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Selected Theory Rational Choice Theory

Ethical Dilemmas in the Provision of Mental Health Services For People with Disabilities in Australia

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Hello everyone and welcome to my presentation about the Ethical Dilemmas in the Provision of Mental Health Services for People with Disabilities in Australia

Research Question: How do the ethical dilemmas encountered by social service practitioners affect the ability of people living with disabilities in rural areas to meet their mental health needs?

Research Aims

An ethical dilemma, also known as an ethical paradox or a moral dilemma, is an issue that arises in the process of decision-making when there are two feasible solutions, both of which are not totally appropriate from an objective standpoint. Many people with intellectual disabilities living in rural areas face challenges when seeking care and assistance from local social workers and other health practitioners. According to Roberts, Battaglia, and Epstein (1999), rural caregivers encounter serious ethical dilemmas on a daily basis. In rural areas, resources are isolated and clinicians give care with minimal support, services, and safeguard for the patients. Rampant ethical issues in the provision of mental health services includes use of therapies and approaches that are not fully tested to fit the population in rural areas. Additionally, personal decision making on the part of mental health providers is often used as opposed to use of best practices founded on research. For such ethical issues, health care providers face a dilemma in choosing to pursue the said actions or waiting for the acceptable practices that would take years.

The aim of the study is to first identify the key ethical dilemmas in the provision of mental health services for people with disabilities in rural Australia. Secondly, the study aims to identify the extent of ethical dilemmas and their effect on patients. In addition, it will determine how ethical dilemmas affect access to mental health services for people with disabilities in rural Australia.

Selected Theory: Rational Choice Theory

Social work practice is the backbone of mental health. The audience for the current study, individuals with disabilities, is a group that requires more attention than the conventional health care receivers. As such, the complexity of social work becomes relevant and requires nuanced decision making based on the unique and complex needs of clients. Here, the rational choice theory is useful in an attempt to understand whether and how social workers can balance the factors including their expertise, rationality, and retail ethical practices in their decision making. Understanding the rational choice theory would inform the practices within social work to influence the decision-making processes in order to make the best, most effective, and ethical choices.

Rational choice theory is an important tool for aiding social workers in understanding the motives of the people they serve via the profession of social work. Using rational choice theory, social workers may learn why their clients engage in specific behaviors and end themselves in difficult circumstances. A social worker’s knowledge of rational choice theory may be useful in the process of developing treatments and therapies. Social workers may influence their interactions with and recommendations for their clients by understanding their clients’ decision-making processes, which are driven by what is in their clients’ best interests. Social workers in rural Australia may apply the rational choice theory to investigate more effective approaches to tackle client difficulties.

Positioning of the Research from a Review of Relevant Social Work and Literature

According to Bipeta (2019), the moral and ethical sanctity of confidentiality binds the patient-physician relationship, particularly in mental health. The caregiver is tasked with ensuring that the patient-physician relationship is established and retained on these grounds. However, some patients with mental health issues want the physicians to disclose information to third parties regardless of such information being restricted through signed consent forms(ref). Mostly, the third party in this is the caregiver. As a result, the presence of written consent may derail social work practice and care for patients.

Ellem et al. (2008) points out that there is a need to uphold ethical considerations when conducting life story on people with intellectual disability. The author categorically lists beneficence, respect for people, justice and integrity are aspects of consideration and should guide a research when conducting life story research on intellectual disability. Considering these aspects is vital as it can assist the researcher respond to difficulties during the research process. Ellen et al. (2008) goes further to point out that researchers need a good understanding of principles and concepts of social justice and should be motivated and committed to put the established principles into practice. Moreover, Ellen et al. (2008) calls for the need of the researchers to look into power dynamics when interacting with their participants.

Toquero (2021) conducted research with the aim of examining how Covid-19 interfered with the delivery of care to mental health patients living with disabilities in the Philippines. The main outcome of the research was that mental health patients living with disabilities experience increased systemic, social and scientific barriers in their quest to access healthcare. The situation was worse during the Covid-19 pandemic. For this reason, Toquero (2021) argues that people with disabilities should be offered healthcare support and accessible health services to help improve their living conditions in the post-Covid-19 world.

