Summative Essay






Morley et al (2015) define polysubstance use as the use of different substances within a specific time frame. Individuals engaged in polysubstance use are at a high risk of involving themselves in high-risk behaviours such as engaging in unprotected sexual activities and violence amongst other criminal behaviour (Howe 2008). Polysubstance use also increases the risk of sexual transmitted diseases, poor physical health and incarceration. Past studies on polysubstance use associate usage of wide range of illicit drugs with development of deviant behaviour such as stealing amongst the users (Morley et al. 2015).  Andrade (2013) affirms that there is a link between polysubstance use, violence behaviour and mental illness. It is estimated that approximately 75% of individuals suffering from mental disorder demonstrate comorbid substance use   (Dorn et al. 2009). According to Dorn et al. (2009) ‘the consequences of substance use are equally problematic for persons with mental illness’ (p. 465).  A combination of mental illness and comorbid substance use is associated with violence and high treatment and social costs.

Despite the fact that stakeholders in the mental health and the public perceive individuals suffering from mental disorders and particularly schizophrenia present the highest risk of violence, Dorn et al. (2009) is of the view that individuals characterised by substance use, personality disorders, and affective disorders similarly present a high risk.  Dunn (2007), assert that individuals suffering from schizophrenia are at high risk of mortality and medical morbidity.  This paper entails a summative essay consisting of an in-depth analysis on the ethical and or legal conflict or aspect of care in relation to the life of one client/service user. The analysis is in relation to a case study involving a 32 year old male diagnosed with paranoid schizophrenia and polysubstance use, as evidenced by prevalence of different histories such as alcoholism, involvement in criminal behaviour.


Impact of past and current legislations on the health, lifestyle and quality of life and rights for people with mental ill health

The World Health Organisation (WHO) defines healthy life with to include the physical, social and mental components of one’s life. During the 2014 World Mental Health Day, the WHO underlined its commitment in prioritising ‘living a health life with schizophrenia’ (Bobes et al. 2007).  According to Dunn (2007), schizophrenia refers to a severe mental illness characterised by neuropsychological deficits which impairs a patient’s insight and capacity to make decision regarding their own care.  The WHO’s commitment in improving individuals health is underlined by adoption of the slogan ‘no mental health without physical health’.  Improving the quality of life constitutes one of the cornerstones in public health care. The WHO defines quality of life to include ‘an individual’s perceptions of their positions in life in the context of culture and the value systems in which they live, and in relation to their goals, expectations, standards and concerns’ (Bobes et al. 2007). Improving the quality of life for people suffering from schizophrenia has become an area of major concern.  The WHO is committed to improve the quality of life for people suffering from schizophrenia by ensuring that they effectively and efficiently access health services (Howe 2008).  The rationale of this commitment is underlined by the fact that schizophrenia impacts diverse facets of the patient’s life.

Amongst the fundamental elements in improving the quality of life for individuals suffering from mental illness or disorders such as schizophrenia entails observing ethics in offering them health care services (Howe 2008). Dunn (2007) accentuates that ‘clinicians who treat patients with schizophrenia may encounter a variety of ethical issues related to both psychiatric and medical treatment of patients’ (p.145).  Amongst the ethical issues encountered by clinicians and psychiatrists relate to the patients’ rights and information disclosure. 

In the quest to improve the quality of life for patients suffering from mental illness and substance abuse, the UK government drafted the Mental Health Act of 1983 (Great Britain 2007). The Act specifies the circumstances within which individuals suffering from mental illness or disorder can be detained in order to receive treatment for the mental condition without obtaining his or her consent (Great Britain 2007). Moreover, the Act stipulates the processes that should be adhered to in order to ensure that the patients’ rights are not inappropriately treated. The 32 year old male outlined in the case study can be categorised as a patient suffering from mental disorder in accordance with the  Mental Health Act of 1983, which categorises schizophrenia as one of the mental disorders (Prins 2015). According to Section 37/41 of the Mental Health Act, mental health professionals have the right to bring an individual suffering mental disorder to hospital for treatment (Great Britain 2007). Therefore, the detention of the patient under section 37/41 is legally justified.  

