The present study aims to survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations. Nearly half of the parents and adolescents (...) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China. (shrink)

This paper reports the responses of 251 mental health care practitioners to a mail survey examining their views concerning ethical conflicts and practices within their work environments. Besides identifying the sources and types of conflicts they experience, respondents were asked how ethical standards have changed over the last 10 years as well as the factors influencing these changes. Conclusions and implications are outlined and future research needs are described.

The COVID-19 global pandemic has led to significant disruptions in the lives of high-performance athletes, including the postponement of the Tokyo Olympic and Paralympic Games, the cancellation of many international and national competitions, and drastic changes in athletes’ daily training environment. The purpose of this research was to examine the interplay between the mental health and mental performance of Canadian national team athletes and the impact of the COVID-19 pandemic on these variables from the perspective of (...) class='Hi'>mental performance consultants and mental health practitioners. Twelve individuals working in these roles with national team athletes participated in focus groups and interviews during the second wave of the COVID-19 pandemic in Canada. Findings from the inductive reflexive thematic analysis revealed three main themes: factors impacting athlete mental health, consequences of COVID-19 for athletes, and impact of the pandemic on practitioners. Interestingly, athletes with prior good mental performance skills were perceived to be more equipped to cope with challenges related to the pandemic, which concurrently seemed to facilitate good mental health throughout the pandemic. Furthermore, even though the pandemic had several debilitative consequences on athletes’ mental health, it imposed a break from training and competition that allowed them to rest and enjoy their life outside of sport. Finally, participants discussed the need for more mental health resources and better access to practitioners supporting mental performance and mental health in the Canadian sport system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 623 Jaye Cee Whitehead, Kath Bassett, Leia Franchini, and Michael Iacolucci “The Proof Is in the Pudding”: How Mental Health Practitioners View the Power of “Sex Hormones” in the Process of Transition In the United States today, popular discourse touts the power of “sex hormones” and hormone receptors in the brain to chemically produce gender (...) expressions (manifested in physical sex traits, behaviors, and attitudes) and identities (a sense of self as feminine or masculine). These accounts range from common assumptions that Western ideals of femininity (such as empathy understanding, cooperative orientation, nurturing behavior) and masculinity (rational/spatial understanding, competitive orientation, violent behavior) are produced by corresponding sex hormones, to studies that reduce complex gender identities and macrosocial economic phenomena to presocial, binary, hormonal processes.1 For sociologists, accounts that reduce complex identities to internal hormonal reactions are problematic for two primary reasons: first, they are inaccurate because they fail to examine how hormonal reactions are embedded in a complex cultural process of meaning and interpretation; second, they operate as bioreductive ideologies that obscure the social power inherent to the process of gender identity construction. In what follows, we extend both of these insights by examining mental health 1. For an example of a hybrid popular-scientific account of the power of sex hormones to destabilize economic structures, see Jon Coates and Joe Herbert, “Endogenous Steroids and Financial Risk Taking on a London Trading Floor,” Proceedings of the National Academy of Sciences 105, no. 16 (April 2008): 6167–72. 624 Whitehead, Bassett, Franchini, and Iacolucci practitioners’ divergent interpretations of the power of sex hormones in the process of gender transition.2 In doing so, we examine the cultural power of sex hormones in crafting gender identities without reproducing reductionist interpretations of trans embodiment. Perhaps what is most perplexing about the way we speak of sex hormones is that we know it is inaccurate to describe these hormones as sexed; scientists have acknowledged since the 1930s that they are neither sex specific in their function, nor in terms of their location in male or female bodies.3 In her extensive historicization of sex hormones, Anne Fausto-Sterling concludes that it is more accurate to call androgen- and estrogen-based hormones, “steroid hormones” as they have functions that are not confined to corresponding sexed bodies. In fact she urges scientists to “break out of the sex hormone straightjacket” and to look at steroids as just one of a number of components that are important to the creation of sex and gender, including environment and experience.4 Scholars also point to an inextricable link between the chemical operation of hormones and the social process of constructing meaning, both at the level of social interaction and macrocultural constructions of sex categories and gender ideologies.5 While brain organization/activation theory attributes sex and gender differences to hormonal interactions within the developing brain, Fausto-Sterling questions the distinction between activation and organization by pointing out how “the brain can respond to hormonal stimuli with anatomical changes…hormonal systems, after all, respond exquisitely to experience, be it in the form of nutrition, stress, or sexual activity (to name but a few possibilities ).”6 Drawing from Elizabeth Grosz, Fausto-Sterling argues that the power of hormones is best understood according to the model of the 2. “Gender transition” is a controversial phrase, as it implies that transgendered individuals who receive hormone therapy are changing identities. We are only using it for lack of clear alternative phrasing, not because we believe body modifications change gender identities. 3. See Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000); Rebecca Jordan-Young, Brainstorm: The Flaws in the Science of Sex Differences (Cambridge, MA: Harvard University Press, 2010); and Nelly Oudshoorn, Beyond the Natural Body: An Archeology of Sex Hormones (New York: Routledge, 1994). 4. Fausto-Sterling, Sexing the Body, 193–94. 5. Fausto-Sterling, Sexing the Body. 6. Ibid., 232. Whitehead, Bassett, Franchini, and Iacolucci 625 Möbius strip, wherein internal components of the self are always connected to and continuous with outer components such as culture and environment.7 In other... (shrink)

