The role of therapeutic jurisprudence to support persons with intellectual and developmental disabilities in the courtroom: Reflections from Ontario, Canada
نقش فقه درمانی برای حمایت از افراد دارای معلولیت ذهنی و رشد و نمو در دادگاه: بازتاب از انتاریو، کانادا-2019
It is generally recognized that persons with intellectual and developmental disabilities (IDD) are at greater risk than the general population when they encounter the criminal justice systemdue to vulnerabilities such as cognition, memory and language (Jones, 2007). To date, little evidence has been generated regarding best practice to support persons with IDD in the criminal justice system, specifically the courtroom. Various models of problemsolving courts have developed across Canada to divert cases composed of complex human social problems to more appropriate community-based treatment and supports. Past Canadian authors have raised critical questions that require reflection about the broader theory of Therapeutic Jurisprudence (TJ) and its current implementation in problem-solving courts. Given the risk and vulnerabilities of persons with IDD in the criminal justice system, problem-solving courts (specifically mental health courts) hold great promise to address some of the unique needs of these individuals.We reflect on the critical questions raised by previous Canadian authors regarding problem-solving courts and suggest some considerations that need to be addressed to maximize the benefits of these courts for persons with IDD.
Keywords: Therapeutic jurisprudence | Mental health courts | Intellectual disabilities
Surveying the Geneva impasse: Coercive care and human rights
بررسی بن بست ژنو: حقوق مراقبت اجباری و انسانی-2019
The United Nations human rights system has in recent years been divided on the question as to whether coercive care interventions, including coercive psychiatric care, can ever be justified under UN human rights standards. Some within the UN human rights community hold that coercive care can comply with human rights standards, provided that the coercive intervention is a necessary and proportionate means to achieve certain approved aims, and that appropriate legal safeguards are in place. Others have held that coercive care is never justified. Disagreement over this issue has produced an impasse in the UN human rights system. We survey the impasse with particular attention to the legal arguments that inform the divergent positions. In doing so we introduce a distinction among a variety of different ‘abolitionist’ positions regarding coercive care, and draw a distinction between ‘non-consensual’ and ‘coercive’ treatment. We conclude with three proposals for moving beyond the current impasse.
Keywords: Human rights | mental health | consent | psychiatric coercion | psychiatric detention | Coercive treatment | United nations human rights committee | United nations convention on the rights of | persons with disabilities | Non-consensual treatment | Involuntary treatment
Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making
بیماران روانی درخواست کشتن از سر ترحم: دستورالعمل هایی برای تصمیم گیری بالینی و اخلاقی سالم-2019
Background: Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial cases. This has prompted several healthcare organisations and committees to develop policies on the management of these requests. Method: Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1) proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards going beyond these criteria; and 3) remaining fields of tension. Results: The initiatives are well in keeping with the legal requirements but are often more stringent. Additional safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists; an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the patients euthanasia request and on that persons continuing treatment. Although the initiatives are similar in intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an emphasis on practical clinical assessment versus broad ethical reflection. Conclusions: All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients. By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives are important instruments to prevent potential abuses. Apart from the additional safeguards suggested, the importance of a decision-making policy that includes many actors (e.g. the patients relatives and other care providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending physicians should manage negative or conflicting advices, or patients suicide threats in case of refusal. Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to what extent the recommendations made in these guidelines are currently being implemented.
