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Ethics and the Treatment of the Mentally Ill, Homeless Person: a Perspective on Psychiatry Resident Training

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Abstract

Objective

The authors outline the unique ethical challenges that psychiatry residents face in working with individuals who are homeless and mentally ill. The authors also propose steps to develop effective teaching methods with residents working with these patients.

Methods

The authors reviewed literature relevant to the training of psychiatry residents in ethics and treating individuals who are homeless and mentally ill.

Results

The authors summarize current literature and, with the use of case examples, provide guidelines for effective teaching.

Conclusions

Teaching psychiatry residents who are working in the community with individuals who are mentally ill and homeless needs to address a number of unique ethical conflicts that arise in this area. The authors outline approaches to this teaching.

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References

  1. Gillig P, McQuistion H. Clinical guide to the mentally ill homeless person. Washington DC: American Psychiatric Publishing; 2006.

  2. Bauer LK, Baggettt TP, Stern TA, O’Connell JJ, Shtesel D. Caring for homeless persons with serious mental illness in general hospitals. Psychosomatics. 2013;54:14–21.

    Article  PubMed  Google Scholar 

  3. Substance Abuse and Mental Health Services Administration. Behavioral health services for people who are homeless. Treatment Impact Protocol (TIP) Series 55. HHS Publication No. (SMA) 13–4734. Rockville, MD, Substance Abuse and Mental Health Services Administration; 2013.

  4. Liegeois A, van Audenhove C. Ethical dilemmas in community mental health. J Med Ethics. 2005;31:452–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Beauchamp T, Childress J. Principles of biomedical ethics. 7th ed. Oxford: Oxford University Press; 2012.

    Google Scholar 

  6. Christensen R. The ethics of treating the untreatable. Psychiatr Serv. 1995;46:1217.

    Article  CAS  PubMed  Google Scholar 

  7. Yedidia MJ, Gillespie CC, Bernstein CA. A survey of psychiatric residency directors on current priorities and preparation for public sector care. Psychiatr Serv. 2006;57:238–43.

    Article  PubMed  Google Scholar 

  8. Roberts L, Geppert C, Bailey R. Ethics in psychiatric practice: essential ethics skills, informed consent and confidentiality. J Psychiatr Pract. 2002;8:290–305.

    Article  PubMed  Google Scholar 

  9. Morrison A, Roman B, Borges N. Psychiatry and emergency medicine: medical student and physician attitudes toward homeless persons. Acad Psychiatry. 2012;36:211–5.

    Article  PubMed  Google Scholar 

  10. McQuistion HL, Ranz JM, Gillig PM. A survey of American Psychiatric Residency programs concerning education in homelessness. Acad Psychiatry. 2004;28:116–21.

    Article  PubMed  Google Scholar 

  11. Brill JR, Jackson TC, Stearns MA. Community medicine in action: an integrated, fourth year urban continuity preceptorship. Acad Med. 2002;77:739.

    Article  PubMed  Google Scholar 

  12. Woodhead EL, Sperry JA, Bower EH, Fitzpatick KM. Attitude change following a homeless clinic experience. Fam Med. 2009;41:83–4.

    PubMed  Google Scholar 

  13. Melamed Y, Fromer D, Kemelman Z, Barak Y. Working with mentally ill homeless persons: should we respect their quest for anonymity? J Med Ethics. 2000;26:175–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Stovall J. Is assertive community treatment ethical care? Harv Rev Psychiatry. 2001;9:139–43.

    Article  CAS  PubMed  Google Scholar 

  15. Appelbaum P. Ethics in evolution: the incompatibility of clinical and forensic functions. Am J Psychiatry. 1997;154:445–6.

    Article  CAS  PubMed  Google Scholar 

  16. Fleisch SB, Kelly AC. Street psychiatry as a community rotation for residents: the UNC Homeless Support Program. Acad Psychiatry. 2014;38:246–7.

    Article  PubMed  Google Scholar 

  17. Lemelle S, Arbuckle MR, Ranz J. Integrating systems-based practice, community psychiatry, and recovery into residency training. Acad Psychiatry. 2013;37:35–7.

    Article  PubMed  Google Scholar 

  18. Widge AS, Hunt J, Servis M. Systems-based practice and practice-based learning for the general psychiatrist: old competencies, new emphasis. Acad Psychiatry. 2014;38:288–93.

    Article  PubMed  Google Scholar 

  19. McQuistion HL. Homelessness and behavioral health in the new century. In: McQuistion HL, Sowers WE, Ranz J, Feldman JM, editors. Handbook of community psychiatry. New York: Springer; 2012. p. 407–22.

    Chapter  Google Scholar 

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Disclosures

There are no conflicts of interest to disclose by any of the authors.

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Authors and Affiliations

  1. Vanderbilt University School of Medicine, Nashville, TN, USA

    Jeffrey Stovall & Sheryl B. Fleisch

  2. New York University School of Medicine, New York, NY, USA

    Hunter L. McQuistion

  3. University of Maryland School of Medicine, Baltimore, MD, USA

    Ann Hackman

  4. Baylor University College of Medicine, Houston, TX, USA

    Toi Harris

Authors
  1. Jeffrey Stovall
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  2. Sheryl B. Fleisch
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  3. Hunter L. McQuistion
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  4. Ann Hackman
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  5. Toi Harris
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Corresponding author

Correspondence to Jeffrey Stovall.

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Stovall, J., Fleisch, S.B., McQuistion, H.L. et al. Ethics and the Treatment of the Mentally Ill, Homeless Person: a Perspective on Psychiatry Resident Training. Acad Psychiatry 40, 612–616 (2016). https://doi.org/10.1007/s40596-015-0330-0

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  • DOI: https://doi.org/10.1007/s40596-015-0330-0

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