This paper1 aims to develop a model of practitioner narrative competence specifically for mental health care. I begin by considering the status of narratives as a form of evidence. Following Rita Charon and Cheryl Misak, I claim that there is no distinction to be made between evidence-based medicine and narrative medicine. I then explore Charon’s model of practitioner narrative competence, and suggest that it can be fruitfully adapted for mental health care contexts, a project for which (...) I employ Jennifer Radden and John Z. Sadler’s psychiatric ethics. This project brings together two independently promising accounts to develop what I refer to as the adapted model of... (shrink)

Refining the model for an emergency department‐based mental health nurse practitioner outpatient service The mental health nurse practitioner (MHNP) role based in the emergency department (ED) has emerged in response to an increase in mental health‐related presentations and subsequent concerns over waiting times, co‐ordination of care and therapeutic intervention. The MHNP role also provides scope for the delivery of specialised primary care. Nursing authors are reporting on nurse‐led outpatient clinics as a method of healthcare (...) delivery that allows for enhanced access to health‐care, particularly following hospital discharge. However, due to a lack of in‐depth substantiation, this mode of service delivery requires more thorough investigation. This study describes the refinement phase undertaken before the implementation and pilot evaluation of a formalised and structured MHNP outpatient service in the ED of a large inner‐city hospital in Sydney, Australia. An expert advisory panel (EAP) consisting of key local informants was convened to provide feedback on and refinement to the proposed model. This related to issues such as target population, structure and process considerations, outcome measures and interface within the overall health service. Findings from the EAP meeting are presented and discussed. The importance of linking methods with the appropriate methodology in evaluating a healthcare program is highlighted. (shrink)

Positive mental health involves not the absence of mental disorder but rather the presence of certain mental goods. Institutions, practitioners, and theorists often identify positive mental health with well‐being. There are strong reasons, however, to keep the concepts of well‐being and positive mental health separate. Someone with high positive mental health can have low well‐being, someone with high well‐being can have low positive mental health, and well‐being and (...) positive mental health sometimes conflict. But, while positive mental health and well‐being are not identical, there is an informative conceptual connection between them. Positive mental health usually contributes instrumentally to the living of a good human life, where a good human life includes (but is not limited to) well‐being. (shrink)

BackgroundThe positive component of Mental Health Literacy refers to a person’s awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners.AimTo identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications.MethodsLiterature search and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach.ResultsPositive component of Mental (...) class='Hi'>Health Literacy is considered one component of MHL, integrating positive mental health. The concept’s attributes include: competence in problem-solving and self-actualization; personal satisfaction; autonomy; relatedness and interpersonal relationship skills; self-control; and prosocial attitude. Four case scenarios were used to clarify the antecedents and consequences of PMeHL.ConclusionPositive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families. (shrink)

