The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement's aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.
Science studies scholar Bruno Latour suggests that contemporary democracy is shifting from "matters of fact" to "matters of concern": contentious conditions entwined with everyday life. What is the role of human-computer interaction (HCI) design in this shift? In this paper we draw from five design projects to explore how design can express matters of concern by communicating the factors and consequences of issues. In the process, we consider the role of design in contributing to the formation of publics and discuss an emerging orientation to publics in HCI design.
Objective: The goal of this study was to test the degree to which client clinical characteristics and environmental context and social workers' practice values and experience influenced support for client's autonomy and willingness to engage in shared decision making (SDM), and whether willingness to engage in SDM was mediated by support for autonomy. Method: A randomized factorial survey of social workers working with adults with severe mental illness was employed. Eighty-seven social workers responded yielding 435 vignettes. Results: Hypotheses were partially supported. Diagnosis, symptomology, threats of harm, treatment adherence, substance use, and social workers' values and experience predicted support for autonomy and willingness to engage in SDM. Willingness to engage in SDM was modestly mediated by support for autonomy. Conclusion: Helping social workers avoid bias in decision making is critical to the goal of supporting clients' autonomy, building their capacity, minimizing disempowerment, and promoting recovery.
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