In addition to the fact that medical practitioners have the right to make the decision to relating to the patient’s retention, medical practitioners also possess substantial right with reference to information disclosure on the patient’s mental condition. Walston-Dunham () emphasise that ensuring informed consent constitutes a critical element in administering health care services. In cases that does not involve emergencies, medical practitioners are obligated to provide their clients or an authorised party in cases of mental incapacitation information on diagnosis, alternative treatment options, risks and benefits associated with the recommended treatment plan, and the expected outcome of the recommended treatment (Appelbaum & Gutheil 2007).

 In an effort to comply with this requirement, most jurisdictions have entrenched informed consent as one of the legal requirements in the medical profession. Thus, informed consent constitutes one of the fundamental patient’s rights. Subsequently, most medical care providers have adjusted their codes of ethical codes ethics by imposing the duty to communicate the benefits and risks of a particular form of treatment or care services on all the medical practitioners (Walston-Dunham). The rationale of information disclosure is to ensure that the client or patient retains the controlling role with reference to his or her health care decisions. In recognition of the need for informed consent, the US Congress enacted the Patient Self Determination Act, 42 U.S.CA Section 1395, et.seq (Walston-Dunham). Appelbaum and Gutheil (2007) are of the opinion that failure to obtain informed consent is one of the major malpractices in the medical field.

In spite of the dominance of the doctrine of informed consent, medical practitioners experience ethical and legal conflicts in dealing with some situations such as psychiatric cases (Lollar & Andresen 2010). For example, decision on information disclosure in treating patients suffering from paranoid schizophrenia and polysubstance use as evidenced in the case under investigation entails determining the extent to which patients should be provided with information on their illness. According to Howe (2008), psychiatrists and clinicians encounter conflicting situations with reference to how to handle and disseminate patient information in such situations. Kelly (2011) argues that providing such information to the patient may result in some patients failing to continue with the treatment plan, which limits provision of adequate care to the patient (Appelbaum & Gutheil 2007). Some individuals are of the view that withholding such information might amount to infringement of the patient’s autonomy in the treatment process and may further constitute lying by omission, which is unethical.

Howe (2008) argues that lying by omission may in some situations constitute a warranted ethical price because of ‘other competing and mutually exclusive values that may benefit the patient in other ways’ (Howe, p. 59). This aspect is evidenced in treating patients suffering from paranoiac schizophrenia, whereby clinicians experience significant challenges because of the ethical conflict involved in making decision on whether to disclose all the information regarding the patients’ illness. Howe (2008) asserts that treating such delusional patients requires clinicians to be maximally effective by withholding some information on their illness.

Under such situations, Appelbaum and Gutheil (2007) accentuates that the conduct of medical practitioners to conceal some information on the patients illness does not in some situations constitute unethical practice if it is in the patient’s best interest. Such cases are regarded to include ‘therapeutic privilege’ in which the medical practitioner makes the decision between lying and providing the truth (Richard, Lajeunesse & Lussier 2010). The fact that the patient under the case study suffers from paranoid schizophrenia underlines the need for legal intervention in order to improve the patients’ quality of life.

 Equality and inequality in health care

According to Mihanovic et al. (2015) patients suffering from schizophrenia require long-term psychosocial and pharmacological treatment and rehabilitation, which leads to incurrence of huge costs.   This aspect might lead to prevalence of inequalities in accessing health care. For example, the case under evaluation presents a patient who is characterised by paranoid schizophrenia in addition to other substance abuse.   Past evidence indicate that patient suffering from mental illness experience prejudice in accessing health care service. Moreover, a significant amount of evidence indicates that mentally disabled people characterised by co-morbid physical disorders are extensively discriminated in receiving treatment compared to their mentally well counterparts (Burns 2013).  Due to the perceived discrimination, such patients do not receive the right treatment in time which contributes to non-treatment or non-adherence to treatment. This leads to deterioration in the patient’s health condition (Burns 2013). According to the case study, the patient depicted misuse of alcohol during his adolescence. This behaviour led to polysubstance use which has greatly contributed to the patient suffering from paranoid schizophrenia.  The patient’s non-treatment has significantly contributed to the patient developing a history of offenses such as polysubstance abuse, shoplifting, sexual offenses, violence, theft, and disorderly conduct. These aspects indicate that the patient is a victim of long term mental illness.