Normality Does Not Equal Mental Health: The Need to Look Elsewhere for Standards of Good Mental Health is the first book to question the equation of psychological normality and mental health. It is also the first book to take contemporary psychiatry and clinical psychology to task for deeply flawed thinking when they accept the diagnostic system propounded by the DSM, which reifies syndromes into alleged “mental disorders.” Where Thomas Szasz argued that “mental (...) disorders” are myths, Bartlett makes the much more damaging charge that reifying mental disorders involves a provable form of fallacious thinking, producing a variety of epistemological nonsense. /// -/- -/- The author weighs the evidence, and with strict logic, compelling evidence, and careful analysis, challenges the current paradigm of mental health theorists and practitioners. Never has the case against the standard of psychological normality and against the non-scientific creation of “mental disorders” been made with such boldness, multidisciplinary knowledge, solid scholarship, and clarity of language. /// -/- -/- Normality Does Not Equal Mental HealthAlthough the need to question psychological normality as a satisfactory standard of good mental health has been staring us in the face for a long time, no one, clinical professional or scholar, has had the courage or the intellectual willingness to face with unflinching honesty the shortcomings and disappointments of psychological normality and to propose that we should look elsewhere for standards of good psychological health. /// -/- -/- Contemporary psychiatry and clinical psychology, on the contrary, base their conception of mental health on the standard of psychological normality. This supposition has come to be accepted uncritically and without question, and yet it has become fundamental to current clinical theory and practice, and forms the core of the psychiatric classification system of the DSM, which has become today’s diagnostic authority. /// -/- -/- While touting today’s scientific gold standard of “evidence-based” research, DSM’s authoritative classification of “mental disorders” is itself hardly “evidence-based,” for it is recognized, but seldom emphasized, that the majority of DSM’s “mental disorders” have no known empirical, organic basis. /// -/- -/- Normality Does Not Equal Mental Health takes DSM to task not only for its failure to adhere to today’s evidence-based standard, but for its failure to rein in its highly speculative diagnostic labeling, in accordance with the modern paradigm of rigorous science, which repudiates metaphorical reifications whose alleged validity rests only on the voting preferences of a professional membership. /// -/- -/- The book is a carefully argued critique of the dominant assumption in current psychiatry and clinical psychology that psychological normality is fundamental to mental health and therefore good. In place of this unsatisfactory presumption, Normality Does Not Equal Mental Health proposes a positive and constructive revision in our understanding of mental health and of our conception of mental disorders. (shrink)

This discussion paper offers a critical provocation to my mental health nursing colleagues. Drawing upon David Graeber's account of bullshit work, work that is increasingly meaningless for workers, I pose the question: Is mental health nursing a bullshit job? Ever‐increasing time spent on record keeping as opposed to direct care appears to represent a Graeberian bullshitisation of mental health nurses' work. In addition, core aspects of the role are not immune from bullshit. Professional rhetoric (...) would have us believe that mental health nursing is a therapeutically beneficent occupation organised around ideals of care and compassion and providing fulfilling work for practitioners. Yet, there are some key characteristics of the experience of mental health nursing work that afford alternative judgements on its value and meaningfulness. Not least of these is the fact that many mental health nurses feel quite existentially unsettled in the practise of their work and many service users do not recognise the professional ideal, especially when compelled into increasingly coercive and restrictive services. In this context, Graeber's thesis is explored for its applicability to mental health nursing with a conclusion that many aspects of mental health nursing work are commensurate with bullshit but that mental health care can possibly be redeemed from bullshitisation by authentically democratising reforms. Engaging with posthumanist ideas, this exploration involves a flexing of aspects of Graeber's theory. (shrink)

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family (...) Medicine residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)

IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (shown (...) here to represent 'counter stories' to the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, (...) patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

Mental health practitioners often come across a number of challenges in their clinical practice. One such challenge that posed a management dilemma presented with the history of reincarnation. This subject has been discussed in non-scientific literature at length but there is an absolute paucity in scientific literature. This paper describes a case where a boy presented with memories of previous life that started haunting him and caused significant anxiety. The subject of reincarnation needs extensive research in order (...) to understand and manage the resultant clinical challenges. (shrink)

This practical and accessible guide tackles the challenges that busy childcare educators face with their mental health in what is a wonderful, rewarding, but often exhausting role. Drawing from 'day-in-the-life' experiences and case studies, this book sets out high-quality staff wellbeing practices that can revolutionise the way childcare practitioners approach their job and their own health. Chapters guide the reader through a process of reflection and development, encouraging and empowering them to create a workplace culture that (...) positively contributes to their personal wellbeing. This book: Focuses on the realities of early years education, combining the authors' lived experience with examples of real-life practice; Encourages educators to think and feel positively about themselves; to identify the individual skills, strengths and talents they bring to their work; Can be used individually or collaboratively by team members, with guidance on creating a positive workplace culture with a shared vision, core values and beliefs. Essential reading for anybody who finds that the job they love can sometimes leave them feeling worn out, stressed and depleted, this book has been written to enrich the lives of all training and practising early years educators. (shrink)

