Title: The Unethical Treatment of Psychiatric Patients

Brittany L Sullivan Nursing Department, Berea College, Berea, KY, USA

Session Title: Rising Stars of Nursing Invited Posters - Group 1 Slot (superslotted): RSG STR 1: Thursday, September 25, 2014: 9:45 AM-10:30 AM Slot (superslotted): RSG STR 1: Thursday, September 25, 2014: 2:30 PM-3:15 PM

Keywords: Ethics, Psychiatric Patients and Treatment References: Antipuesto, D. (2011, January 11). Ethical Principles. Nursing Crib RSS. Retrieved October 27, 2013, from http://nursingcrib.com/nursing-notes-reviewer/fundamentals-of-nursing/ethical-principles/ Association of Nurses. (n.d.). Short Definitions of Ethical Principles and Theories. Ethical Principles N450. Retrieved October 27, 2013, from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf. Centers for Disease Control and Prevention. (2011, July 01). Stigma of mental illness. Retrieved from http://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm Entwistle, V., & Watt, I. (2013) http://www.tandfonline.com/doi/full/10.1080. The American Journal of Bioethics, 13(8), 29-39. Retrieved September 9, 2013, from http://www.tandfonline.com/doi/full/10.1080 Garey, J. (2013, August 10). When Doctors Discriminate - NYTimes.com. The New York Times - Breaking News, World News & Multimedia. Retrieved September 13, 2013, from http://www.nytimes.com/2013/08/11/opinion/sunday/when-doctors-discriminate.html?pagewanted=all&_r=1& Goar, C. (2012, September 20). Health-care providers openly discriminate against the mentally ill | Toronto Star. thestar.com | Toronto Star | Canada's largest daily. Retrieved September 13, 2013, from http://www.thestar.com/opinion/editorialopinion Hanlon, C., Tesfaye, M., Wondimagegn, D., & Shibre, T. (2010). Ethical And Professional Challenges In Mental Health Care In Low- And Middle-income Countries. International Review of Psychiatry, 22(3), 245-251. Hansson, L., Jormfeldt, H., Svedberg, P., & Svensson, B. (2013). Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? . International Journal of Social Psychiatry , 59(1), 48-54 . Horsfall, J., Cleary, M., & Hunt, G. E. (2010). Stigma in Mental Health: Clients and Professionals. Issues In Mental Health Nursing, 31(7), 450-455. doi:10.3109/01612840903537167 Jenson, M., Pease, E., Robinson, O., McCoy, K., Barut, J., Musker, K., et al. (2013). Championing Person-First Language: A Call to Psychiatric Mental Health Nurses . Journal of the American Psychiatric Nurses Association, 19(3), 146-151. Katon, W., Lin, E., Von Korff, M., Ciechanowski, P., Ludman, E., Young, B., Peterson, D., & Rutter, C, et. al. (2010). Collaborative care for patients. The new england journal of medicine, 363, 2611-2620. doi: 10.1056/NEJMoa1003955 Kliff, S. (2012, Dec 17). Seven facts about america’s mental health-care system. Retrieved from http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/ Lawrence, D., & Kisely, S. (2010). Review: Inequalities In Healthcare Provision For People With Severe Mental Illness. Journal of Psychopharmacology, 24(4 ), 61-68. Lilja, L., & Hellzén, O. (2008). Former patients' experience of psychiatric care: A qualitative investigation. International Journal Of Mental Health Nursing, 17(4), 279-286. doi:10.1111/j.1447-0349.2008.00544.x Mauer, B. (2006, Oct). Morbidity and mortality in people with serious mental illness. Retrieved from http://www.dsamh.utah.gov/docs/mortality-morbidity_nasmhpd.pdf Mental Health Care. (2013). Department of Managed Health Care. Retrieved September 15, 2013, from www.dmhc.ca.gov/dmhc_consumer/br/br_mentalhlth National Alliance on Mental Illness. (2009). The state of public mental health services across the nation. Retrieved from

http://www.nami.org/Content/NavigationMenu/Grading_the_States_2009/Findings/Findings.htm Ngui, E. M., Khasakhala, L., Ndetei, D., & Roberts, L. W. (2010). Mental Disorders, Health Inequalities And Ethics: A Global Perspective. International Review of Psychiatry, 22(3), 235-244. Ross, C. A., & Goldner, E. M. (2009). Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. Journal Of Psychiatric & Mental Health Nursing, 16(6), 558-567. doi:10.1111/j.1365-2850.2009.01399.x Thornicroft, G., Rose, D., & Kassam, A. (2007). Discrimination In Health Care Against People With Mental Illness. International Review of Psychiatry, 19(2), 113-122. Thornicroft, G., Rose, D., & Mehta, N. (2010). Discrimination Against People With Mental Illness: What Can Psychiatrists Do?. Advances in Psychiatric Treatment, 16(1), 53-59. Tracy, N. (2013, August 16). How Doctors Discriminate Against the Mentally Ill. Medical Information & Trusted Health Advice: Healthline. Retrieved September 13, 2013, from http://www.healthline.com/health-blogs/bipolar-bites/how-doctors-discriminate-against-mentally-ill Whalen, D. (n.d.). The stigma associated with mental illness. Retrieved from http://cmhanl.ca/pdf/Stigma.pdf World Health Organization. (2013.). Disability and health. World Health Organization. Retrieved September 9, 2013, from www.who.int/mediacentre/factsheets/fs352/en/ Learning Activity:

