedo
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain; (A.M.); (M.L.M.); (M.Á.A.)
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11
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Newton-Howes G. Is the Problem Bioethics Versus Law or the Principles of Doctors. AJOB Neurosci 2020; 11:28-31. [PMID: 32043935 DOI: 10.1080/21507740.2019.1704919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Alhusein N, Macaden L, Smith A, Stoddart KM, Taylor AJ, Killick K, Kroll T, Watson MC. 'Has she seen me? ': a multiple methods study of the pharmaceutical care needs of older people with sensory impairment in Scotland. BMJ Open 2018; 8:e023198. [PMID: 30082364 PMCID: PMC6078270 DOI: 10.1136/bmjopen-2018-023198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore the pharmaceutical care needs of, and service provision to, older people with sensory impairment (visual, hearing and dual impairment) on prescribed polypharmacy (≥4 medicines) in Scotland. DESIGN Interviews were conducted with older people with sensory impairment and community pharmacy personnel, which informed the content of a subsequent national cross-sectional survey of community pharmacists. SETTING Scotland, 2015-2016. PARTICIPANTS Older people with sensory impairment and community pharmacy personnel. RESULTS Interviews were completed with 23 older people with sensory impairment (dual impairment n=13, visual or hearing impairment n=5 of each) and 30 community pharmacy personnel from eight of 14 Scottish Health Boards. A total of 171 survey responses were received.Older people reported that they did not always disclose their sensory impairment to pharmacy personnel. They also reported that medicines were difficult to identify particularly when their name, shape or colour changed. Pharmacy personnel relied on visible cues such as white canes or guide dogs to identify visual impairment and suggested that hearing loss was less visible and more difficult to identify. Many assistive aids in support of medicine management, such as dosette boxes, seemed inadequate for complex medication regimens. Few community pharmacy personnel reported receiving training in the care of people with sensory impairment. CONCLUSIONS This is the first comprehensive, multistakeholder, in-depth exploration of the pharmaceutical care needs of older people with sensory impairment. Strategies are needed to enable people with sensory impairment to disclose their impairment to pharmacy personnel (and other healthcare providers). Community pharmacy personnel require training to deliver person-centred pharmaceutical care for older people with sensory impairment particularly regarding communication with individuals in this vulnerable population.
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Affiliation(s)
- Nour Alhusein
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Leah Macaden
- Department of Nursing, Centre for Health Science, University of the Highland and Islands, Inverness, UK
| | - Annetta Smith
- Department of Nursing, Centre for Health Science, University of the Highland and Islands, Inverness, UK
| | | | - Andrea J Taylor
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Kirsty Killick
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Margaret C Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Duffy RM, Kelly BD. Rights, laws and tensions: A comparative analysis of the Convention on the Rights of Persons with Disabilities and the WHO Resource Book on Mental Health, Human Rights and Legislation. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 54:26-35. [PMID: 28962684 DOI: 10.1016/j.ijlp.2017.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 06/28/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Good mental health legislation is essential for ensuring high quality mental health care and protecting human rights. Many countries are attempting to bring mental health legislation in line with the UN - Convention on the Rights of Persons with Disability (UN-CRPD). The UN-CRPD requires policy-makers to rethink the 'medical model' of mental illness and existing laws. It also challenges WHO guidelines on drafting mental health law, described in the WHO Resource Book on Mental Health, Human Rights and Legislation (WHO-RB). AIMS This study examines the relationship between the UN-CRPD and the WHO-RB. METHODS It compares the documents, highlighting similarities and identifying areas of disagreement. The WHO-RB contains a checklist of human rights standards it recommends are met at national level. This study analyses each component on this checklist and identifies the relevant sections in the UN-CRPD that pertain to each. RESULTS Both the UN-CRPD and WHO-RB address more than just acute exacerbations of illness, providing guidelines on, inter alia, treatment, education, occupation and housing. They are patient-centred and strongly influenced by social rights. The UN-CRPD, however, gives just superficial consideration to the management of acute illness, forensic and risk issues, and does little to identify the role of family and carers. CONCLUSION The UN-CRPD has evolved from disability research and strong advocacy organisations. Careful consideration is needed to enable it to address the specific needs encountered in mental illness. Both the UN-CRPD and WHO-RB highlight common tensions that must be resolved by clinicians, and provide some guidance for stakeholders who commonly need to observe one principle at the expense of another.
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Affiliation(s)
- Richard M Duffy
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin D24 NR0A, Ireland.
| | - Brendan D Kelly
- Trinity College Dublin, Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin D24 NR0A, Ireland
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Duffy RM, Kelly BD. Concordance of the Indian Mental Healthcare Act 2017 with the World Health Organization's Checklist on Mental Health Legislation. Int J Ment Health Syst 2017; 11:48. [PMID: 28828037 PMCID: PMC5563026 DOI: 10.1186/s13033-017-0155-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/12/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND India is revising its mental health legislation with the Indian Mental Healthcare Act 2017 (IMHA). When implemented, this legislation will apply to over 1.25 billion people. In 2005, the World Health Organization (WHO) published a Resource Book (WHO-RB) on mental health, human rights and legislation, including a checklist of 175 specific items to be addressed in mental health legislation or policy in individual countries. Even following the publication of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006), the WHO-RB remains the most comprehensive checklist for mental health legislation available, rooted in UN and WHO documents and providing the most systematic, detailed framework for human rights analysis of mental health legislation. We sought to determine the extent to which the IMHA will bring Indian legislation in line with the WHO-RB. METHODS The IMHA and other relevant pieces of Indian legislation are compared to each of the items in the WHO-RB. We classify each item in a binary manner, as either concordant or not, and provide more nuanced detail in the text. RESULTS The IMHA addresses 96/175 (55.4%) of the WHO-RB standards examined. When other relevant Indian legislation is taken into account, 118/175 (68.0%) of the standards are addressed in Indian law. Important areas of low concordance include the rights of families and carers, competence and guardianship, non-protesting patients and involuntary community treatment. The important legal constructs of advance directives, supported decision-making and nominated representatives are articulated in the Indian legislation and explored in this paper. CONCLUSIONS In theory, the IMHA is a highly progressive piece of legislation, especially when compared to legislation in other jurisdictions subject to similar analysis. Along with the Indian Rights of Persons with Disabilities Act 2016, it will bring Indian law closely in line with the WHO-RB. Vague, opaque language is however, used in certain contentious areas; this may represent arrangement-focused rather than realisation-focused legislation, and lead to inadvertent limitation of certain rights. Finally, the WHO-RB checklist is an extremely useful tool for this kind of analysis; we recommend it is updated to reflect the CRPD and other relevant developments.