The first words in the inaugural version of the American Psychological Association Ethical Standards of Psychologists (1953) declared, ?Psychology is a science? (p. v). Professional ethics for all of the mental health disciplines support science (and objectivity) for knowledge and practice. Using school psychology as an example, consideration is given to the presence of science and research in the scientist-practitioner, professional practitioner, and psychoeducational training and practice models. Although none of the three models truly ignores a commitment to (...) science, the potential Achilles heel comes from the individual practitioner who fails to rely on science in planning, implementing, and evaluating interventions. Similarly, idiosyncratic preferences within training programs could lead to a diminution of science in the curriculum. (shrink)

Simonet, Emanuel Nicolas Cortes A Voice at the Table: An Integrated Model for Pastoral Care in Aged Mental Health, written by Rosemary Kelleher with Olga Yastrubetskaya, describes a practical model for integrating pastoral care practitioners into multidisciplinary teams within aged mental health services. While highlighting the importance of spiritual care within healthcare, the book also emphasises the need for pastoral care practitioners to have the essential skills and knowledge vital to being significant members of (...) the multidisciplinary team. This article offers a concise review of a most valuable resource. (shrink)

The following dialogue takes up recent calls within nursing scholarship to critically imagine alternative nursing futures through the relational process of call and response. Towards this end, the dialogue builds on letters which we, the authors, exchanged as part of the 25th International Nursing Philosophy Conference in 2022. In these letters, we asked of ourselves and each other: If we were to think about a new philosophy of mental health nursing, what are some of the critical questions that (...) we would need to ask? What warrants exploration? In thinking through these questions, our letters facilitated a collaborative enquiry in which philosophy and theory were generative tools for thinking beyond what is and towards what is yet to come. In this paper, we expand the dialogue within these letters—in a ‘dialogue‐on‐dialogue’—and take up one thread of our discussion to argue that a new philosophy of mental health nursing must rethink the relationships between ‘practitioner’/‘self’ and ‘self’/‘other’ if it is to create a radically different future. Further, we posit solidarity and public love as possible alternatives to foregrounding the ‘work’ of mental health nursing. The possibilities we present here should be received as partial, contingent and unfinished. Indeed, our purpose in this paper is to provoke discussion and, in so doing, to model what we believe is a necessary shift towards criticality in our communities of nursing scholarship. (shrink)

Community treatment orders are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longer-term. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, (...) patients and family carers to show how these ethical considerations map onto the different ways that community treatment orders are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty and to act beneficently should be interpreted in order to make judgements about the ethics of community treatment orders is presented. The article argues that, due to such complexity, no general ethical justification for community treatment orders can be provided, but a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a community treatment order in some limited circumstances. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

Within an ethics framework, this article explores mental health practitioners' use of credentials that lack acceptable accreditation or authority. Increased competition among mental health care providers has elevated the importance of credentials for marketing professional services. Practitioners worried about economic survival, along with certain personality characteristics (e.g., sheer ego), are tempted to rely on credentials that lack proof of quality, thereby potentially jeopardizing professionalism. Specific assertions and recommendations are set forth in the interest of (...) safe-guarding consumers and promoting professionalism. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring (...) rather than ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and (...) practice community's view of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to ‘do good’ in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations. (shrink)

People experiencing mental distress and illness are frequently on the receiving end of stigma, epistemic injustice, and social isolation. A range of strategies are required to alleviate the subsequent marginalisation. We ran a series ‘philosophy of mind’ workshops, in partnership with a third-sector mental health organisation with the aim of using philosophical techniques to challenge mental health stigma and build resources for self-understanding and advocacy. Participants were those with lived experience of mental distress, or (...) unusual beliefs and experiences; mental health advocates; and mental health service providers. We draw on a shared perspective as a participant and facilitator of the workshop series to assess their impact. We discuss the following benefits: the opportunity for structured discussion of experiences and models; dialogue across different mental health backgrounds; the potential to reduce self-stigma and to increase self-understanding and advocacy; and the potential to alleviate epistemic injustice. We invite researchers and mental health practitioners to consider further opportunities to investigate the potential benefits of philosophy groups in mental health settings to establish whether they generalise. (shrink)

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical‐legal (...) challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self‐determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain. (shrink)

