Whether working in a hospital, a care home, or in the community, nurses are faced with a number of ethical dilemmas on a daily basis. Ethical nursing principles include ensuring confidentiality, obtaining consent, veracity and honesty, always acting in a fair manner and ensuring justice, and the intention of always doing good and not causing harm. Ethical dilemmas can affect both nurse and patient, none more so than issues of mental health.
A nurse must be able to face ethical quandaries and make decisions based on experience and key principles learnt in higher education or through training, while also following legislative procedure. Being a mental health nurse is a challenging role that comes with its own rules, ethics, and issues.
The Mental Health Act 1983
The Mental Health Act 1983 (amended in 2007) allows a person to be detained without their consent when they pose a potential threat to themselves and/or to others. Those who seek medical assistance voluntarily are called informal patients, while those who have been detained under this Act are classed as formal patients. This law applies to Wales and England – Scotland and Ireland have their own separate legislation, and the laws in other countries vary, too.
Increase in Mental Health Admittance
Unfortunately the number of patients admitted under this piece of legislation is on the increase. The Guardian outlines this rise and states that over 50,000 people were detained under the Act in England during the year 2012-13, a rise of 12% from 2008-9 of 44,000 patients. Worryingly, they also highlight a growing number of patients who are being denied their basic human rights, from restricting visiting, limiting food, and banning internet usage, none of which can be found in nursing guidance or have any legal grounding. So how can nurses facilitate care and comply with legal procedures while also meeting the needs and requirements of the individual?
The Act in Practice
The Code of Practice that accompanies the Mental Health Act lays out clear guidelines for the care of patients. These are classed as ‘Guiding Principles’ and must be considered when issuing treatment. For example, although it is written in the terms of the Act that a sectioned patient can be given medical assistance against their will, in practice the person’s consent should always be sought before administering treatment. Where applicable, the patient should also be as involved as possible when health professionals plan treatment and a programme of care, and their individual wishes must be considered. In addition, the Care Quality Commission or CQC (the UK regulator that aims to implement a standard level of care) operates the second opinion appointed doctor (SOAD). This service acts as a safeguard to ensure that the rights of the individual detained are respected, especially in cases where the patient lacks the capacity to make a decision or has refused treatment.
Training is essential to ensure a high level of care. Recently, a nurses confession led to a wake-up call about mental health treatment in the UK. She stated that she felt unprepared and unequipped to be able to adequately deal with, and care for, patients with mental health related illness. Unfortunately, a nurse possessing a degree may enter the profession with little knowledge about mental health, unless they have chosen a specialist or tailored course, due to broad syllabuses encompassing a wide range of topics. Taking training courses aimed at patient care can benefit those who are newly qualified, or even highly experienced nurses. Training can work to equip staff with the necessary knowledge who in turn will be better prepared to face ethical dilemmas when issues arise, while also safeguarding patients and ensuring that their human rights are respected.