Reena Kapoor

Cultural competence in correctional mental health.

Cultural competence is an essential aspect of competence as a mental health professional. In this article, the framework of cultural competence developed in general psychiatry-acquiring knowledge, attitudes, and skills necessary to understand the interaction between culture and the individual-is applied to the prison setting. Race and ethnicity, extremes of age, gender, and religion are highlighted and examined as elements of the overall culture of prisons. The model of the cultural formulation from the DSM-IV is then adapted for use by clinicians in the correctional setting, with particular emphasis on the interaction between the inmates culture of origin and the unique culture of the prison environment.

Voluntary and Involuntary Hospitalization

This chapter begins by reviewing a scenario commonly encountered in emergency rooms across the United States: what to do when a patient agrees to voluntary psychiatric admission but lacks the capacity to make this decision. The landmark US Supreme Court case Zinermon v. Burch is used to guide this discussion. In brief, Mr. Burch was allowed to admit himself to the hospital voluntarily, even though the mental health staff knew that he believed he was signing into “heaven.” Mr. Burch later sued the hospital and treatment staff, claiming he had been deprived of liberty without adequate due process. The US Supreme Court agreed with Mr. Burch, finding that his Constitutional rights were violated because he was detained in the hospital based on voluntary admission paperwork that he was incompetent to sign; in short, patients must give informed consent for voluntary hospitalization. However, this was not always the case. This chapter briefly discusses the complicated historical interface of psychiatry and involuntary hospitalizations, as well as the resulting complex framework of legal (e.g., parens patriae, police powers) and ethical (e.g., beneficence) justifications for involuntary hospitalization, which must be balanced against patients’ rights to make their own medical decisions and remain free from confinement. Views of both patients and physicians, as well as outcomes, are subsequently discussed, with a final suggestion that, when in doubt, psychiatrists should proceed with caution, using involuntary hospitalization protocols to ensure that the patient’s due process rights are adequately protected.

Employee Health in the Mental Health Workplace: Clinical, Administrative, and Organizational Perspectives

Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.