This article contextualizes some of the more specifically focused articles in this Special Issue of ‘Women and Mental Health’ by reviewing general historical and political currents structuring contemporary discussions around questions of models, treatment and provision for women within British mental health services. We highlight some particularities of the current British context (in relation to other national scenes) in terms of the forms and expressions of feminist activity around mental or emotional distress. While not absolute (...) mirrors of each other, resonances between general trends in feminist debates and organizational forms within feminist mental health work give rise to a wide spectrum of sites of intervention. We discuss some of the conditions that gave rise to these forms of (visible) feminist intervention within mental health service provision, focusing particularly on women's counselling and therapy services, and we offer an analysis of the range and conceptual tensions within which such interventions may be situated, including contested perspectives on power and empowerment. We also consider ways in which women's political activity around mental health issues is likely not to be noticed as such, given women's prototypical positions as patients and practitioners. We end by identifying what we see as current challenges for feminist activism around distress and its links with the conditions of women's lives and oppression more generally, not only as instances of more general tensions and challenges within contemporary feminisms, but also as offering an arena of opportunity for broader alliance and coalition-building. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we (...) describe the experience of moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify (...) and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy. (shrink)

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles (...) and concepts, the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion?informal types of leverage, and the (...) legally mandated use of Community Treatment Orders?to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion. (shrink)

This article reviews the development of a feminist analysis of female and male psychology from 1970 to 1990; the acceptance, rejection or indifference to feminist theory and practice by women in general and by female patients and mental health practitioners in specific. The article describes what feminist therapy ideally is and discusses the need for a Feminist Institute of Mental Health.

This study was part of a larger cross-national research project at the Norway’s University of Bergen, which involved participants from over 30 countries. This undertaking delves into developmental assets, creativity, and thriving, and the part they play in determining mental health. Thus, this study examined the developmental assets, creativity, thriving, and their importance to mental health in a sample of Malaysian emerging adults. This study was based on a sample of 394 undergraduate students, comprising 264 females (...) and 130 males, ranging between the ages of 18 and 26 years. Two subscales of the Reisman diagnostic creativity assessment were used to measure creativity. Meanwhile, thriving indicators of Search Institute were used to measure thriving while the short form of the mental health continuum for adolescents was used to measure mental health. An online Google form was used to collect data from university students enrolled in both public and private universities. The correlation analysis results revealed that all the variables were positively correlated to each other and that the relationship between development assets, creativity, thriving, and mental health ranged from weak to moderate. Multiple regression analysis produced four models that indicated that positive identity, support, creativity, and thriving have a significant influence on mental health among emerging adults. Further, analyses using the PROCESS procedure demonstrated significant indirect effects of positive identity and support on mental health through its effects on creativity and thriving. As such, it is our recommendation that mental health practitioners tailor their treatment approach to include positive identity, support, creativity, and thriving in their sessions with Malaysian emerging adults. (shrink)

Standards for professional training and practice are defined by accrediting organisations or statutory bodies. These describe the arena in which the practitioner may speak with authority. The sphere of authorised practice is further delineated by the external resources available. Within this explicit framework, unconscious mental processes can affect the professional response in potentially adverse ways. This is particularly important in mental health practice. Professionals must be prepared to examine their own responses on this basis in order to (...) enhance their knowledge of the patient and minimise the possibilities of the patient becoming the victim of the professional's own psychopathology. The maintenance of such a position in an institution or organisation requires a similar process within its structure in order to provide the necessary setting and define the limits of good practice. In this paper, the field of adolescent mental health is specifically examined. (shrink)

