Good Psychiatric Practice Research Articles

Formulation in psychiatry - a guide to developing competence.

This paper highlights the importance of psychiatric formulation and provides guidance to those learning the art of formulation. To achieve this, we explore the guidance on formulation that has been previously published in Australasian Psychiatry, identify the key components of psychiatric formulation, and outline an approach to comprehensive formulation in routine clinical practice. Formulation is the foundation of good psychiatric practice but presents a considerable challenge to the novice practitioner. Understanding the ingredients of formulation and a method for meaningfully putting these together will guide deliberate practice to learn the art of psychiatric formulation.

Ethics and Law.

Ethics and Law.

Governance of Protecting Patients

AimsInvoluntary commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into inpatient or outpatient treatment. These criteria vary between nations. The goal of this presentation is to compare the governance of protecting patients among different parts of the world.BackgroundUnderstanding the relevance of the judicial committeemen in psychiatry is an essential part of good psychiatric practice. A majority of patients who need inpatient psychiatric treatment fall into one of the following categories: dangerous to self, dangerous to others, or gravely disabled.In the United States, the Parens Patriate doctrine has had great application in the treatment of mentally ill persons, children, and other individuals who are legally incompetent to manage their affairs. The states, which act as parens patriae, can make decisions regarding mental health treatment. State law governs involuntary commitment, and procedures may vary among states.MethodOne of the essential duties of St. Tammany Parish Coroner Office, Louisiana, USA is Mental Health Service, From January 2017 to October 2019, 887 Order of Protective Custody (OPC), 17,838 Physician Emergency Certificates (PEC), and 13096 Coroner Emergency Certificates (CEC) were issued. These certificates allow legal authority to transport a patient to the nearest ER for assessment by physician and mental health providers.ResultPatients with active Physician Certificate are examined by a coroner according to patient's mental history and clinical presentation. Coroner Certificate helps the treatment facilty detail the patient for diagnosis and treatment for fifteen days.ConclusionSt. Tammany Parish Coroner Office is fulfilling its responsibility to provide proper mental health to psychiatric patients. It is necessary for each country/state/parish to have legal structure and provide proper care who are dangerous to self or others, or gravely disabled. The procedures of OPC, PEC, and CEC will be presented.

Psychotherapy in the Time of COVID

Psychotherapy in the Time of COVID

Montgomery v Lanarkshire Health Board: Implications of the Supreme Court ruling for psychiatry

In ruling in favour of Nadine Montgomery in her claim of negligence against Lanarkshire Health Board, the Supreme Court changed the law in matters of informed consent. Having previously relied on the Bolam test of the professional opinion of medical peers, the information doctors must disclose to their patients is now determined by a much more patient-centred test. Despite this, it is not clear how, if at all, the ruling affects modern medical practice. In this article, the implications of the Supreme Court’s ruling for psychiatry are considered. It is unlikely the ruling will alter day-to-day clinical practice. It does, however, serve to highlight and reinforce key principles of good psychiatric practice.

Looking at Psychiatry Through a Population Lens

Looking at Psychiatry Through a Population Lens

From taking to using medication: recovery-focused prescribing and medicines management

SummaryMental health services are increasingly supporting recovery-oriented practice as a basis for service delivery. There is considerable overlap between the values and approaches associated with recovery-based practice and those already endorsed as good psychiatric practice. However, these agreed principles may not be consistently applied and further steps may be needed if the reorientation of the relationship between psychiatrists and people using psychiatric services is to fully reflect recovery principles. This article describes ways in which psychiatric practice could develop, including conceptualising medication as one of many possible recovery tools that a person can actively use to support their well-being, and a range of practices available to professionals to support people in taking up an active stance in relation to medication. It also identifies recovery-supportive practices for when someone is unable to fully participate in decision-making, owing to crisis, loss of capacity or concerns about safety.

The Low Pass Rate in the RANZCP Clinical Examinations: Is the Exam the Problem?

The aim of this study was to examine the role of supervision during psychiatric training in ensuring that registrars are adequately trained to meet the standards of the RANZCP examinations and to consider the implications for improving examination pass rates. Audiotaped recordings of 50 h of supervision involving six supervisors and thirteen trainees, obtained 2000-2003, were transcribed and analysed thematically in a qualitative study, informed by a postmodern, foucaultian perspective. Until an examination loomed, supervisors rarely required evidence of theoretical study or structured case presentations from their trainees. The examination and the examiners served to justify the supervisors requiring such discipline. This enabled the supervisors to remain in a supportive role, while requiring higher standards from trainees. Paradoxically, while requiring higher standards 'for the exam', trainees were told that the examiners expected nothing more than 'good psychiatric practice'. In presenting cases, the attributes of prioritization, thoughtfulness, conciseness and good timing were valued, as reported in both undergraduate and other postgraduate medical training. Much of supervision bore little relationship to preparation for college examinations until these were imminent. While the daily practice of trainees and supervisors continues to be at variance with the practices required to pass the examination (reflected by reference to 'exam-style' and 'non-exam style' presentations) the pass rates will remain low. If we believe that the standard set in the examination is that required of a practising psychiatrist, change is required to supervision and daily practice standards to reflect these standards.

