The experiences of detained mental health service users: issues of dignity in care

BMC Medical Ethics

Xenya Kantaris¹  Kati Turner²  Steve Gillard²  Rohan Borschmann³  Ann Gallagher⁴  Mary Chambers¹ 

[1] Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK;Institute of Population Health Research, St. George's, University of London, London, UK;Institute of Psychiatry, King’s College, London, UK;Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

关键词: Respect;    Nursing;    Ethics;    Dignity;    Service users;    Mental health;    Detained;   

Others  :  1090165
DOI  :  10.1186/1472-6939-15-50

 received in 2013-07-31, accepted in 2014-06-20,  发布年份 2014

【 摘 要 】

Background

When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored.

Methods

This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not).

Results

The service users considered their dignity and respect compromised by 1) not being ‘heard’ by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom.

Conclusions

Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice.

【 授权许可】

   
2014 Chambers et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]MIND 2010. http://www.mind.org.uk/help/research_and_policy/dangerousness_and_mental_health_the_facts webcite. Accessed January 7, 2013
• [2]United Nations: Universal Declaration Of Human Rights. 1948. http://www.un.org/events/humanrights/ webcite. Accessed July 14, 2014
• [3]International Council of Nurses’ (ICN): Code Of Ethics For Nurses. 2005. http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ webcite. Accessed November 16, 2012
• [4]Macklin R: Dignity is a useless concept. BMJ 2003, 327:1419-1420.
• [5]Mandelstam M: How We Treat The Sick: Neglect And Abuse In Our Health Services. London: Jessica Kingsley Publishers; 2011.
• [6]Shotton L, Seedhouse D: Practical dignity in caring. Nurs Ethics 1998, 3:246-255.
• [7]Gallagher A, Wainwright P, Baillie L, Ford P: The RCN dignity survey: implications for leaders. Nurs Man 2009, 16(4):12-16.
• [8]Bonney S, Stickley T: Recovery and mental health: a review of the British Literature. J Psychiatr Ment Health Nurs 2008, 15:140-153.
• [9]Tew J, Ramon S, Slade M, Bird V, Melton J, Le Boutillier C: Social factors and recovery from mental health difficulties: a review of the evidence. J Soc Work 2011, 42:443-460.
• [10]Chochinov HM: Dignity Therapy: Final Words For Final Days. Oxford University Press; 2012.
• [11]Bagheri A: Elements of human dignity in healthcare settings: the importance of the patient's perspective. J Med Ethics 2012, 38:729-730.
• [12]Georgieva I, Mulder CL, Whittington R: Evaluation of behavioral changes and subjective distress after exposure to coercive inpatient interventions. BMC Psychiatry 2012, 12:54. BioMed Central Full Text
• [13]Care Quality Commission: Count Me In 2010. 2010. http://www.cqc.org.uk/content/care-quality-commission-looks-ahead-last-count-me-census-published webcite. Accessed July 14, 2014
• [14]NICE 2005. http://www.nice.org.uk/patientsandpublic/index.jsp?action=guidancesearch webcite. Accessed January 7, 2013
• [15]Streubert-Speziale HJ, Carpenter DR: Qualitative Research in Nursing: Advancing the Humanistic Imperative. Lippincott Williams & Wilkins; 2007.
• [16]Gillard S, Borschmann R, Turner K, Goodrich-Purnell N, Lovell K, Chambers M: Producing different analytical narratives, coproducing integrated analytical narrative: a qualitative study of UK detained mental health patient experience involving service user researchers. Int J Soc Res Meth 2012, 15(3):239-254.
• [17]Babbie ER: The Practice of Social Research (10th edition). Wadsworth: Thomson Learning Inc; 2004.
• [18]Robinson OC: Relational analysis: an add-on technique for aiding data integration in qualitative research. Qual Res Psychol 2011, 8:197-209.
• [19]Smart C: Personal Life. New Directions In Sociological Thinking. London: Polity Press; 2007.
• [20]Social Exclusion Unit: Joint Commissioning Panel for Mental Health. 2004. http://www.slideshare.net/jcpmh/jcpmh-publicmentalhealthguide webcite. Accessed January 7, 2013
• [21]Curtice MJ, Exworthy T: FREDA: a human rights-based approach to health care. Psychiatrist 2010, 34:150-156.8.
• [22]Royal College of Nursing (RCN): Defending Dignity Report. 2008. http://www.rcn.org.uk/__data/assets/pdf_file/0011/166655/003257.pdf webcite. Accessed January 7, 2013
• [23]Slade M: Rethink: 100 Ways To Support Recovery A Guide For Mental Health Professionals Rethink Recovery Series: Volume 1. 2009. http://www.mentalhealthrecovery.com/recovery-resources/documents/100_ways_to_support_recovery1.pdf webcite. Accessed 14 July 2014
• [24]Vida S, Mary C, Xenya K, Raija K, Lauri K, Anne S, Maria Antónia Rebelo B, Renzo Z, Maritta V: The feelings and thoughts of mental health nurses concerning the management of distressed and disturbed in-patients: a comparative qualitative European study. Open J Nurs 2013, 3:426.
• [25]Horsfall J, Cleary M, Hunt GE: Stigma in Mental Health: Clients and Professionals. Issues Ment Health Nurs 2010, 31(7):450-455.
• [26]Honneth A: Integrity and disrespect: principles of a conception of morality based on the theory of recognition. Polit Theor 1992, 20(2):187-201.
• [27]Raphael K: Recall bias: a proposal for assessment and control. Int J Epidemiol 1987, 16(2):167-170.
• [28]Faulkner A: Dignity In Care: Dignity In Mental Healthcare Practice. 2010. http://www.scie.org.uk/publications/guides/guide15/specialistcare/mentalhealth/index.asp webcite. Accessed April 22, 2013
• [29]Baillie L, Gallagher A: Wainwright Defending Dignity: Challenges and Opportunities for Nursing. London: RCN; 2008. http://www.rcn.org.uk/__data/assets/pdf_file/0011/166655/003257.pdf webcite. Accessed January 7, 2013