This book takes Edmund Husserl's phenomenology and applies it to help psychotherapy practitioners formulate complex psychological problems. The reader will learn about Husserl's system of understanding and its concepts that point to first-person lived experience, and about the work of Husserl scholars who have developed a way to be precise about the experiences that clients have. Through exploring the connection between academic philosophy of consciousness and mental health, themes of biopsychosocial treatment planning, psychopathology of personality and psychological (...) disorders, and the treatment of complex psychological problems become clear. The author shows that Husserlian phenomenology can be used in the design of interventions for clients in a process called formulation. Once the intentionality of consciousness is understood, by asking simple questions, it becomes possible to define problematic experiences. This is a means of creating informed consent for treatment and it makes it clear to clients what is happening for them, so helping them understand themselves and how they see the world. We also see how Husserl's phenomenology is a vehicle for psychotherapists to present their knowledge about the research literature of what has been found to be effective care. This volume applies the concepts and practices of phenomenology in a concrete way, relating them to the practice of therapy and showing the value of a qualitative approach to understanding mental processes and the nature of human beings as motivated by values, meanings and other conscious experiences. This is a readable text in simple language that condenses key aspects of Husserl's thinking in relation to the theory and practice of psychotherapy, and it is suitable for philosophers and practitioners of psychology, psychiatry, and the psychotherapies, including psychoanalysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative Formulation RevisitedOn Seeing the Person in Mental Health RecoveryAnna Bergqvist (bio)The use of narrative in mental health contexts models consciousness as something necessarily embodied, as already part of the world, in an inherently value-laden and perspectival way. As such narrative presents a powerful tool for critical reassessment and reevaluation of preconceived ideas in relating to difficult concepts in clinical interactions.Narrative structures can reveal psychological (...) differences between persons in a way that matters for the provision of effective treatment and management. As emphasized by Solomon (2015), narrative reasoning is also motivated by distinctly first-personal concerns that are operative in the practitioner–client relationship. I maintain that the dynamics of that interpersonal relationship are part and parcel of what it means to address the patient's needs to be seen as a person in humanistic empathetic care—without thereby reducing truth to an individual person's perspective to encourage positive transformation.1The notion of empowering narratives to encourage positive change is a core concept behind the emphasis on the critical role of empathy in explaining human development and psychoanalytic change within the self-psychology tradition but is also key to recovery-based models of the significance of person-centered quality of life in medicine more generally. This is defined in mental health as recovering a good quality of life as determined by the values of (by what matters or is important to) the individual concerned (Allott, Loganathan, & Fulford, 2002; Fulford, 1989, 2004; Fulford, Peile, & Carroll, 2012). The importance of strengths in this regard was reflected for example in the UK government program on values-based mental health assessment. The 3 Keys program, as it was called (National Institute for Mental Health in England, NIMHE, and the Care Services Improvement Partnership, 20082) identified three shared 'keys' to good practice in mental health assessment: three things that were identified in a wide-ranging consultation as being important alike by health professionals of all kinds and by 'service users' thus understood as patients and carers (Fulford, Duhig, Hankin, Hicks, & Keeble, 2015a; Fulford, Dewey, & King, 2015b). The third of these keys was defined in [End Page 7] the subsequently published Good Practice Guidance, as "a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges" (NIMHE, 2008: 6); and the guidance included a number of real-life case examples of best recovery practice reflecting this aspect of mental health care (Slade et al., 2014).What my (Bergqvist, 2018, 2020, 2022, forthcoming) account adds to this claim is that while such choices are revelatory or expressive of a distinctly first-personal stance, they do not constitute or determine selfhood and self-interpretation in a fixed way. Moreover, the reason is that one can also adopt a second-personal stance on one's own experience and address oneself, where the relationship between the first- and the second-personal narrative perspective on experience and self-understanding is itself a dynamic and open-ended evaluative process.Anna Bergqvist Anna Bergqvist is Reader in Philosophy at Manchester Metropolitan University since 2021, and has been Postgraduate Research Coordinator and AHRC North West Doctoral Pathway Consortium Lead for Philosophy since 2020. I was elected to a Visiting Fellowship at St Catherine's College University of Oxford for Michaelmas Term 2021. Her service to the profession out with the University includes acting as Secretary of the World Psychiatric Association (WPA) Section for Philosophy & Humanities in Psychiatry (October 2020 – present), Executive Committee Member of the Royal College of Psychiatry (RCPsych) SIG in Philosophy (February 2020 – present) and External Examiner, University of Liverpool (November 2019 – present, 4-year tenure). She is also Director of the Values-based Theory Network at St Catherine's Collaborating Centre for Values-based Practice at the University of Oxford, and Member of its Whiteness and Race Equality Network. Her approach to philosophy bridges the disciplines of moral philosophy, moral psychology and philosophy of psychiatry to improve lives through her reputable expertise in moral perception and co-production as a mechanism for change.Notes1. Here I side with Goldie (2012) and Solomon (2015), who... (shrink)

