Guidelines For Psychiatric Practice Research Articles

Ethical analysis of a curious event of a forensic case becoming an involuntarily hospitalized psychiatric patient

ABSTRACTIt is not uncommon in forensic psychiatry that the duty to care for the patient conflicts with the responsibility to the court, or the duty to protect the public from harm from the potentially dangerous patient-offender. This paper exemplifies the scenario of what happens when the line between forensic and clinical psychiatry is crossed and whether crossing that boundary can be justified. Ethical discussion also embodies and clarifies the issues of unjustified violation of the patients’ autonomy and an undue infringement on their right to liberty on the arbitrary basis of existing or perceived mental illness. The paper provides an in-depth analysis of the issues of physicians’ conflicting duties, vulnerability of patient-offenders, and their human rights in the light of court orders and involuntary hospitalizations.I argue that in order to promote ethical decision-making we must establish clear rules and guidelines for psychiatric practice, separate conflicting roles, and provide sufficient training of health-care professionals regarding topics of human rights and legislation governing clinical and forensic psychiatric practice. Empowering patients and enhancing their rights to autonomy and liberty can also be potent tools of promotion and protection of their human rights and prevention of ethical breaches in practice.

The Impact of Psychiatric Practice Guidelines on Medication Costs and Youth Aggression in a Juvenile Justice Residential Treatment Program.

Stakeholders have expressed concern over the appropriate use of psychiatric medications and adequacy of mental health services for youths involved with the juvenile justice system. This study assessed the impact of implementing psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice facility. The study examined whether implementing psychiatric practice guidelines in a facility with an organized psychosocial treatment program would reduce psychiatric medication costs, compared with two other facilities, and whether lower psychotropic medication costs would be associated with increases in youth aggression. Administrative data from three state-run juvenile justice facilities were analyzed to determine psychiatric medication costs and rates of youth aggression. Psychiatric practice guidelines that involved screening, shared decision making, psychosocial treatments, medication prescribing, and monitoring of side effects were implemented in only one of the three facilities, with a goal of applying evidence-based psychopharmacology and benefit-risk considerations. Over the ten-year study period (2003-2012), psychiatric medication costs decreased 26% at the facility implementing the psychiatric practice guidelines, whereas costs at the two comparison facilities increased by 104% and 152%. As psychiatric medication costs decreased at the facility implementing the guidelines, youth aggression there did not increase. Implementing psychiatric practice guidelines in juvenile justice facilities can reduce psychotropic medication costs without an increase in youth aggression. Implementation of the guidelines requires an organized psychosocial treatment program to help deter an inappropriate focus on psychotropic treatments.

Tribute to Dr. Hammersley

Back to table of contents Previous article Next article Letters to the EditorFull AccessTribute to Dr. HammersleyGordon Clark, M.D., M.DIV.Gordon ClarkSearch for more papers by this author, M.D., M.DIV.Published Online:19 Oct 2007https://doi.org/10.1176/pn.42.20.0022aHaving recently been jolted by discovering, while reading the September 21 issue, that Dr. Don Hammersley had died, I thought I would take this opportunity to recognize him and others who have contributed to the success of the American Association of Community Psychiatrists (AACP).At the time I was looking to launch the AACP (1984), Don was an APA deputy medical director. He graciously provided APA resources to conduct a national survey of psychiatrists working in community mental health centers regarding their perceived need for an association separate from APA. Don's feeling was that we would be better off as an independent entity functioning outside APA but impacting upon it, rather than trying to function as a component within APA. He thought that we would more likely be able to achieve our goals as a separate entity than as an APA component, which would necessarily be constrained by the bureaucracy and politics of the parent organization. He was correct, and so was spawned the AACP, which has developed largely independent of APA, but which has also collaborated with APA and other national associations and organizations regarding multiple initiatives. Don was a behind-the-scenes kind of guy who made sure the interstices were well lubricated.I want to take this opportunity both to thank Don for his seminal contribution to the AACP and, briefly, to recognize some others who have also been key to its success. Two APA presidents, Drs. John Talbot and Carol Nadelson, provided supportive advice in the gestational phase of the AACP, and a third APA president, Dr. Paul Fink, secured a critical APA Board vote in AACP's infancy that essentially ratified the AACP's guidelines for psychiatric practice in community mental health settings. The central part of these guidelines is a model job description for a community mental health center medical director that ties medical/legal responsibility to commensurate authority.While many deserve recognition for their extraordinary contributions to the AACP, I want to make particular mention of the presidents who have carried the torch since my tenure as founding president. This organization could not have survived, let alone thrived as it has, without the continued vision and commitment of Drs. Cliff Tennison, Mickey Silver, Charlie Huffine, Jackie Feldman, and Wes Sowers. These presidents epitomize the “flaming idealist” mentality and mover-and-shaker activist approach that are pronounced attributes of so many of the AACP's members. For example, Dr. Wes Sowers, the AACP's current president, was the progenitor of the AACP's highly useful and successful LOCUS (Level of Care Utilization System) and CALOCUS (Child/Adolescent Level of Care Utilization System), and he relentlessly continues to work in various homeless shelters and other underprivileged settings.While I have not been actively involved with the AACP for a number of years, due to a change in the focus of my psychiatric practice, I remain very proud of what the AACP has contributed and continues to contribute to the field. I am sure that Don was also quietly proud of what he helped create.Portland, Maine ISSUES NewArchived

