S61: Ethics, Dilemmas & Decision-making

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By October 4, 2023 No Comments

Authors: Bella Burns, Shannon Calver, Christine Cummins, Pan Karanikolas, Hamilton Kennedy, Lucy Bashfield, Hoai- Mi Fiona Nguyen, Emily Rose & Nina Joffee-kohn,

Year: 2023

Event: 2023 The MHS conference - Adelaide

Subject: Ethics, Dilemmas & Decision-making

Type of resource: Conference Presentations and Papers

Presentation 1: Humanity: Exploring the human right to palliative care for people with life-limiting eating disorders.
Authors:Bella Burns & Shannon Calver
Humanity: Exploring the human right to palliative care for people with life-limiting eating disorders
Tragically, people with severe and enduring (SE) eating disorders (EDs) e.g. (terminal) anorexia nervosa (AN), experience traumatic deaths due to lack of recognition of their need for palliative care.
There is increasing debate on whether people experiencing life-limiting complications from SE-EDs should have equitable human rights to receive palliative care. Furthermore, there is a need to upskill the health/mental-health workforce to, a) provide quality palliative care and b) best support individuals with life-limiting/terminal EDs and their loved one/s. Evidence from multi-disciplinary teams and lived experiences indicates those receiving palliative care for life-limiting EDs experience improved quality of life, relationships and wellbeing related to relief of no longer requiring sometimes traumatic life-saving interventions.
Recognizing the complexity and burden of this ethical dilemma, a palliative care discussion paper has been co-designed to synthesize clinical, research and lived experience perspectives, to support community and health professionals understand what palliative care means for people with life-limiting EDs and inform Palliative Care Guidelines.
Learning Objectives:
• Lived experience perspective on the paradox of quality of life versus recovery
• Systems approach for treating palliative care in EDs
• Workforce capacity building in compassionate, trauma-informed care for people with life-limiting/terminal EDs
• Ethical decision-making when determining if palliative care is/is not an appropriate care pathway
Learning Objective
With a humanity-focused approach, this presentation highlights the complexity and burden of chronic and enduring mental illness such as eating disorders. Though controversial, we must have a conversation on the ethical dilemma for people with life-limiting and enduring mental illness to have the equitable human right to receive palliative care.

Presentation 2: Translating ethical reasoning into ethical practice and the cost of bearing witness.
Author:Christine Cummins
What better example is there of enhancing professional practice than through challenging our understanding of and our commitment to the ethical principles that inform our practice. This presentation will provide a discussion on the challenges of leadership when translating ethical reasoning into ethical practice. Christine will use the example of leading a torture and trauma counselling team on Christmas Island and the cost of bearing witness. Offering personal insight Christine outlines the challenges faced when advocating to maintain a practice governed by the bioethical principles of non-maleficence, beneficence, autonomy and justice. Christine describes how bioethics is also a system of moral principles, this is where views may vary or distort because the values we hold are personal and unique to individuals. It takes self-awareness and self-reflection when dealing with ethical issues and in some circumstances strength in leadership and personal courage to advocate and act. Christine’s presentation will highlight the vital role health professionals play in advocating for humanity using our ethical principles and having the strength to lead.
Learning Objective
Healthcare professionals have the power to be effective change makers when we advocate for our patients. Don`t be afraid to speak up for our ethical principles. For compassion, and for humanity. Because believe me, when you have the strength to lead, you can make a difference.