The respect for confidentiality and the rhetoric about openness of information are in conflict in contemporary society, and the tone of the conflict is increasingly inflamed. The senior professions are the battleground. Medical ethics is in turmoil from this social trend, as well as from the high profile technical developments in genetics, transplant surgery, and reproductive technology. But in addition mental health has always had its inherent problems over ethical practice since it has, to this day, inevitably retained (...) some element of medical paternalism. This places practitioners in a position in which they have a responsibility for the care of their patient, but also a responsibility for the protection of society. The particular problems in mental health often have deep moral implications, that do not exist in general medicine. Chris Cordess …. (shrink)

Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health care. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small (...) provider's practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice. (shrink)

In the Netherlands, Forensic Flexible Assertive Community Treatment is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life. The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge (...) about these patients may enhance the effectiveness of ForFACT and therefore reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care. (shrink)

The purpose of this study was to investigate mental effects of coronavirus disease 2019 and its relationship with death attitudes and coping styles among Hungarian, Norwegian, and Turkish psychology students. A total of 388 participants from Hungary, Norway, and Turkey were recruited during the pandemic. The Depression, Anxiety and Stress Scale, the Impact of Event Scale-Revised, the Carver Brief COPE Inventory, and the Death Attitude Profile-Revised were used. The results indicated that escape acceptance might be the most maladaptive death (...) attitude during COVID-19, as it was related to poorer mental health among the Hungarian, Norwegian, and Turkish psychology students. Self-blame, behavioral disengagement, self-distraction, and substance use coping styles were also related to poorer mental health, whereas positive-reframing and humor were related to better mental health among our sample in the context of COVID-19. The findings implied that death attitudes and coping styles may differ in their efficacy among the Hungarian, Norwegian, and Turkish participants. These differences were discussed in detail in the discussion part. During the pandemic, practitioners might pay closer attention to patients with higher escape acceptance death attitude and patients who use dysfunctional coping styles. Additionally, patients can be encouraged to use techniques involving positive reframing and humor coping styles. (shrink)

This paper examines the philosophical substructure to the theoretical conflicts that permeate contemporary mental health care in the UK. Theoretical conflicts are treated here as those that arise among practitioners holding divergent theoretical orientations towards the phenomena being treated. Such conflicts, although steeped in history, have become revitalized by recent attempts at integrating mental health services that have forced diversely trained practitioners to work collaboratively together, often under one roof. Part I of this paper (...) examines how the history of these conflicts can be understood as a tension between, on the one hand, the medical model and its use by the dominant profession of psychiatry, and on the other, those alternative models and practitioners in some way differentiated from the medical model camp. Examples will be given from recent policy and research to highlight the prevalence of this tension in contemporary practice. Part II of this paper explores the deeper commonalities that lay beneath the theoretical conflict outlined in Part I. These commonalities will be shown to be apart of a captivating framework that has continued to grip the conflict since its inception. By exposing this underlying framework--and the motivations inherent therein--the topic of integration appears in wholly different light, allowing a renewed philosophical basis for integration to emerge. (shrink)

No known cure exists for COVID-19, and medical practitioners are exhausted and at their wits’ end trying to find treatments that prevent patients from ending up in hospital or intensive care, or even dying. A variety of treatments tried by medical practitioners include standard registered medicine, investigational or so-called experimental, unapproved or preapproved medicines, emergency or compassionate-use authorised medicine and pre-market approved medicine. However, the medicines that can be accessed via each of these categories are at different stages (...) of efficacy testing and knowledge about adverse effects, dosages and risks. To obtain ethical and legal informed consent, medical practitioners must deal with a lot of medical uncertainty, and care must be taken to ensure that the patient understands the difference in risks they may be willing to take depending on the medicine’s stage of development. Often additional information is required to obtain ethical consent as opposed to legal consent. A purely legal approach to informed consent, especially when dealing with the medical uncertainties of health emergencies and pandemics, may lead to patients’ consent lacking in enough substance to be truly considered legal and ethical. Informed consent as respect for autonomy in this sense requires more than the patient’s explicit agreement or compliance with a certain treatment proposal. This article explains the difference in consent content attached to each different stage of a medicine’s development, especially considering the additional difficulties posed by obtaining truly informed consent during a pandemic with uncertain characteristics, treatment and solutions. (shrink)

