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This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates. At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. The experiences of these clinicians pose a single overarching question: how should we bear responsibility for the most vulnerable among us?

This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children’s relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.

This article deals with the treatment and wider understanding of shell-shock and trauma in modern Russia. At the beginning of the twentieth century, when psychiatrists in many European countries were beginning to think about the issue of shell-shock, Russian psychiatrists took part in the general debate. After the Bolshevik revolution, however, the Russian psychiatric profession became isolated and heavily ideologized, and the treatment of all forms of trauma within the Soviet Union developed along specific lines. At the social level, trauma disappeared as an issue. The idea of a damaged ego was not a central consideration in Soviet psychological thinking. People survived by working, and by reference to the collective, rather than to individual consciousness. Trauma, in its modern form of PTSD, only re-emerged in Soviet psychological discourse as a result of contact between veterans of the Soviet Union's war in Afghanistan and American veterans of Vietnam. Despite the Soviet Union's anguished history, the concept of trauma is still largely ignored by the population as a whole.

Psychiatry Under the Influence investigates the actions and practices of the American Psychiatric Association and academic psychiatry in the United States, and presents it as a case study of institutional corruption.

To examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual. We identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded. Coercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual. All forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.

Background Influence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patient behaviour and improve treatment adherence. One ethical concern about using such strategies is that they may constitute coercive behaviour (\"informal coercion\") and negatively impact patient satisfaction and the quality of care. However, some influence strategies may affect patients' perceptions, so an umbrella definition of “informal coercion” may be unsatisfactory. Furthermore, previous research indicates that professionals also perceive dissonance between theoretical explanations of informal coercion and their behaviours in clinical practice. This study analysed mental health professionals’ (MHPs) views and the perceived ethical implications of influence strategies in community care. Methods Qualitative secondary data analysis of a focus group study was used to explore the conflict between theoretical definitions and MHPs’ experiences concerning the coerciveness of influence strategies. Thirty-six focus groups were conducted in the main study, with 227 MHPs from nine countries participating. Results The findings indicate that not all the influence strategies discussed with participants can be defined as “informal coercion”, but they become coercive when they imply the use of a lever, have the format of a conditional offer and when the therapeutic proposal is not a patient’s free choice but is driven by professionals. MHPs are rarely aware of these tensions within their everyday practice; consequently, it is possible that coercive practices are inadvertently being used, with no standard regarding their application. Our findings suggest that levers and the type of leverage used in communications with the patient are also relevant to differentiating leveraged and non-leveraged influence. Conclusion Our findings may help mental health professionals working in community care to identify and discuss influence strategies that may lead to unintended coercive practices.

The Freedom CureRelease from incarceration can rapidly alleviate people’s psychiatric symptoms. This “freedom cure” is a structural intervention whose benefits may exceed those of standard treatments.

Abstract employment is critically important in mental health care. Unemployment worsens mental health and gaining employment can improve mental health, even for people with the most serious mental illnesses. In this editorial, we argue for a new treatment paradigm in mental health that emphasises employment, because supported employment is an evidence-based intervention that can help the majority of people with mental health disability to succeed in integrated, competitive employment. Unlike most mental health treatments, employment engenders self-reliance and leads to other valued outcomes, including self-confidence, the respect of others, personal income and community integration. It is not only an effective short-term treatment but also one of the only interventions that lessen dependence on the mental health system over time.

Stigma is one of the most important barriers to help-seeking and to personal recovery for people suffering from mental disorders. Stigmatizing attitudes are present among mental health professionals with negative effects on the quality of health care. Network and moderator analysis were used to identify what path determines stigma, considering demographic and professional variables, personality traits, and burnout dimensions in a sample of mental health professionals (n = 318) from six Community Mental Health Services. The survey included the Attribution Questionnaire-9, the Maslach Burnout Inventory, and the Ten-Item Personality Inventory. The personality trait of openness to new experiences resulted to determine lower levels of stigma. Burnout (personal accomplishment) interacted with emotional stability in predicting stigma, and specifically, for subjects with lower emotional stability lower levels of personal accomplishment were associated with higher levels of stigma. Some personality traits may be accompanied by better empathic and communication skills, and may have a protective role against stigma. Moreover, burnout can increase stigma, in particular in subjects with specific personality traits. Assessing personality and burnout levels could help in identifying mental health professionals at higher risk of developing stigma. Future studies should determine whether targeted interventions in mental health professionals at risk of developing stigma may be effective in stigma prevention.