Keywords: Medical assistance in dying | Psychiatry | Mental health | Belgium | Euthanasia | Guidelines
Responding to adolescent mental health difficulties: Irish law through a gendered lens
پاسخ به مشکلات سلامت روان بزرگسالان: قانون ایرلند از طریق یک لنز جنسیتی-2019
Associations of Lesbian, Gay, Bisexual, Transgender, and QuestioningeInclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U:S: High School Students
انجمن های لزبین ، همجنسگرا ، دوجنسگرا ، ترنسجندر و سؤال از آموزش فراگیر جنسی با پیامدهای سلامت روانی و قربانی سازی مدارس در دانش آموزان دبیرستانی ایالات متحده-2019
Purpose: Homophobic school climates are related to increased victimization for sexual minority youth (SMY), leading to increased risk of adverse mental health outcomes. Interventions that promote positive school climate may reduce the risk of victimization and adverse mental health outcomes in SMY. This study explored whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ)einclusive sex education is associated with adverse mental health and school-based victimization in U.S. youth. Methods: Data analysis of representative data from the 2015 Youth Risk Behavior Survey and the 2014 School Health Profiles was conducted using multilevel logistic models testing whether youth in states with higher proportions of schools teaching LGBTQ-inclusive sex education had lower odds of reporting being bullied in school and experiencing adverse mental health outcomes, including depressive symptoms and suicidality. Results: After controlling for covariates, protective effects for all youth were found for suicidal thoughts (adjusted odds ratio [AOR]: .91, 95% confidence interval [CI]: .89e.93) and making a suicide plan (AOR: .79; 95% CI: .77e.80). Lesbian and gay youth had lower odds of experiencing bullying in school as the proportion of schools within a state teaching LGBTQ-inclusive sex education increased (AOR: .83; CI: .71e.97). Bisexual youth had significantly lower odds of reporting depressive symptoms (AOR: .92; 95% CI: .87e.98). Conclusions: Students in states with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health. These findings can be used to guide intervention development at the school and state levels
Keywords: Sexual minority youth | Mental health | Bullying | Inclusive sex education | School climate
نگرشها و اقدامات تخصصی درباره غربالگری افسردگی پس از زایمان: آموزش و همکاری بین تخصصی موردنیاز
سال انتشار: 2019 - تعداد صفحات فایل pdf انگلیسی: 4 - تعداد صفحات فایل doc فارسی: 18
اهداف: اگرچه تحقیقات بیان می کند که مدیریت کردن افسردگی پس از زایمان امکانپذیر است و در شرایط مربوط به امراض کودکان موثر است، اما بررسی نحوه برخورد و اقدامات متخصصان کودکان درباره غربالگری افسردگی پس از زایمان و همکاری بین - تخخصی مهم است. این مقاله نتایج یک ارزیابی دربین متخصصان کودکان را در یک شهر بزرگ در جنوب غرب آمریکا ارائه می کند. روشها: یک پرسشنامه 20 بخشی برای بررسی نگرشها و اقدامات متخصصان کودکان درباره غربالگری افسردگی پس از زایمان و همکاری بین - تخصصی تولید شد. نتایج: با اینکه اکثر متخصصان کودکان نگرشهای مثبتی را درباره به وجود آمدن نشانه های جدیدی از افسردگی مادران بیان کردند اما فقط 69 (3/66%) آخرین باری را که تشخیص دادند که یک مادر در معرض خطر افسردگی پس از زایمان است به یاد می آوردند. دربین 69 متخصص ذکر شده، 9 (13%) گزارش کردند که آنها مادران جدید را به یک متخصص سلامت روانی ارجاع داده اند و هشت نفر از این نه متخصص سلامت روانی کارگران اجتماعی هستند. نبود زمان (84%) و نا آشنا بودن با منابع سلامت روانی (5/53%) دو مانعی هستند که متخصصان کودک را از اقدام به غربالگری افسردگی پس از زایمان در کار خود بازمی دارند. 23 متخصص کودک (1/22%) آموزش های افسردگی پس از زایمان را در سال گذشته دیده اند. متخصصان آموزش دیده در بررسی افسردگی پس از زایمان (t (36)=3.218, p=.002) و دانش معیارهای تشخیص افسردگی (t(45)=4.108, p < .001) به صورت قابل توجهی نمرات بالاتری را به اعتماد به نفس خود دادند. متخصصانی که آموزش دیده بودند همچنین احتمال بالاتری برای غربالگری مادران جدید ازنظر داشتن افسردگی پس از زایمان در کار خود داشتند (ضریب فیشر = 845/7، 012/0 = p). نتیجه گیری: اجرای آموزش افسردگی پس از زایمان به متخصصان کودکان کمک خواهد کرد تا کارآمدی غربالگری را بهبود ببخشند. کارگران اجتماعی منبع اصلی متخصصان سلامت روانی در شرایط امراض کودکان هستند. ما حرکت به سمت یک همکاری بین – تخصصی و یک مدل یکپارچه غربالگری – ارجاع – مداخله را توصیه می کنیم جاییکه کارگران اجتماعی می توانند ارزیابی و مداخلات بیشتری پس از غربالگری و ارجاع متخصصان کودکان داشته باشند.
|مقاله ترجمه شده|
The rehabilitation of the mentally disabled in the community act in Israel: Entrepreneurship, leadership, and capitalizing on opportunities in policy making
بازسازی معلول ذهنی در عمل جامعه در اسرائیل: کارآفرینی، رهبری، و سرمایه گذاری در فرصت ها در سیاست گذاری-2019
This paper examines the role of policy entrepreneurs in the formation of a rehabilitation program in the field of mental health in Israel, shedding light on their role in general and specifically in mental health policy formation. Our research is based on a historical case study. The legislation process was examined through interviews with key actors in the legislative process and archival materials. While in general our findings reinforced existing literature, our research also revealed new information on several topics: organizations as policy entrepreneurs; inter-sectorial coalitions of entrepreneurs; and possible problems arising from the concept of ‘leadership by example.
