2018-10-25 09.30 C3-4b Destigmatizing Mental Health ... · Microsoft PowerPoint - 2018-10-25 09.30...
Transcript of 2018-10-25 09.30 C3-4b Destigmatizing Mental Health ... · Microsoft PowerPoint - 2018-10-25 09.30...
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National Share the Experience 2018
Improving Person-Centered Outcomes Through
Collaboration
October 23–26, 2018Bloomington, Minnesota
Destigmatizing Mental Health Advance DirectivesNICKY LEWIS, LMSW
ADVANCE CARE PLANNING COORDINATOR
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Disclosures
•Conflict of InterestNo conflict of interest to report
•Off Label UseOff-label use of any products will not be discussed
•Commercial SupportThere is no commercial support for this program
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Learning Objectives
1. Summarize the Michigan legal statutes regarding Mental Health Advance Directives.
2. Explain the general treatment decisions listed in the Mental Health section of the Making Choices Michigan Advance Directive.
3. Make use of Mental Health Advance Directive Guide to assist patients with document completion.
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Mental Health in the U.S.
44.7 million people or 1 in 5 adults in the U.S. in 2016 lives with mental illness
10.4 million adults lives with a serious mental illness*
Public stigma** remains a pervasive issue for people with mental illness
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*Serious mental illness is defined as a condition resulting in serious functional impairment which substantially interferes with or limits one or more major life activities
**Stigma is a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid and discriminate against a particular group
Impact of Mental Health Stigma
Fear of stigma can lead people with mental illness to avoid seeking assistance – including Advance Care Planning
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Stereotypes • Negative belief about a group (e.g., dangerous, incompetent, character weakness)
Prejudice • Agreement with belief and/ or negative emotional reaction (e.g., anger, fear)
Discrimination• Behavior response to prejudice (e.g. avoidance,
withhold employment and housing opportunities, withhold help)
Stigma consists of three components:
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Attitudes Towards Mental Illness
Fear and Exclusion
Persons with severe mental illness should be feared and therefore kept
out of most communities
Authoritarianism
Persons with severe mental
illness are irresponsible,
so life decisions should be made by others
Benevolence
Persons with severe mental
illness are childlike and need to be cared for
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Patient-Centered Care (PCC)
Patient – Provider Communication
Entering the World of the Patient
Patient Expertise
Patient Empowerment
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PCC: The Role of Mental Health/Psychiatric Advance Directives (MH/PAD)
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Addressing Loss of
Decisional Capacity
Confronting Stigma
Mental Health/
Psychiatric Treatment
Preferences
Normalizing the
Conversation
Preserve Patient
Autonomy/ Avoid Care
Delays
States with MH/PAD Statues
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Mental Health/Psychiatric Advance Directive (MH/PAD): General Requirements
•The National Resource Center on Psychiatric Advance Directives (www.nrc-pad.org) is an excellent resource for information specific to your state.
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Appointment of an Agent &
Specific Psychiatric Advance Instructions
Appointment of an Agent &
General Advance Instructions
Appointment of an Agent Only
•Vary from state to state
Advance Directives in Michigan
Public Act 386 of 1998: The Estates and Protected Individuals Code (a.k.a. EPIC)
In general authorizes Patient Advocate to make medical and mental health treatment decisions
Includes specific provisions regarding mental health/ psychiatric decision-making
Certain decisions require “clear and convincing evidence”
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EPIC: Specific Mental Health Provisions
Designate specific physician/provider
to assess
Consent to Inpatient
Hospitalization/ Psychotropic Medications
Consent to Electro-convulsive
Therapy
30-day Revocation
Waiver
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MH/PAD Form
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Conversation Guide
Guide discussion of MH Tx
preferences/ goals
Address patient fears
Educate facilitator/ Address concerns
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MH/PAD Options
Outpatient Therapy
Voluntary Hospitalization
Involuntary Hospitalization
Psychotropic Medications
Electro-convulsive Therapy (ECT)
30-day Revocation Waiver
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Questions
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References
• Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20. Retrieved July 16, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
• Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest, 15(2), 37-70. doi:10.1177/1529100614531398
• Dingfelder, S. F. (2009). Stigma: Alive and well. Monitor on Psychology, 40(6), 56. doi:10.1037/e542802009-028
• Making Choices Michigan. (2017, May 18). MCM advance directive: Durable power of attorney for healthcare. Retrieved August 6,2018, from https://makingchoicesmichigan.org/wp-content/uploads/2018/08/MCM-AdvanceDirective-051817-fillable.pdf
• Michigan Estates and Protected Individuals Code, Michigan Complied Laws §§ 700.5506-700.5520 (1998)
• Michigan Mental Health Code, Michigan Complied Laws §§ 330.1400-330.1422 (1974)
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References
• Mental Illness. (2017, November). Retrieved July 16, 2018, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
• National Resource Center on Psychiatric Advance Directives. (2018). Retrieved July 16, 2018, from https://www.nrc-pad.org/
• Code of ethics of the National Association of Social Workers. (2017). Washington, D. C.: National Association of Social Workers.
• Parcesepe, A. M., & Cabassa, L. J. (2012). Public Stigma of Mental Illness in the United States: A Systematic Literature Review.Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 384-399. doi:10.1007/s10488-012-0430-z
• Van Dorn, R. A., Scheyett, A., Swanson, J. W., & Swartz, M. S. (2010). Psychiatric Advance Directives and Social Workers: An Integrative Review. Social Work, 55(2), 157-167. doi:10.1093/sw/55.2.157
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