According to Darby & Weinstock (2018), psychiatry exists as a specialty of medicine that involves immense moral questions. The conditions treated threaten the vital elements that define human beings as autonomous, developing, accountable and contented individuals. In addition, these conditions are defined by extreme disability, suffering, and stigma (Morisse et al., 2013). It remains important to ensure that such patients receive quality and ethical care to ensure they establish and retain tremendous adaption and strength to overcome challenges.

Informed consent empowers the patient to assume control in making health-care-related decisions. Darby & Weinstock (2018) claim that healthcare-related decisions must reflect the true desires of the patients build on a unique set of personal values. Physicians are required by the law to ensure they operate under ethical practices as guided by informed consent. The law is selective and requires them to offer information in certain cases while withholding information in others. Thus, it remains important that physicians are aware of the legal perspectives of ethical practices, particularly confidentiality. However, it becomes a challenge for practitioners when certain events have compelling, competing ethical reasons that limit obtaining fully informed consent. Practitioners may avoid obtaining fully informed consent in cases they define as high-risk and could cause harm to the patient or third parties. Such decisions are complex and lack straightforwardness.

The introduction of tele-health for patients in rural or remote areas presents benefits and challenges. According to Moghbeli et al. (2017), advancements in technology have seen increased utilization of information technology and telemedicine in rehabilitating and treating diseases. Consequently, the importance of ethical issues has increased. It remains important for healthcare practitioners to keep patient information confidential and secure. Authorized access to patient information provides another challenge since not all employees in the clinical settings have the authority to access full patient health records.

The issue of confidentiality is critical to mental health for people with disabilities. According to Evans et al. (2012) people with disabilities are more vulnerable to mental disorders such as anxiety, sadness and grief, sleep disturbances, irritability, apprehensions, and withdrawal compared to non-disabled peers with mental health issues. People with disability have challenges accessing mental healthcare. Such issues vary in degree from one individual to the other as determined by various demographic factors such as age. Individuals with developmental and intellectual disabilities need assistance in comprehending the existing and consequent disruptions that affect their routine lives. Thus, it becomes important that health care practitioners observe confidentiality to minimize impacts such as anxiety, irritability, and withdrawal from social life and mental health care.

Methodology: Systematic Literature Review

A systematic literature review is a kind of review that gathers and synthesizes the results of several research papers in order to address a specific research question. The key activities required in doing a systematic review are the identification of relevant research, careful assessment of research reports, synthesis of findings, and understanding of study conclusions. The approach is a reproducible methodology that includes established eligibility rules for included research as well as a systematic search strategy to locate all studies that match the standards. The method was devised to identify all studies that met the qualifying criteria. Systematic reviews may be trusted as a reliable source of information, particularly when they are of high quality, encompass all relevant studies, and thereby reduce bias. The use of a systematic technique to choose the papers for the review decreases the possibility of bias. The review becomes more replicable by making the search strategy and technique more apparent.

The systematic literature review (SLR) will enable the researcher to synthesize the existing scientific evidence to answer the question guiding the study. The question will be approached in a transparent and reproducible approach while including already published evidence on the topic. SLR has become a major methodology commonly used in disciplines such as public policy research and health sciences. For analysis, the thematic approach (Hastings and Cohn, 2013) will help identify the major themes such as fidelity, confidentiality, and client-social worker relationships and their impact on limiting care. It is possible to apply the qualitative research method known as thematic analysis to many different philosophies and fields of study. This adaptability is what makes this study method so useful. It is a method for discovering and revealing the underlying patterns inside a dataset. Applying careful topic analysis may help the study get credible and illuminating results. Because of the theoretical latitude it provides, thematic analysis is an adaptable research strategy that may be used in a broad range of exploratory work relating to social work and the research objectives. Thus, it provides an explanation of the facts that is both detailed and intricate.

