Conversion therapies are any treatments, including individual talk therapy, behavioral (e.g. aversive stimuli), group therapy or milieu (e.g. “retreats or inpatient treatments” relying on all of the above methods) treatments, which attempt to change an individual's sexual orientation from homosexual to heterosexual. However, these practices have been repudiated by major mental health organizations because of increasing evidence that they are ineffective and may cause harm to patients and their families who fail to change. At present, California, New Jersey, Oregon, Illinois, Vermont, Washington, D.C., and the Canadian Province of Ontario have passed legislation banning conversion therapy for minors and an increasing number of U.S. States are considering similar bans. In April 2015, the Obama administration also called for a ban on conversion therapies for minors. The growing trend toward banning conversion therapies creates challenges for licensing boards and ethics committees, most of which are unfamiliar with the issues raised by complaints against conversion therapists. This paper reviews the history of conversion therapy practices as well as clinical, ethical and research issues they raise. With this information, state licensing boards, ethics committees and other regulatory bodies will be better able to adjudicate complaints from members of the public who have been exposed to conversion therapies.
Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.
Residents showed significant improvement in knowledge, comfort, and skills following ECT simulation training. With the proposed curriculum, residents would receive comprehensive education not only in the theory behind ECT but also in procedural skills. This curriculum can be modeled in other programs that do not have extensive ECT facilities.
Intimate Partner Abuse (IPA), a major social problem, can lead to mental health conditions and is implicated in 30 % of female and 5 % of male homicide deaths. We hypothesized that due to distinct relationship structures and power dynamics which are immersed in varying sociocultural contexts, victims of male-male, female-female and female-male dyads experience different patterns of IPA. Our objectives were: (1) To examine the demographic and clinical characteristics of victims of male victim-male abuser (M-M), female victim-male abuser (F-M), male victim-female abuser (M-F), and female victim-female abuser (F-F) dyads. (2) To compare patterns of IPA reported by the victims in these groups. Out of 397 subjects in the general population that attempted this Internet-based study, 214 English-speaking subjects were older than 18 years, had experienced IPA, and provided complete information for the analysis. Victims of IPA were screened and specific methods of abuse were evaluated. M-Ms were significantly more educated (70 %) than other groups. F-Fs experienced more abuse before age 18 by a parent or relative. F-Fs experienced the most physical abuse while M-Ms the least (p = 0.004). Physical abuse or threats of abuse in front of children was reported more in F-Fs (p < 0.01) and least in M-Ms. IPA patterns differ significantly with F-Fs presenting the most physical profile and M-Ms presenting the least.
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