Dilemmas in Private Psychiatric Practice

Background:A practicing psychiatrist faces dilemmas on a number of occasions, in deciding the best course of action he/she needs to undertake while treating a patient. At times, this choice may not be in accordance with the ethical and moral principles and may in fact appear to violate patient's autonomy and rights.Aim:To study the nature of psychiatric practice by the practicing psychiatrist in the areas of admission, discharge, consent, physical restraint, electroconvulsive therapy (ECT), certification, treatment, suicide and psychotherapy.Settings and Design:Cross-sectional observational study.Materials and Methods:Forty-eight psychiatrists gave consent to participate in the study. A special proforma was prepared, which addresses the common dilemmas in the clinical psychiatric practice. All the psychiatrists were given specially designed profoma and were requested to fill the proforma with appropriate answers. Statistical analysis was done using SPSS software.Results:There were 42 male and 6 female psychiatrists. The age of the psychiatrists ranged from 28 to 65 years with a mean of 43.08 years. The mean duration of practice of these psychiatrists was 14.81±11.07 years. Question and answers related to admission, discharge, consent, physical restraint, ECT, certification, treatment, suicide and psychotherapy are discussed.Conclusions:The present standard and practice especially in private psychiatric set-up does not confirm to the rules, recommendations, and regulations suggested by Mental Health Act 1987, Mental Health Authorities and various guidelines of practice. Indian Psychiatric Society and other professional bodies need to take steps to prepare guidelines for a good psychiatric practice.

The moral content of psychiatric treatment

Psychiatric treatment can enhance human morality. It can promote the emergence of moral motives and intentions, aid in the acquisition of skills essential to moral action, and help to develop the ability to apply moral understanding and skills in particular circumstances. Good psychiatric practice demands an honest appraisal of its moral dimension.

Good Psychiatric Practice (3rd edn)

Good Psychiatric Practice (3rd edn)

S55-01 What are the prerequisites for good clinical practice in Europe?

Good Medical Practice and Good Psychiatric Practice are key documents in the UK, indicating characteristics of a good doctor and a good psychiatrist respectively. Individual aspects of what constitutes a professional can be seen in relationship with other disciplines, team members and stakeholders. A key task of any organisation that purports to speak for the profession is to identify what these qualities are, how they are to be inculcated and developed. The Royal College of Psychiatrists, therefore, is in a unique position to do this and take it forward without guilt and shame. Leadership, teams, education, appraisals, careers and research are themes which have to be looked at. For any leadership to be successful it must have vision, strategic thinking, motivation and trust, all of which are being challenged at present. The profession of psychiatry must move from nostalgic professionalism to ‘new’ professionalism. of We as psychiatrists must ascertain our civic and fiduciary responsibilities by identifying and agreeing standards of quality of care, altruism and values of the profession identified by us and worked at with other stakeholders. The primacy of patient welfare and advocacy for our patients is critical. For our medical-moral interdependence we must be honest with ourselves as to what our strengths and weaknesses are, but also with society to declare what we can deliver in reality and what our aspirations are. Courses in ethics, humanities and human values (medical history, social sciences, literature and films) can sensitize the clinician by raising awareness and developing critical reflection.

Professionalizing psychiatry: from ‘amateur’ psychiatry to ‘a mature’ profession

Professionalizing psychiatry: from ‘amateur’ psychiatry to ‘a mature’ profession

What will revalidation mean for psychiatrists?

In 2007, the UK government published a White Paper setting out a framework (revalidation) by which doctors will be assessed throughout their professional careers. Although revalidation is unlikely to be welcomed with open arms by many doctors, its discussion in the White Paper is a measured one in which medical Royal Colleges are given a strong voice in the setting and measuring of standards. The details of the revalidation process for psychiatrists have yet to be determined, but it is likely that it will include strengthened appraisal within which doctors will provide evidence that they have met the standards set by the Royal College of Psychiatrists. These will be laid out in a revised edition of the College document Good Psychiatric Practice.

‘QUIS CUSTODIET?’: WHO HAS ULTIMATE RESPONSIBILITY FOR CONFIDENTIALITY IN MENTAL HEALTH SERVICES?

Confidentiality is a complex and engaging subject. One of the questions I would ask the reader to consider is whether ‘absolute’ confidentiality can truly exist within the analytic relationship and whether it is worth asking the same question in relation to psychotherapy as it is practised within the NHS. Is the position of absolute confidence a noble aspiration or could it be regarded as a rather inflexible stance whose advocates occupy an arrogant and even omnipotent position? This last question deliberately invokes a false dichotomy and I would argue that the clinical reality of working with patients continually dispels the myth that ‘absolute’ confidentiality can exist within the analytic relationship. If we can accept this position, then the stage is set for a potentially more fruitful, if complex, debate about where the line of disclosure lies for individual cases. It would seem timely, in view of the recent publication of the Royal College of Psychiatrists' report Good Psychiatric Practice: Confidentiality & Information Sharing (2006), to reflect upon how the ‘contract’ of confidentiality is drawn up in the apparently dyadic relationship of analytic therapy as practised in the private sector and to consider the particular conflicts and threats to patient confidence posed by the multidisciplinary and highly transparent ways of working that have evolved within modern NHS mental health services.

Good Psychiatric Practice: Confidentiality and Information Sharing

Good Psychiatric Practice: Confidentiality and Information Sharing

Good psychiatric practice: interim guidance on the relationship between psychiatrists and commercial sponsors and the sponsorship of College activities (CR117)

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Good psychiatric practice: interim guidance on the relationship between psychiatrists and commercial sponsors and the sponsorship of College activities (CR117)

This article is intended to provide guidance on the boundaries of good practice for psychiatrists in their relationships with pharmaceutical companies and other commercial organisations. The first part addresses issues relating to good practice for individual practitioners. It has been written in

Good psychiatric practice. CPD in Ireland

Good psychiatric practice. CPD in Ireland

The care programme approach

The CPA encourages good psychiatric practice in the continuing care in the community of people who suffer with serious mental illness. The tiered CPA has recently been proposed with a view to channel resources towards those patients who are most in need. This study assesses whether the CPA is used appropriately and effectively among patients discharged in an inner city sector where there is a high level of serious mental illness. The results suggest that it is feasible provided there is an adequately developed community mental health team.