LEARNI

NG

OBJECTI

VES

EXPAN

DED

CONTE

NT

OUTLIN

E

TIME

ALLOT

TED

FACULTY/SPE

AKER

TEACHING/LEA

RNING

METHOD

EVALUATION/FE

EDBACK

Example

Critique

selected

definition

of the

term,

"curriculu

m"

Example

Definitio

ns of

"curricul

um"

Course of

study

Arrange

ments of

instructio

nal

materials

The

subject

matter

that is

taught

Cultural

"training"

Planned

engagem

Example

20

minutes

Example

Name,

Credentials

Example

Lecture

PowerPoint

presentation

Participant

feedback

Example

Group discussion:

What does cultural

training mean to you?

ent of

learners

The

learner

will be

able to

identify

ethical

issues

(justice,

beneficenc

e and

respect)

that are

violated

within the

healthcare

setting, as

experience

d by

psychiatric

patients.

Definitio

ns and

examples

of:

Justice,

beneficen

ce,

respect

discussed

with

planned

engagem

ent of the

learners.

10

minutes

Brittany L.

Sullivan, BCSN

Poster and asking

participants

questions

Have you ever heard

or witnessed ways in

which the ethical

issues of justice,

beneficence and

respect have been

violated? What is

your response to such

treatment, as

experienced by

psychiatric patients?

The

learner

will be

able to

identify

ways in

which

nurses,

healthcare

personnel,

and the

governme

nt are

working to

improve

the ethical

issue faced

by

psychiatric

patients

Discussio

n of

solutions

and

possible

solutions

10

minutes

Brittany L.

Sullivan, BCSN

Poster presentation What is your take

what is currently

being done to

improve the

healthcare setting for

psychiatric patients?

Do you have any

other suggestions for

what else could be

done?

Abstract Text:

The healthcare system aims to provide appropriate support and treatment to enhance the quality of a person’s emotional and psychological health. However, the United States has not fulfilled this aim when providing patient centered care to people with mental illnesses, and consequently, they have unmet needs for healthcare. Annually, approximately 30% of people, will be diagnosed with a mental illness. A national report card of the United States, observing each state’s service to psychiatric patients, revealed that treatment for psychiatric patients is not at an optimal level. One category in this report observed how each state promotes healthy living. Based on the ‘A’-‘F’ letter grade system, ‘A’ being the best and ‘F’ being the worse, 70% of the states in America scored an ‘F’ or a ‘D,’ reflecting poor efforts for the wellness and survival for people with mental illness. In comparison to other populations, mental health patients receive, not only inadequate mental health treatment, but also inadequate treatment for physical diseases. People with mental disorders are more likely to die prematurely of cardiovascular, respiratory and infectious diseases more than any other population. Therefore, the healthcare system is in violation of the ethical principles of respect, beneficence, and justice, in the care delivered to those with a mental illness. The government and the World Health Organization are implementing changes to improve this care. Although there are limited evidence based changes, there have been several initiatives from the United States government and researchers to improve the quality of care for patients with mental illnesses, such as: providing mental health services to all patients when services are inaccessible or unavailable and bringing awareness and knowledge of mental health and the causes of mental illnesses. Both of these areas have been recognized as having contributed to psychiatric patients being a lower priority to policy makers and the healthcare team.

Recommendations

Increasing awareness and education of professionals who care for those with mental disorders is one step to improving the overall health and healthcare delivery to psychiatric patients. Additionally, if each healthcare facility undergoes ongoing surveillance to ensure the proper treatment of psychiatric patients, as evidenced by positive and inclusive attitudes and language from the healthcare personnel, then that can also aid in improving the healthcare setting for these patients.

Conclusion

It is very important that healthcare professionals address the unethical delivery of care experienced by the mental health population. The negative stigma attached to mentally ill individuals compromises their medical treatment, increasing the morbidity rate. Mental health patients receive little treatment, no treatment, or bad treatment, which violates the ethical principles of justice, respect, beneficence, and autonomy. Overall, even with limited evidence based research to incorporate into treatment for this population, the government, researchers and the World Health Organization (WHO) have made initiatives to make the healthcare setting more inclusive of all patients and aim to promote an atmosphere of respect, beneficence and justice.