ABSTRACT
Community psychiatry is a wonderful and rewarding career path that increasing numbers of psychiatrists are choosing to practice.14 This article was created to provide an orientation to the characteristics of contemporary community psychiatric practice that render it distinct in terms of ethical considerations. We defined and described community practice. We provided a framework based on classical medical ethics that can be used to consider challenges in particular community practice situations. We also offered special considerations of key areas in which community practice demands novel treatment methods coupled with special clinical expertise in assessing risks and benefits. We hope to have provided a discussion that supports a broadening of existing psychiatric ethical guidelines so that they are inclusive of the kinds of situations routinely encountered by community psychiatrists and other community mental health care professionals and paraprofessionals. It is our hope that ideas presented in this article will help to equip psychiatrists and their community teams to facilitate the successful rehabilitation and recovery of the individuals they serve.
Subject(s)
Community Psychiatry/ethics , Beneficence , Community Mental Health Services/legislation & jurisprudence , Community Mental Health Services/organization & administration , Humans , Interprofessional Relations/ethics , Mental Disorders/therapy , Personal Autonomy , Physician-Patient Relations/ethics , Practice Guidelines as Topic , Social Justice/ethics , Vulnerable Populations/psychologyABSTRACT
Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.
Subject(s)
Child Abuse/legislation & jurisprudence , Ethics, Institutional , Licensure, Hospital , Mental Disorders/therapy , Quality Assurance, Health Care/legislation & jurisprudence , Residential Treatment/legislation & jurisprudence , Accreditation/ethics , Accreditation/legislation & jurisprudence , Adolescent , Child , Child Abuse/ethics , Child Abuse/prevention & control , Consumer Organizations/ethics , Consumer Organizations/legislation & jurisprudence , Humans , Licensure, Hospital/ethics , Mental Disorders/psychology , Patient Care Team/ethics , Patient Care Team/legislation & jurisprudence , Quality Assurance, Health Care/ethics , Residential Treatment/ethics , United StatesABSTRACT
Over the past 20 years, child and adolescent community mental health has evolved conceptually, clinically, and scientifically towards the community-based systems of care model. This model asserts important values and principles, including the centrality of the child and family in the care process, the integration of the efforts of disparate agencies and interveners into a contextual approach, and the importance of serving children with serious disturbances in their homes and communities. The article reviews the evolution of the community-based systems of care model, its evidence-base, its application in practice, and the challenges it faces in today's human services environment.
Subject(s)
Adolescent Psychiatry/organization & administration , Child Psychiatry/organization & administration , Community Mental Health Services/organization & administration , Adolescent , Adolescent Psychiatry/trends , Child , Child Psychiatry/trends , Child Welfare/trends , Community Mental Health Services/history , Community Mental Health Services/trends , History, 20th Century , History, 21st Century , Humans , Interprofessional Relations , United StatesABSTRACT
Leaders of national groups that have focused on issues of community and social psychiatry present their ideas about the future of psychiatry. They identify five areas: theory development; the relevance of community psychiatry in the 21st century; education and training; the relationship between community psychiatry and health maintenance organizations; and role of community psychiatry in bridging medical science with humanism. The unifying theme for these topics is that community psychiatry can be a vehicle for modifying general psychiatry's propensity towards individualism and reductionism by offering a more holistic and integrative approach to illness and well-being.
Subject(s)
Community Mental Health Services/trends , Community Psychiatry/trends , Forecasting , Humans , Managed Care Programs , Societies, MedicalSubject(s)
Behavior Therapy , Benchmarking , Decision Support Techniques , Mental Disorders/rehabilitation , Needs Assessment/statistics & numerical data , Personality Assessment/statistics & numerical data , Substance-Related Disorders/rehabilitation , Adolescent , Adult , Child , Community Mental Health Services/classification , Humans , Psychometrics/statistics & numerical data , Reproducibility of Results , United StatesABSTRACT
This article considers the appropriate legal and ethical response to those whose advocacy of "alternative" or unvalidated therapies places people at risk of harm. What are our professional responsibilities with respect to such advocacy, and what sorts of harm will justify government intervention?
