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About this book

Mental health is the one area of health care where people are often treated against their will, with the justification that it is in their own interest. This raises significant ethical questions and value dilemmas; questions of autonomy, human rights, power and treatment. An understanding of how values matter is of vital importance across all disciplines working within the mental health field.

This book provides a comprehensive and exploratory text for practitioners, students and all those interested in developing a knowledge of both ethics and the wider framework of values-based practice. It is unique in being fully co-written by authors representing both service user and service provider perspectives. This exciting new text will enable the mental health practitioner to work more co-productively with service users within a humane and just approach to care.

With an emphasis on rights-based compassionate care throughout, this book:

• tackles the issues of how mental health is understood through key theoretical debates about mental distress, values and labelling;
• encourages readers to think critically about their understanding of key issues such as recovery, autonomy, power, knowledge, diagnoses and empathy;
• draws on a wide range of case examples and exercises to help readers deepen their knowledge of values-based practice and ethics in mental health.

Table of Contents

1. Ethics and values in mental health practice

Abstract
This chapter will:
  • Introduce the importance of ethical thinking and ethical questions for mental health practice.
  • Show the need for values and values-based practice as a complement to ethical thinking.
  • Emphasise the plurality and diversity of values, and the aim of balanced decision making where values are in conflict.
  • Discuss the context of power, in which both ethics and values operate.
  • Raise the question of what it means to put people who use services at the centre of values-based practice.
  • Raise issues about narratives and how they are presented in this book.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

2. Ethics: Theories, contexts and questions

Abstract
This chapter will:
  • Introduce the reader to definitions of ethics and moral philosophy and consider the centrality of ethical questions to mental health practice.
  • Outline four core theoretical approaches for mental health practice -deontology, consequentialism, virtue ethics and the ethics of care.
  • These four theoretical approaches are each related to practical examples of mental health care and practice.
  • Outline the four principles of biomedical ethics — autonomy, beneficence, non-maleficence and justice.
  • Offer case examples and exercises to deepen and enhance learning and reflection.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

3. Ethics and values: Developing a values toolkit

Abstract
This chapter will:
  • In Part I, discuss values.
  • In Part II, discuss values in health care.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

4. Values-based practice

Abstract
This chapter will:
  • Present an overview of values-based practice.
  • Discuss the clinical skills for values-based practice.
  • Consider professional relationships in values-based practice:
    • Person-values-centred care
    • The extended multidisciplinary team.
  • Discuss values and evidence in values-based practice.
  • Consider partnership in values-based practice.
  • Demonstrate how to pull it all together: making balanced decisions in individual situations.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

5. The importance of power

Abstract
This chapter will:
  • Introduce the reader to definitions of power and the importance of considering issues of power when thinking about values and ethics in mental health care practice.
  • Outline liberal theories of power and consider their application in mental health care, and consider critiques of psychiatry based around notions of liberal power and freedom.
  • Outline Marxist theories of power, and consider the concept of ideological power in mental health practice.
  • Outline Foucault’s theories of power and consider critiques of power, based around Foucault’s ideas and questions of the medicalisation of everyday life by psychiatry.
  • Outline theories of power as empowerment and consider application to ideas of co-production when working in mental health practice.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

6. Power, knowledge and personal narratives

Abstract
This chapter will:
  • Introduce the reader to concepts of power and narratives in knowledge production.
  • Introduce the reader to personal narratives of mental distress, including a brief summary of their presence in the history of psychiatry, and an overview of their variety in terms of scope and objectives.
  • Critically appraise how they have been engaged with in mental health theory and practice.
  • Address methodological and ethical questions in working with personal narratives within values-based practice.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

7. Coercion and autonomy

Abstract
This chapter will:
  • Explore the potential tensions in mental health practice when promoting autonomy and choice.
  • Examine the use of coercive interventions in mental health practice using the example of community treatment orders.
  • Consider how the concepts of informed consent and capacity influence decision making.
  • Outline therapeutic approaches which facilitate autonomy and choice.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

8. Diagnosis as an ethical question in psychiatry

Abstract
This chapter will:
  • Explore why diagnosing mental distress is both an ethical issue and value-laden.
  • Analyse the debate around one contemporary contested diagnosis: schizophrenia.
  • Introduce the reader to debates about the usefulness and validity of diagnostic categories used in mental health care.
  • Explore ethical issues in the global mental health agenda, and the “exporting” of psychiatric categories to the majority world.
  • Analyse possible alternative conceptualisations of mental distress.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

9. Values-based assessment

Abstract
This chapter will:
  • Present the 3 Keys Programme: a shared approach to assessment in mental health.
  • Discuss the 3 Keys and values-based practice.
  • Present examples of the First Key: person-centred assessment.
  • Present examples of the Second Key: multidisciplinary assessment.
  • Present examples of the Third Key: strengths based assessment.
  • Present an overview of the 3 Keys, co-production and recovery.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

10. Values, ethics and recovery

Abstract
This chapter will:
  • Explore recovery and the different ways that this term has been used in mental health services.
  • Describe how therapeutic approaches such as the strengths model, therapeutic risk taking and shared decision making can facilitate a person’s recovery journey.
  • Consider the personal recovery journey of mental health staff, exploring peer support roles alongside the benefits and challenges of mental health staff disclosing their own experiences of being wounded.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

11. Valuing persons

Abstract
This chapter will:
  • Build on the ideas of recovery and autonomy introduced in previous chapters and apply them to the notion of “personhood.”
  • Identify the role of narrative in exploring the person within their experience of dementia.
  • Identify how these principles and approaches could apply to working with people with other mental health problems.
  • Consider the ethical implications of these approaches to care and how they may influence the practitioner’s ability to demonstrate compassion and empathy within their practice.
  • Offer case examples and exercises which will encourage you to apply the theoretical ideas introduced here to practice scenarios and reflect on the potential challenges which may present when implementing these approaches.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey

12. Daring to care: Maintaining our values in practice

Abstract
This chapter will:
  • Summarise and emphasise the key themes of the book.
  • Explore of the challenge of maintaining our values in practice.
  • Look at the particular difficulties this raises in the transition from student to professional and review some of the resources that can support us in this.
Alastair Morgan, Anne Felton, Bill K. W. M. Fulford, Jayasree Kalathil, Gemma Stacey
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