Presentation 3: Experiences of police apprehension in a mental health crisis: a co-designed investigation
Authors: Pan Karanikolas, Hamilton Kennedy, Lucy Bashfield & Hoai- Mi Fiona Nguyen
Existing literature on police involvement in mental health crisis responses centres the perspectives of police. Working to fill this gap, our presentation presents the findings from one of the first research projects co-designed with people who have experienced and survived police apprehension in a mental health context.
The experience of being apprehended and transported to hospital by police is known to be disabling and traumatic, but remains the main way that individuals are taken to mental health facilities (Short et al., 2014). People experiencing mental distress are also over-represented in incidents involving both fatal and non-fatal use of force by police (Bowler et al., 2022) and are also subject to excessive police contacts, stops, searches, inappropriate fines, and charges.
The project was conceived of by lived experience academics and was led by a lived experience group, convened regularly throughout the project and involved in strategic decision-making. The project utilised qualitative semi-structured interviews with twenty participants, all of whom had experienced mental health-related police apprehension in Australia.
Findings included that people who experienced police apprehension faced multiple intersecting kinds of disadvantage prior to being apprehended by police (including experiencing intimate partner violence, homelessness, and discrimination on the basis of psychiatric diagnoses). It was not uncommon for people to report excessive use of force by police, including being handcuffed, pepper-sprayed and locked in police vans, which compounded trauma. Police apprehension has long-lasting impacts, including loss of employment, discrimination. Police apprehension led to victims of family violence being ‘misidentified’ by police as a perpetrator, while also being relied on by perpetrators as a tactic of coercive control.
We present participants’ ideas for change, including removing police as responders, the need for investment in peer-led responses and the importance of a human rights approach.
Learning Objective
1. Police apprehension has long-term, lasting impacts on impacting identity and self-perceptions, and compounds existing disadvantage and trauma. Police non-attendance, peer-led responses and human rights-focused approaches and alternatives are needed.
2. The distinction between police and the mental health system is messy and unclear – experiences of involuntary treatment, seclusion and restraint were often an extension of a traumatic and dehumanising police response.
Bowler, L., Hine, K.A. and Fleet, R.W., 2022. Fatal police encounters–it’s not just shootings. Current Issues in Criminal Justice, 34(4), pp.383-400.
Short, T.B., MacDonald, C., Luebbers, S., Ogloff, J.R. and Thomas, S.D., 2014. The nature of police involvement in mental health transfers. Police practice and research, 15(4), pp.336-348.

Presentation 4: Resisting from within: Promoting system change as a dissident psychologist with lived-experience.
Author:Emily Rose
Despite research suggesting a large number of psychologists and trainee psychologists have first-hand experience of mental health difficulties (Grice et al., 2018; Tay et al., 2018), public acknowledgment and open dialogue of lived-experience amongst these populations is rare (Victor et al., 2022).
This personal story details my two-decade long struggle with dual identities after first encountering the mental health system as a patient, and later as a mental health professional. In a system predicated on power differentials inhabiting this liminality was difficult, and I encountered significant stigma and self-stigma along the way. Often my formal training and education were at odds with what I learned from personal experience and exposure to other peer-experts, and changing a system from within is challenging when this system also tries to change you.
Ultimately I've learned that the consumer movement is one of the best antidotes we have to a system sickened by power differentials and dichotomies, and that telling our stories is a subversive act that can lead to radical transformation on a personal, professional and community-wide level. Facilitating this lived-experience disclosure should be the responsibility of individuals in relative positions of power in the mental health system.
Learning Objective
1. The power of personal stories in promoting personal, professional and systems-wide change, and how peer-experts working in the field can leverage their knowledge to promote systems change.
2. Owning our own stories promotes the mental health of practitioners as well as those they work with & for.
Tay, S., Alcock, K., & Scior, K. (2018). Mental health problems among clinical psychologists: Stigma and its impact on disclosure and help‐seeking. Journal of Clinical Psychology, 74(9), 1545-1555.
Victor et al. (2022). Leveraging the Strengths of Psychologists With Lived Experience of Psychopathology. Perspectives on Psychological Science, 17(6).

Presentation 5: Authorising bodily harm: Intersections of genocide and authorised restrictive practices in mental health care.
Authors:Nina Joffee-kohn
Generational trauma impacts many people in Australia, from hundreds of different nations of origin. Often, generational trauma is inflicted on communities by state actors, sanctioned by legislation, and carried out by mechanisms of the state. This presentation aims to present a discussion of how people with generational trauma experience the mental health system - in particular, how they experience authorised practices on their bodies such as restrictive interventions and seclusion. The Royal Commission into Victoria’s Mental Health System recommended the elimination of seclusion and restraint within 10 years, however the new Victorian legislation - the Mental Health and Wellbeing Act 2022 (Vic) does not create a legislative pathway to ending restrictive interventions. So, how does the system re-imagine itself towards safety with no legislative pathway forward?
This presentation will offer lived experience insight on why it is important for practitioners to be aware of the impacts of state-inflicted trauma and generational trauma on consumers’ bodies and minds, and will consider some of the complexities including:
1. Where an individual holds fears of interacting with the mental health system due to generational trauma.
2. State-based trauma forcibly fragments families and communities. For any number of survivors and descendants of survivors their bodies may be carrying wounds of trauma that they themselves are not explicitly aware of.
3. What are the impacts of authorised practices on a colonised land where Indigenous people are disproportionately impacted by seclusion, restraint, and police interactions by the mental health system?
Learning Objective
For healthcare professionals, it is vital to integrate into practice the understanding that an ‘outsider’ may not know what trauma an individual is surviving or has survived, but also where in their lifelong journey of integration, understanding and healing that person is placed.

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