Tratamiento ambulatorio involuntario: implicaciones éticas y deontológicas / Involuntary outpatient treatment: the ethical implications

No disponible

Compulsory Mental Health Treatment in Hong Kong: Which Way Forward?

On 25 to 26 August 2017, the 'Compulsory Mental Health Treatment in Hong Kong: Which Way Forward?' conference was held in Hong Kong. Academics and practitioners from the United Kingdom, United States, New Zealand, and Hong Kong came together to discuss such important topics as the philosophical justifications for compulsory treatment, constitutional and human rights, and how compulsory powers are and should be used in practice. Speakers and conference participants then engaged in roundtable discussions on various issues that arose, in particular how reform of the law regulating compulsory mental health treatment in Hong Kong should proceed.

[Voluntariness in Outpatient Psychotherapy with Children and Adolescents]. / Über die Freiwilligkeit in der ambulanten Kinder- und Jugendlichenpsychotherapie.

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.

["I Would Never have done it Without Coercion " - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic]. / "Freiwillig hätt' ich's nicht gemacht " ­ Erfahrungen mit Zwangskontexten und erzwungenen Aufenthalten in einer familienpsychiatrischen und -psychotherapeutischen Tagesklinik.

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.

Involuntary mental health treatment in the era of the United Nations Convention on the Rights of Persons with Disabilities.

Based on interviews with a variety of participants, Vikram Patel and colleagues advocate for philosophical and practical progress toward recognizing decision-making capacity in people with psychosocial disabilities.

Coercive mental health care - dilemmas in the decision-making process. / Bruk av tvang i psykisk helsevern ­ dilemmaer i beslutningsprosessen.

BACKGROUND: The use of coercive mental healthcare contravenes the principle of voluntary examination and treatment. However, it should be possible for persons at acute risk to receive imperative health assistance. MATERIAL AND METHOD: After evaluating 37 emergency interviews in psychiatric outpatient clinics where the use of coercive mental health care was considered, interviews were conducted with emergency assistance staff. RESULTS: The study includes interviews that resulted in involuntary hospitalisation (n = 15), coerced observation (n = 2), voluntary hospitalisation (n = 14) and follow-up by the outpatient clinic (n = 6). Important factors in assessing the use of coercion were the severity of psychotic symptoms, suicide risk and risk for others, and difficult social circumstances. Three-quarters of emergency assistance staff were in some degree of doubt, and 16 out of 37 experienced uneasiness during the assessment. With a view to enhancing the patient's perception of having been met with respect, the emergency assistance staff emphasised the need for the patient's opinion to be heard. Where the emergency assistance staff were in doubt, a number of professional and ethical issues were highlighted in the process of reaching a decision. DISCUSSION: Latitude should be given for ethical and professional reflection in relation to assessing the use of coercion in daily clinical practice, as well as training in measures to reinforce patients' experience of participation during the interview.

Legal and Ethical Challenges, Part 1: General Population.

Several federal and state laws and regulations, as well as ethical medical principles, govern the emergency clinician's practice of care. Although some common legal-medical and ethical principles are shared with other medical specialties, emergency medicine and emergency psychiatry have unique legal and ethical challenges. This article presents and discusses these challenges, including the physician-patient relationship, malpractice, confidentiality and privilege, duty to report, decision-making capacity and vicarious decision-making, the Emergency Medical Treatment and Labor Act, right to treatment, hospital admissions, involuntary commitment, forced medication administration, and child and elder abuse.