Moral Experiences of Crisis Management in a Child Mental Health Setting: A Participatory Hermeneutic Ethnographic Study

Restraints and seclusion are routinely used in child mental health settings for conflict and crisis management, but raise significant ethical concerns. Using a participatory hermeneutic ethnographic framework, we studied conflict and crisis management in a child mental health setting offering care to children aged 6-12 years old in Quebec, Canada. The use of this framework allowed for an in-depth examination of the local imaginaries, of what is morally meaningful to the people in the setting, in addition to institutional norms, structures and practices. Data collection involved participant observation, interviews, and documentation review, with an interpretive framework for data analysis. We argue that the prevalent view of children shared by staff members as "incomplete human becomings" led to the adoption and legitimization of authoritative norms, structures and practices guided largely by a behavioral approach, which sometimes led to an increased use of control measures for reasons other than imminent harm. Children experienced these controlling practices as abusive and hindering the development of trusting relationships, which impeded the implementation of more collaborative approaches staff members sought to put in place to prevent the use of control measures. Study results are discussed in light of conceptions of children as moral agents.

Constant Observation in the general hospital: a review

The role of Constant Observation (COb) in the general hospital is addressed. The difficulties of managing acute psychological disturbance in the general hospital are described. Concerns about confused behavior and suicidal risk appear to be the most common reasons for ordering COb. Organic brain syndrome is the most common diagnosis made in patients receiving COb. Medico-legal, ethical and therapeutic aspects of COb are noted. To our knowledge there is no research evidence that COb significantly decreases the rate of suicide in the general hospital. It appears that the role of COb is enshrined in the general hospital as a result of medico-legal process in addition to its therapeutic role. Further research in this area is needed.

Noncredible Psychiatric and Cognitive Symptoms in a Workers' Compensation “Stress” Claim Sample

Information is lacking regarding the prevalence of fraudulent psychiatric and cognitive symptoms in the "stress" claim workers' compensation population. Using various validity indices (Negative Impression Scale, the Malingering Index, and the Rogers Discriminant Function) of the Personality Assessment Inventory (PAI), between 9 and 29% of 233 workers' compensation "stress" claim litigants were identified as exhibiting noncredible psychiatric symptoms. In addition, 15% of the subjects were determined to have noncredible cognitive symptoms on the Dot Counting Test, although only 8% displayed suspect effort on the 15-Item Memorization Test, with 5% of subjects failing both cognitive effort tests. The percentage of positive identifications on both a PAI and cognitive credibility index ranged from only 2 to 4%. Further, correlations between PAI validity indices and cognitive effort scales were nonexistent to modest, indicating that the psychiatric and cognitive credibility indices are measuring different aspects of noncredible symptom production. It was predicted that the PAI profiles of the participants displaying suspect cognitive symptoms would be elevated on the Somatic Concerns, Antisocial, and/or Borderline scales; however, elevations (relative to subjects with credible cognitive performance) were instead noted on the Somatic Concerns, Depression, Anxiety, Anxiety-Related Disorders, and Schizophrenia scales.

[Clinical ethics in psychiatry: the experience at Douglas Hospital]

The authors present a brief overview of the clinical ethics committee within their mental health university institute as well as its evolving mandates over the past few decades. The main functions include case consultation, input on elaboration of institutional policy, and staff education as well as public information on issues of ethics and mental illness. With examples and questions brought to the committee's attention, the authors demonstrate how these functions are intertwined. The authors conclude that ethical questioning helps examine clinical practices and serves ultimately in guiding towards best practices in mental health.

Advocacy in practice: the experiences of independent advocates on UK mental health wards

Independent advocacy in mental health has become increasingly valued in the UK although little work has examined the day-to-day experiences of advocates themselves. This article reports on a small-scale exploratory qualitative study of practising advocates' experiences of their work in acute and continuing care wards. The project results from collaboration between members of the UK Advocacy Network and the Department of Mental Health and Learning Disability at the University of Sheffield. Although the findings will be of interest to any professional allied to these areas they are particularly relevant to mental health nurses wishing to increase their knowledge of advocacy and gain a fresh perspective on inpatient care. The findings reveal difficulties inherent in advocacy practice as well as the nature and importance of good working relationships between advocates and clinicians. Despite acknowledging such relationships frequently exist, advocates can still encounter ignorance of their role and opposition to their presence. The clearest implication of the findings is the need for greater training of nurses and other clinicians in the role of the advocate.

Ethical aspects when treating traumatized refugee children and their families

Basic ethical principles are worth analysing step by step when dealing with refugee children and their families. Three issues where potential ethical conflicts might arise for healthcare professionals in treating refugees with different cultural background are pointed out--traumatic life events, hierarchy and repatriation. An ethical analysis of the decision to admit a traumatized teenage refugee to a psychiatric ward is discussed with respect for the ethical principles autonomy, non-maleficence, beneficence and justice. There are both gains and losses, which are valued differently depending on the actors involved.

Multi-disciplinary working in a forensic mental health setting: ethical codes of reference

This paper reports on a small research project on multidisciplinary team-working within a medium secure forensic unit in the United Kingdom. Although multidisciplinary team working is widely accepted as an effective strategy for the delivery of healthcare services in modern society it is also recognized that interdisciplinary problems can also occur. This study developed two questionnaires, one being delivered to a number of groups and teams in the secure unit, whilst the second one was geared to individuals. A thematic analysis was employed to develop category building and concept formation. The results highlighted a three-level ethical code referencing system that was employed by both individuals and groups. Within this, three domains, or trajectories, were identified that were polarized continuums of main tensions for multidisciplinary staff working in forensic practice.