Scattergood Ethics

Commentary


 

Lack of Resources Plagues Philadelphia’s Mental Health Court

Andrea Segal, MS

Last week, the ScattergoodEthics team observed Philadelphia’s mental health court.  Philadelphia Assistant District Attorney Noel DeSantis and Mental Health Court Coordinator David Ayers graciously served as guides and liaisons for the ScattergoodEthics team.  In the morning the team observed mental health court proceedings in the first judicial district of Pennsylvania.  In the afternoon, we observed a screening meeting where case managers were present to discuss the progress of their clients in preparation for the following day’s court proceedings.  It was eye opening to see firsthand the great disparity between needed resources and available resources. more...

 


 

Behavioral Healthcare & the Affordable Care Act by Dominic Sisti, PhD

It seems, that on balance, the impact of the Affordable Care Act (ACA) will be extremely positive for both providers and consumers of behavioral healthcare. In addition to expanding insurance coverage, the ACA includes dozens of initiatives that reflect the core goals of recovery-based and patient-centered healthcare.  more...

 

 

 


 

The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan M. Metzl, MD, PhD
A prominent story appeared on the front page of the Washington Post on June 28, 2005. "Racial Disparities Found in Pinpointing Mental Illness" read the headline above an article that was at once shocking and sadly familiar. Researchers had examined the largest American registry of psychiatric patient records looking for "ethnic trends" in schizophrenia diagnoses. As the Post described it, schizophrenia, "a disorder that often portends years of powerful brain-altering drugs, social ostracism and forced hospitalizations…has been shown to affect all ethnic groups at the same rate." more...

 

 


 

Ethical Issues in Forensic Psychiatry: Minimzing Harm by Robert L. Sadoff, MD
The concept of primum non nocere—first, do no harm—is the basis for ethical medical practice and treatment in psychiatry. However, it cannot, and does not, apply to forensic cases where there is no doctor-patient relationship and the forensic psychiatrist may indeed cause harm to the examinee.  Consider, for example, the psychiatrist hired by the prosecution in a capital murder case. His or her assessment of the defendant may lead to a verdict of guilty and subsequent death penalty. more...

 

 

 


 

Healing Psychiatry: Bridging the Science/Humanism Divide by David Brendel, MD, PhD
The healing of psychiatry demands a thorough appreciation of the field's explanatory models. Most current explanatory models in psychiatry are either primarily scientific or primarily humanistic. The former are attractive inasmuch as they aim to justify clinical explanations and treatments by way of empirical evidence and scientific rigor, but they are flawed inasmuch as they tend to restrict options for diagnostic and therapeutic paradigm choice. The latter have the advantage of acknowledging the complex, subjective, and multifaceted features of most mental disorders, but they are imperfect because they often lack a coherent and well-defined basis in empirically derived scientific evidence. more...

 

 


 

Drug Therapy for Alcohol Dependency: What’s the Issue? by Arthur Caplan, Ph.D.
Naltrexone, which is sold under the trade names Depade and Revia and in an extended release version called Vivitrol, has been shown in many studies by many groups in the United States and other nations to be a very safe drug that is highly effective in treating alcoholism.  Yet, relatively few programs that treat chronic alcoholics use the drug.  Why? more...
 


 





Borderline Personality Disorder & Ethical Practice in Psychiatry by Nancy Potter, Ph.D.
I began taking an interest in the diagnosis and treatment of borderline personality disorder (BPD) when I worked as a crisis counselor and would be warned by other workers to avoid so-and-so because “she’s a borderline.” The pejorative tone was hard to miss. Since then, I have taken it upon myself to investigate BPD both in terms of its conceptual features and its bearing on psychiatric ethics. more...