Keywords: Policy formation | Policy entrepreneurs | Mental health policy | Mental health rehabilitation
Psychotropic medication profile in a community youth mental health service in Australia
نقش داروهای روان گردان در سلامت روانی جوانان جامعه در استرالیا-2018
Aim There has been a rise in the use of psychotropic medication in young people, despite limited risk-benefit profile of psychotropic medication for this population. Given their side effect profile, the use of psychotropic medications should occur with caution. This study investigated psychotropic prescribing pattern in a public youth community mental health service and gives an estimate of general level of psychotropic medication use in this setting. Methods A retrospective file review was undertaken of all young people aged 12–17 who received care from the service in 2016 (N = 189) for a range of mental health problems, excluding psychosis. Files were reviewed for demographical information (age, gender), diagnosis/presenting issues, prescribed medications, indications of medications, and prescriber type (e.g. psychiatrist, general practitioners (GPs), paediatrician). The data was analysed descriptively. Results Over 60% (60.8%, n = 115) of young people were prescribed psychotropic medications. Over half of the entire sample were on antidepressants (51.32%, n = 97), nearly a quarter (n = 46, 24%) on antipsychotics, 6% on ADHD medications (6.35%, n = 12), and a fifth (19.58%, n = 37) on polypharmacy. Antidepressants and antipsychotics were mostly used off-label, prescribed by public psychiatric staff. Quetiapine was the most prescribed antipsychotic predominantly for insomnia. Fluoxetine and fluvoxamine were the most prescribed antidepressants predominantly for anxiety disorders. Girls are more likely to be prescribed psychotropic medications than boys, specifically antipsychotic medication. Conclusions A high proportion of young people were prescribed psychotropic medication, including antipsychotic medication, mostly for the treatment of anxiety and depressive disorders. There is little evidence around how psychotropic medication is used in youth mental health settings, and this study contributes to this gap.
keywords: Psychotropic medication |Adolescent mental health |Prescribing patterns |Antidepressants |Antipsychotics
PTSD, burnout and well-being among rescue workers: Seeking to understand the impact of the European refugee crisis on rescuers
PTSD، فرسودگی شغلی و رفاه کارکنان نجات: برای درک تاثیر بحران پناهندگان اروپا برای امدادگران-2018
Individuals who perform rescue and recovery duties, as part of their daily work activities, confront diverse stressors that can affect their mental state and overall well-being. The study aimed to assess the prevalence and the factors associated with self-assessed PTSD, perceived well-being and burnout among rescue workers oper ating at Lesvos during the European refugees crisis. 217 rescuers participated in the study, while the PTSD Checklist-Civilian Version (PCL-C), the Maslach Burnout Inventory (MBI) and the Well-being Index (WHO-5) were utilized. The prevalence of self-assessed PTSD and perceived burnout syndrome was 17.1% and 57% re spectively, while 72.8% of the rescuers reported low levels of perceived well-being. Self-assessed PTSD was positively correlated with perceived burnout and inversely correlated with perceived well-being. Perceived burnout was also inversely correlated with perceived well-being. A number of significant predictors were identified for self-assessed PTSD, perceived burnout and well-being, including: family status, age, duration of shifts, collection of dead adults or dead children bodies. The impact of the refugee crisis is visible on the rescue workers that offer rescue and first aid services. There is an urgent need for implementing effective interventions focusing on the identified determinants in order to enhance the occupational psychological burden of rescuers.
Keywords: Occupational risk ، Psychological burden ، Mental health ، Emergency workers
Application of the SEIPS Model to Analyze Medication Safety in a Crisis Residential Center
کاربرد مدل SEIPS برای تحلیل ایمنی دارو در یک بحران مرکز مسکونی-2018
Purpose: Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. Background: The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of tech nology, tasks, persons, environment, and organization to guide the collection of data. Methods: In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. Results: Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. Conclusion: The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality im provement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the doc umentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project.
Keywords: Medication administration ، Mental health ، Process improvement ، SEIPS model ، Drug administration ، Medication errors and control ، Quality improvement