To study whether Tai Chi practice can improve the brain connectivity of the prefrontal lobe of college students, the positive psychological capital questionnaires and resting EEG signals were acquired from 50 college students including 25 TC practitioners and 25 demographically matched TC healthy controls. The results showed that the score of the positive psychological capital questionnaire of the TC group was significantly higher than that of the control group, and the node degree of the frontal lobe and temporal lobe (...) of both groups was positively correlated with the score of the positive psychological capital questionnaire. In addition, the response time of the TC group under auditory stimulation was significantly shorter than that of the control group, and there was a significant positive correlation between response time and its characteristic path length, and a significant negative correlation with global efficiency. Meanwhile, during the selected range of sparsity, the difference in global network parameters between two groups is significant in the alpha band. Under all single sparsity, the clustering coefficient, global efficiency, and local efficiency of the TC group have a higher trend, while the characteristic path length tended to be shorter. In the analysis of the local characteristics of the resting brain functional network, it was found that the node degree of the frontal lobe and temporal lobe of the TC group was higher, and the difference was significant in some nodes. These results all point to the fact that TC practice has a certain impact on specific brain areas of the brain. (shrink)

The European Biomedical Ethics Practitioner Education Project (EBEPE), funded by the BIOMED programme of the European Commission, is a five-nation partnership to produce open learning materials for healthcare ethics education. Papers and case studies from a series of twelve conferences throughout the European Union, reflecting the ‘burning issues’ in the participants' healthcare systems, have been collected by a team based at Imperial College, London, where they are now being edited into a series of seven activity-based workbooks for individual or group (...) study. These draft workbooks are now being read by a network of critical readers across Europe, whose comments will be incorporated into the final versions of the workbooks. The result will be the first European-wide and Europe-centred resource for teaching students, practitioners, and members of ethics committees. Topics covered include: • Resource allocation and rationing • The rights of children and young people • Long-term care of the elderly • Mental health and mental illness • Autonomy and patient choice • Decisions at the end of life • A study guide to using the workbooks The collaborative nature of the project has highlighted differentiated national approaches in medical ethics. Against the British and Dutch rights-orientated approach have emerged two other alternative models: the Nordic preference for administrative resolution of entitlement disputes, and the southern European emphasis on deontological codes. A genuinely European reconstruction of autonomy and rights, using hermeneutic, feminist and narrative approaches to counterbalance individualistic models, is emerging across the workbooks. The programme has also uncovered national differences in how ethics should be taught, with the workbooks' style being an experiential approach. Thus the EBEPE project is developing new models in both substantive and pedagogic senses, about both what should be taught and how it should be presented. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher-practitioner multiple-role relationships. Participants (N = 35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who (...) were also affiliated with a university (N = 68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, 2(1, N = 30) = 12.80, p < .001, and to have never taken part in a multiple-role relationship, 2(1, N = 33) = 12.44, p < .001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, t(30) = -2.77, p = .009, and the client, t(30) = -2.50, p = .018, in such a relationship. (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher-practitioner multiple-role relationships. Participants (N=35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who were also (...) affiliated with a university (N=68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, ?²(1,N= 30) = 12.80, p <.001, and to have never taken part in a multiple-role relationship, ?²(1, N= 33) = 12.44, p<.001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, r(30) = -2.77, p = .009, and the client, f(30) = -2.50, p = .018, in such a relationship. (PsycINFO Database Record (c) 2008 APA, all rights reserved). (shrink)

The potential for the occurrence of multiple-role relationships is increased when professors also consult with athletic teams on their campuses. Such multiple-role relationships have potential ethical implications that are unclear and largely unexplored, and consultants may find multiple-role relationships both difficult to deal with and unavoidable. Therefore, the purpose of this study was to explore the nature of teacher–practitioner multiple-role relationships. Participants (N = 35) were recruited from Association for the Advancement of Applied Sport Psychology (AAASP) certified consultants (CCs) who (...) were also affiliated with a university (N = 68). All participants completed a 28-item survey exploring the incidence and relevant issues pertaining to multiple-role relationships. Chi-square analyses revealed that licensed mental health practitioners (i.e., psychologists and counselors) were more likely than nonlicensed AAASP CCs to believe that multiple-role relationships were never appropriate in sport psychology, χ2(1, N = 30) = 12.80, p <.001, and to have never taken part in a multiple-role relationship, χ2(1, N = 33) = 12.44, p <.001. Independent samples t tests revealed that mental health practitioners also reported that they would have higher levels of concern for both the practitioner, t(30) = –2.77, p =.009, and the client, t(30) = –2.50, p =.018, in such a relationship. (shrink)