Significance, Strength, and Limitations of Research

Significance

Both the theoretical and practical contributions made by the study will add to the corpus of previous research that has been done in the field of providing care for persons with intellectual impairments. There is a lack of awareness of the restrictions that come with the presence of ethical conundrums in the provision of care for individuals with intellectual impairments who live in rural locations. The theoretical contribution investigates how the rational choice theory affects decision-making in individuals who have a disability. When ethical concerns that were previously agreed upon are disregarded by caregivers and clinical settings, it may be difficult for people who have impairments to continue coming to their scheduled sessions and treatments.

Data will be provided by the theme analysis, which may then be used to investigate the research subject and offer a response to the research question. The hypothesis that has been expressed will be assisted in being proven correct by the data that has been gathered. The SLR approach will be able to assist in providing substantial information that will provide insights that will add to the current body of study.

The results of the study will have an effect, both in theory and in reality, on clinical procedures and the way persons with intellectual impairments are cared for. In the first place, the study will assist in the development of an evidence-based strategy to care for persons with intellectual impairments who live in rural regions. This will be accomplished by overcoming limits caused by the breach of fidelity and confidentiality. In addition, the material will increase awareness assisting patients to overcome ethical limits.

Strength

Quantitative and qualitative approaches to research design are used in this study to varying degrees. The research provides an insightful view of the topic under study. As a consequence of this, the amount of detail obtained from the theme analysis becomes incredibly important, in particular when the data is acquired in a qualitative manner. Through the use of thematic analysis, it will be possible to investigate the issue in more depth and assess the extent to which ethical conundrums impede the provision of care to disabled individuals in rural locations.

Limitations

It is largely agreed by research that knowledge that mental illnesses manifest differently depending on a person’s age, color, and gender (Ellem et al., 2008). There is additional data suggesting these characteristics influence how persons are portrayed in studies of mental health (Bipeta, 2019). One of the trickiest parts of doing research with persons who are disabled or have mental health issues, according to Hayes et al. (2011), is gathering information from a population that is particularly vulnerable. Existing research has limitations, including difficulties in contacting undocumented cases of mental illness due to factors like social workers’ lack of trust and fear of repercussions, the potential for stress reactions among data providers, and the bureaucratic procedures involved in getting studies approved.

Project Issues and Problems Faced

I also encountered many problems in researching and searching the literature. As there are many synonyms for mental healthcare, rural and ethical dilemmas, and although there is a wide range of research on the ethical conflicts of providing mental care to disabled people, the literature on social service practitioners providing services to disabled people in rural areas could not be searched and collated effectively at first, but this difficulty was well improved by completing a table of synonyms and trying out different search strategies. Also selecting the right methodology was another problem faced. By conducting a large number of searches and comparing the methods used for different research questions, an effective method suitable for this research question was finally identified. At the same time, some challenges were confronted in the construction of the framework of the dissertation. For example, the language was not concise enough and the logic and content were not specific enough, including how to make the research logical and cohesive as a whole.

Preliminary Findings

Intellectual impairment is widespread in Australia. 400,000 Australians have an intellectual disability in 2009, according to Trollor (2014). 57% of these people also had mental problems. Increased numbers, especially during the H1N1 pandemic, suggest more people require mental health help. Intellectually disabled patients, especially those in remote places, have trouble getting medical treatment. Remoteness and poverty make it hard for residents to access proper health care. According to ABS (2022) “People with disabilities (7%) were more likely than those without impairments to report having trouble paying bills on time in the last three months. This was 12% for individuals with disabilities and 7% for those without.” 31% of people with intellectual disabilities reported facing this difficulty.