Guidelines for psychiatric practice in public sector psychiatric inpatient facilities.Committee on State and Community Psychiatric Systems of the Council on Psychiatric Services. American Psychiatric Association

Guidelines for psychiatric practice in public sector psychiatric inpatient facilities.Committee on State and Community Psychiatric Systems of the Council on Psychiatric Services. American Psychiatric Association

Guidelines for psychiatric practice in community mental health centers

Guidelines for psychiatric practice in community mental health centers

Assuring Quality in Community Mental Health Centers: The Need for Psychiatric Practice Guidelines

Many have expressed concern regarding both the deterioration in the quality of patient care provided by CMHCs and the exodus of competent psychiatrists from them. Earlier efforts by the Joint Commission to serve as an accrediting body for CMHCs were ineffective. Two factors may well have contributed to this. First, the Joint Commission's community mental health "Principles" were not medically based and, therefore, may not have been sufficiently able to assure quality of care, especially for the seriously mentally ill. Secondly, the "Principles" did not enjoy widespread use among CMHCs. Heretofore, CMHCs have not been required to meet national accrediting standards to qualify for governmental and other third-party reimbursement. Tying reimbursement to a meaningful accreditation process, as is done for hospitals, would solve the latter problem. Redressing the former problem might be accomplished by incorporating guidelines for psychiatric practice, such as those proposed in this article, into JCAHO's and CARF's accreditation standards for CMHCs. Such standards would then, by linking authority to responsibility, provide the CMHC psychiatrist with a foundation upon which to reasonably practice and thereby assure quality patient care. Although 55% of CMHCs were headed by psychiatrists in 1971, only 8% had psychiatrist CEOs as of 1985. Although psychiatrists need not be administratively in charge of CMHCs, the importance of their clinical leadership role is undeniable. Yet, in many centers, this role has been sorely compromised. It is anticipated that a clearer delineation of the psychiatrist's and, more specifically, the medical director's role will benefit all involved: patients, families, psychiatrists, other clinical staff, executive directors, and CMHC boards of directors. Centers that have strong psychiatric leadership will clearly benefit in three ways: (1) liability risk will be kept to a minimum; (2) recruitment and retention of competent psychiatrists will be enhanced; and (3) with CMHCs remaining clearly in the medical mainstream, they will be assured of continued governmental and other third-party healthcare funding. O'Leary, President of JCAHO, writes the following: The Joint Commission has never placed a direct role in the development of clinical standards, and we do not intend to begin now. But we do urge appropriate specialty groups to establish this task as a high priority. While consensus standards are inherently imperfect, they do reflect unique collections of wisdom and experience.(ABSTRACT TRUNCATED AT 400 WORDS)

HIV Disease and Psychiatric Practice

This article sets out guidelines for psychiatric practice prepared at the request of The Royal College of Psychiatrists. It gives an overview of psychosocial and neuropsychiatric problems in HIV disease, service implications and guidance on HIV screening and testing. Advice is given on the issue of confidentiality in relation to HIV status, the avoidance of infection and general recommendations for implementing the guidelines and the development of any necessary special policies or practices in Mental Health Units.

HIV disease and psychiatric practice

This article sets out guidelines for psychiatric practice prepared at the request of The Royal College of Psychiatrists. It gives an overview of psychosocial and neuropsychiatric problems in HIV disease, service implications and guidance on HIV screening and testing. Advice is given on the issue of confidentiality in relation to HIV status, the avoidance of infection and general recommendations for implementing the guidelines and the development of any necessary special policies or practices in Mental Health Units.

Quality care at risk in CMHCs: The need for Guidelines for Psychiatric Practice

The author discusses what he considers the inadequate attention paid to quality of care in many CMHCs. He suggests that the deterioration of quality is related to the exodus of competent psychiatrists. The “Guidelines for Psychiatric Practice in Community Mental Health Centers” should help to assure that quality care is delivered in a cost-effective manner. These guidelines should ultimately be incorporated into an accreditation process for CMHCs, and funding should be tied to such accreditation.

Guidelines for Psychiatric Practice in Community Mental Health Settings

Guidelines for Psychiatric Practice in Community Mental Health Settings