Capacity to choose and refuse? A case study

Abstract

Purpose -This paper aims to present the distinctive roles and perspectives of the members of a multidisciplinary team supporting a man with multiple diagnoses who was under Section by the Mental Health Act.Design/methodology/approach -The management of risk for this man with intellectual disability, mental illness and a degenerative neurological condition was particularly complex due to his self-harming and impulsivity. Each specialist clinician (nurse, speech and language therapist, psychiatrist) reflects on their role as a member of a team approach. The perspective of the man himself is represented, although he was unable to give a consistent descriptive self report.Findings -For people with mental illness and intellectual disability the capacity to understand and retain information about their condition may be limited and variable. The paper discusses the multiple ethical issues in attempting to preserve a modified autonomy and in decision making around best interests.Practical implications -Supporting someone with dysphagia presents specific challenges to staff teams due to the everyday and familiar nature of mealtimes. When the person is unable to understand and refuses to comply with guidelines outlining restrictions to mealtime choices, the staff's role in safeguarding is particularly complex. The paper considers how to mitigate against risks to mental and physical health.Originality/value -In cases of self harm the care team is challenged to respect autonomy and maintain quality of life whilst ensuring safety of the individual. The paper discusses maintaining professional integrity when considering compromise.

Mealtime difficulties in adults with mental health conditions: an integrative review

“…The rate of swallowing is known to increase with emotional arousal (Fonagy and Calloway, 1986) and increased stress is also reported to reduce saliva and contribute to dyspepsia (Lee et al, 2017, Leopold and Kagel, 1997, Lorena et al, 2004. In the field of psychiatric research, there have been few studies exploring the links between environmental stressors and choking (Guthrie and Stansfield, 2017, Guthrie et al, 2012, Fioritti et al, 1997. Mealtimes have been identified as a volatile time of day impacting on social wellbeing, escalating levels of anxiety and triggering aggressive incidents (Ferguson et al, 2005).…”

“…All were retained to give a wide range of data across different patient settings and psychiatric diagnoses. Only one paper quoted a patient's comments directly (Osman and Devadas, 2016) with four others quoting caregiver spoken or written comments (Guthrie et al, 2012, Guthrie et al, 2015, Guthrie and Stansfield, 2017, Hemsley et al, 2019.…”

“…Most studies did not describe the potential impact of mealtime difficulties on mental wellbeing or on relationships with friends, family and direct support staff. Only two studies described the impact of the dysphagia on mealtime experience in detail (Guthrie et al, 2012, Guthrie andStansfield, 2017).…”

“…Studies described the impact of mental health deterioration influencing or inhibiting the person's reporting of swallowing difficulties (Crouse et al, 2017, Guthrie et al, 2012, Guthrie and Stansfield, 2017. Studies suggested that specific delusions, fears, or fixed ideas may have reduced self-awareness and reporting of difficulty (Chen et al, 2015, Guthrie et al, 2012, Hwang et al, 2010, Osman and Devadas, 2016.…”

Modèles D’intervention Médical Et Environnemental Auprès Des Personnes Manifestant Un Trouble Grave Du Comportement, Quelles Sont Les Divergences?

“…La catégorie « équipe d'intervention » fait référence à l'étude des caractéristiques des membres des équipes d'intervention des milieux d'hébergement et à leurs perceptions de la clientèle ou des services offerts. Par exemple, les types et les causes des blessures subies (Finlayson, Jackson, Mantry, Morrison et Cooper, 2015); leur niveau de stress ou de détresse (Rose et al, 2013), ainsi que leur satisfaction à l'égard de leur travail ou des services offerts aux personnes hébergées (Darbellay-Robbiani et al, 2014;Deveau et McGill, 2014 Guthrie, Roddam, Panna et Fairburn, 2012). Aucune des études recensées n'a été réalisée dans un établissement psycholégal ou un milieu hospitalier.…”