Due to frequent social connections between client and caregiver in mental health treatment settings, confidentiality is a moral problem. This is true in rural and smaller areas (Allen et al., 2020). Allen et al. Since privacy is unattainable, this is difficult. Mental health professionals must always protect patient privacy. More than two-fifths of 16-to-85-year-old Australians endure mental health concerns at some point. 43.7% of the population. In Australia, anxiety disorders affect 16.8% of the population (Australia Government, 2022). Anxiety disorders cause unease, discomfort, and tension. Women with disabilities are more anxious than men with the same limitations. 31.5% of 16-24-year-olds experienced long-term anxiety symptoms (Australian Bureau of Statistics, 2022). According to the study, Australians with impairments are more likely to experience mental health concerns than their age-matched peers (Australia Government, 2022). According to the study, people with disabilities are four times more likely to develop psychological distress. 76% of Australians with psychological impairments will feel psychological discomfort, 60% with intellectual disabilities, and 55% with brain damage, stroke, or head injury. These numbers are based on Australians with disabilities (Australia Government, 2022). The number of people with impairments grows with age, according to the report. 1.8% of men ages 15 to 24 have a sensory impairment, compared to 4.2% of boys ages 0 to 14. (Australian Bureau of Statistics, 2022). 5.8% of 0-14-year-old boys had intellectual impairment, against 4.9% of 15-24-year-old males. The ABS Girls are less likely than boys their age to suffer brain or sensory impairments. Risk diminishes between 0 and 14 years old.

Inclusion/Exclusion Criteria

Table 1: Study Results Table

Table 2: Study Characteristics Table

Table 3: Important elements of quality assessment for health care intervention studies

Table 4: Common types of study designs

Presentation of Data Extraction Tables

Author and Year Collaborative Research Model Sample and Sample Size Design and Data Collection Experiential Research Approach Student Benefit

Atmewarddoyo (2018) Mixed approaches are appropriate 38 participants from rural Australia Research methods in TEFL studies Surveys looking at the features of the participants including their mental health issues and the concerns they have while seeking health services The study will help identify mental health patterns. Mixed approaches are appropriate because they offer insight into the Australian population.

Australian Government (2022) Mental health issues in rural areas in Australia require attention Individuals with mental health issues in rural Australia aged above 21 years People with disabilities in Australia Primary data collected on mental health statistics, demographic data, geographic data, and unmet needs relating to intellectual disabilities. The government data provided in this article will be appropriate in creating solutions based on patterns and issues highlighted.

Bipeta (2019) Legal and ethical aspects of mental health care necessitate more research 108 young adults Mental health issues in recent times Definition of mental health issues and the ethical concerns from a legal point of view amongst participants Ethical issues must be addressed from a research-based point of view, enabling specially-tailored recommendations to mental health issues.

Chan et al. (2004) Services for adults with intellectual disabilities and mental illnesses need to be updated 35 adults in mental health institutions and records Intellectual disabilities in rural populations is significantly high Recording the definition of ethical issues from surveys issues to adults with mental health issues Intellectual disabilities and mental health issues must be addressed in terms of ethical direction and issues affecting different population.

Further Steps that need to be conducted

Further steps include conducting thorough thematic analysis of secondary research to supplement what the research has already gathered. Consequently, the researcher will identify the main themes and experiences from the information collected. In addition, the information will facilitate the completion of the findings and discussion sections.

Thank you for your time.

References

Atmowardoyo, H. (2018). Research Methods in TEFL Studies: Descriptive Research, Case Study, Error Analysis, and R & D. Journal of Language Teaching and Research, 9(1), 197. https://doi.org/10.17507/jltr.0901.25Australia Government (2022). Australia Institute of Health and Welfare. People with disability in Australia. https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/health/health-statusBipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108. https://doi.org/10.4103/ijpsym.ijpsym_59_19Chan, J., Hudson, C., & Vulic, C. (2004). Services for adults with intellectual disability and mental illness: are we getting it right?. Australian e-Journal for the Advancement of Mental Health, 3(1), 24-29. https://www.tandfonline.com/doi/abs/10.5172/jamh.3.1.24?casa_token=Ln49Xfuz5u4AAAAA:HjevyrUzhsa2k4Wx8HsvTzZoR90ubOaqMYqtILe7ZVoOYPxVjc8UU-uWfRyeX-NcT_9tqbhUi00Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. FOCUS, 16(4), 395–401. HYPERLINK “https://doi.org/10.1176/appi.focus.20180020” https://doi.org/10.1176/appi.focus.20180020