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Affiliation(s)
- Richard M. Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Science, Tallaght Hospital, Dublin, D24 NR0A Ireland
| | - Brendan D. Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Science, Tallaght Hospital, Dublin, D24 NR0A Ireland
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Abstract
PURPOSE OF REVIEW After a large majority of UN member states ratified the Convention on the Rights of Persons with Disabilities (UNCRPD), this article aims to provide an overview of its implementation and possible effects in the area of mental health services in individual contract states. RECENT FINDINGS This article looks at the implementation processes of the UNCRPD in individual industrialized, emerging and developing countries. In addition to changes in national legislation, potential influences on the supply and support systems for persons with mental illness are considered. Positive approaches and efforts are described. Difficulties and barriers that could be responsible for the long process of implementation of the UNCRPD are described, and so is the restructuring and development of adequate supply and support systems in the area of mental healthcare in industrialized, emerging and developed countries. SUMMARY The UNCRPD is a groundbreaking encouragement for various changes in the area of mental health services. The path to subject orientation and individual support structures is long and slow in all countries - in industrialized, emerging and developed countries. National law and health legislation must be adjusted and developed to create an obligatory context for inclusive services required for persons with mental illnesses. Community-based care is prioritized, and this facilitates participation and inclusion.
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Gwee K. Psychology and psychiatry in Singapore courts: A baseline survey of the mental health landscape in the legal arena. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:44-54. [PMID: 28408047 DOI: 10.1016/j.ijlp.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 02/02/2017] [Accepted: 03/23/2017] [Indexed: 06/07/2023]
Abstract
Despite the increasing prevalence and involvement of mental health professionals in local courts, there has been no systematic study of the role played by these expert witnesses in Singapore courtrooms. An empirical study of all existing recorded cases on Lawnet (Singapore's legal database of all court trial cases) from 1975-2014 involving psychologists and psychiatrists was conducted. Results revealed that, not only were these mental health experts increasingly dotting the landscape of the legal arena, the variety of their contributions has also been gradually growing. Furthermore, there were marked differences across criminal, civil and custody cases with regards to the issues of how these experts were consulted and how their inputs utilized and appreciated by judges. Differences between psychology and psychiatry were also apparent. A future with more assistance rendered by these professions to courts, as well as greater synergy between law and mental health, was predicted for Singapore courts.
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Affiliation(s)
- Kenji Gwee
- National University of Singapore, Singapore; Department of Psychology, Institute of Mental Health, Singapore.
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Sun W, Wilson MG, Schreiber D, Wang RH. Ethical challenges related to assistive product access for older adults and adults living with a disability: a scoping review protocol. Syst Rev 2017; 6:24. [PMID: 28143554 PMCID: PMC5286736 DOI: 10.1186/s13643-017-0419-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the surge of research and development in assistive products for older adults and/or people living with disabilities, policies on access and procurement have lagged in responding to the growing demand from users. Developing policies to address these concerns require an understanding of the ethical challenges underlying approaches for providing assistive products. The purpose of this scoping review is to identify and map the literature pertaining to ethical challenges related to assistive product access and procurement to inform policy development. METHODS/DESIGN We will use established approaches to conducting scoping reviews which include five stages: (1) conducting broad searches to identify potentially relevant literature, (2) refining selection criteria, (3) reviewing search results, (4) mapping literature according to conceptual areas of interest, and (5) summarizing results. We will analyze data by thematically grouping the descriptions of assistive products identified in the included articles and conducting a content analysis to iteratively develop a targeted synthesis of literature focused on ethical challenges in relation to assistive product access and procurement by older adults and/or adults living with disabilities. DISCUSSION Our scoping review findings will focus on and provide insight about the models, frameworks, and principles that have been used to understand ethical challenges related to technology access and procurement. We will use the findings to help inform a series of citizen panels in Canada to identify Canadians' values and preferences for enhancing equitable access to assistive products.
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Affiliation(s)
- Winnie Sun
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St. N., Oshawa, ON L1H 7K4 Canada
| | - Michael G. Wilson
- McMaster Health Forum, McMaster University, 1280 Main St W, MML-417, Hamilton, ON L8S 4K1 Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
| | - Daphne Schreiber
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON M4H 1A4 Canada
| | - Rosalie H. Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7 Canada
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Battams S. Editorial: Public Mental Health Policy, Mental Health Promotion, and Interventions Which Focus on the Social Determinants of Mental Health. Front Public Health 2017; 4:285. [PMID: 28083529 PMCID: PMC5183633 DOI: 10.3389/fpubh.2016.00285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Samantha Battams
- Torrens University Australia, Adelaide, SA, Australia; Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia; Health Outcomes International, Glynde, SA, Australia
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Duffy R, Kelly B. Privacy, confidentiality and carers: India's harmonisation of national guidelines and international mental health law. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jemep.2017.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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