Ellem, K., Wilson, J., Chui, W. H., & Knox, M. (2008). Ethical challenges of life story research with ex‐prisoners with intellectual disability. Disability & Society, 23(5), 497-509. https://www.tandfonline.com/doi/full/10.1080/09687590802177064Evans, E., Howlett, S., Kremser, T., Simpson, J., Kayess, R., & Trollor, J. (2012). Service development for intellectual disability mental health: a human rights approach. Journal of Intellectual Disability Research, 56(11), 1098–1109. https://doi.org/10.1111/j.1365-2788.2012.01636.x https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=07bbdc64-ee16-4d30-9d13-e39da01f4319%40redisEvans, E., Howlett, S., Kremser, T., Simpson, J., Kayess, R., & Trollor, J. (2012). Service development for intellectual disability mental health: a human rights approach. Journal of Intellectual Disability Research, 56(11), 1098-1109.

Hastings, S.L. and Cohn, T.J. (2013). Challenges and opportunities associated with rural mental health practice. Journal of Rural Mental Health, 37(1), pp.37–49. doi:10.1037/rmh0000002.

Hayes, S., McGuire, B., O’neill, M., Oliver, C., & Morrison, T. (2011). Low mood and challenging behaviour in people with severe and profound intellectual disabilities. Journal of Intellectual Disability Research, 55(2), 182-189. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2788.2010.01355.x?casa_token=-u6Oh7zEMzoAAAAA:cQ_jzIw4wwOLqH8r6dx4yTlHiBcqhTJerrbpITosbL7U9xFr73Asfr5rIl9AgLmzlwrJiQn92srYlwhttps://eds.p.ebscohost.com/eds/detail/detail?vid=0&sid=d4178efc-4f7e-4d11-aaf5-416e2b4c7ca2%40redis&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=edsdoj.42f90213c13448eb9d743cc3436ef2a5&db=edsdojhttps://eds.p.ebscohost.com/eds/detail/detail?vid=0&sid=f3d25634-08e6-43c5-b79d-94b817867824%40redis&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=29284905&db=mnhhttps://eds.p.ebscohost.com/eds/detail/detail?vid=36&sid=87ff5bf7-d720-4c0e-867b-4daf9e9852f0%40redis&bdata=JkF1dGhUeXBlPXNoaWImc2l0ZT1lZHMtbGl2ZSZzY29wZT1zaXRl#AN=edspsy.appi.focus.20180020&db=edspsyhttps://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=07bbdc64-ee16-4d30-9d13-e39da01f4319%40redishttps://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=f4c33288-08bb-4477-baf9-7b613e0a8355%40redisMoghbeli, F., Langarizadeh, M., & Ali, A. (2017). Application of Ethics for Providing Telemedicine Services and Information Technology. Medical Archives, 71(5), 351. https://doi.org/10.5455/medarh.2017.71.351-355Morisse, F., Vandemaele, E., Claes, C., Claes, L., & Vandevelde, S. (2013). Quality of Life in Persons with Intellectual Disabilities and Mental Health Problems: An Explorative Study. The Scientific World Journal, 2013, 1–8. https://doi.org/10.1155/2013/491918Roberts, L.W., Battaglia, J. and Epstein, R.S. (1999). Frontier Ethics: Mental Health Care Needs

and Ethical Dilemmas in Rural Communities. Psychiatric Services, 50(4), pp.497–503. doi:10.1176/ps.50.4.497.

Toquero, C. M. D. (2021). Provision of mental health services for people with disabilities in the Philippines amid coronavirus outbreak. Disability & Society, 36(6), 1026-1032. https://www.tandfonline.com/doi/full/10.1080/09687599.2021.1916885


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