One of the factors that might have contributed to deterioration in the patients’ mental illness considering its duration relates to structural barriers. Burns (2013) identifies structural inequalities as one of the major barriers that limit ease of access to mental health care services in both the middle and high income countries.  A survey conducted in the United States revealed that adolescences from low income families experience significant structural barriers in accessing mental health care services compared to their middle and high income families (Kohn, Saxena & Levav 2004). Such structural inequalities contribute to significant treatment gap. A study conducted by the WHO in 14 countries revealed that 76-85% of patients suffering from serious mental illness in low and middle income countries do not receive any form of treatment. On the other hand, 35% to 50% of such patients in the high income countries receive treatment (Kohn, Saxena & Levav 2004).

Mental health advocacy

            The prevalence of mental illness has contributed to development of advocacy groups and movements that are focused on improving the quality of life for patients suffering from mental illness or disorders (World Health Organization 2003).  The advocacy movements focus on different aspects such as promoting and protecting the rights of mental illness patients, and improving provision and care for such patients.  The advocacy groups are comprised of different entities such as governments and non-governmental organizations (World Health Organization 2003).  One of the notable contributions of the efforts by the advocacy groups relate to integration of information technology in administering treatment to mental illness patients. For example, development of the ‘buddy tracker’ in the United Kingdom is one of the notable efforts that have contributed to improvement in administration of mental health care services (Abrar 2016).  The buddy tracker involves a technology that supports an individual’s emotional, mental and physical wellbeing by tracking the patients’ mood. On the basis of this technology, healthcare professionals are able to tailor a care therapy that best suits the individual patient.  Application of such technology can significantly contribute to improvement in administering health care service to patients characterized by mental illness such as paranoid schizophrenia (Abrar 2016).  

In addition to the above aspects, the effort by advocacy groups have greatly contributed to elimination of inequalities in administering  health care services to patients suffering from mental illness. This goal has been achieved by eliminating barriers to mental health by ensuring that the society develops a positive perception on patients suffering from mental illness. This has led to elimination of stigma, which is one of the major barriers to patients suffering from mental illness (World Health Organization 2003).    


The summative analysis underlines the existence of significant issues with reference to mental health.  Amongst the notable aspects relate to identification of the legal and ethical issues encountered in the administration of health care services to patients suffering from mental illness.  In an effort to improve the quality of life for mental illness patients, the case study underlines the conflict between the patient’s rights, ethics and how the law has contributed to elimination of such conflicts. According to law and medical code of conduct, medical practitioners are obliged to obtain informed consent from patients in administering treatment. However, in some cases such as emergencies and dealing with paranoid schizophrenia, medical practitioners are protected by law to administer the most appropriate treatment without the patients consent. Under such circumstances the medical practitioners does not engage in violation of patients rights or the law. Moreover, the case study underlines the existence of boundaries with reference to right to information for mental illness patients. To improve their wellbeing and quality of life, medical practitioners have the legal right to conceal information on mental illness diagnoses. The analysis further underlines the existence of structural inequalities as one of the major barriers that limits improvement in administration of mental health care. However, the efforts by the advocacy groups and movements are significantly contributing to improvement in administration of care to mental health patients.



Reference List

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Mihanovic, M, Branka, R, Anamarija, B, Ena, E, Davor, B & Ivan, P 2015, ‘Quality of life for patients with schizophrenia treated in foster home care and in outpatient treatment’, Neuropsychiatr Dis Treatment, vol. 11, pp. 585-595.

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Prins, H 2015, Offenders, deviants or patients? An introduction to clinical criminology, Routledge, New York.

Richard, C, Lajeunesse, Y & Lussier, M 2010, ‘Therapeutic privilege; between the ethics of lying and the practice of truth’, Journal of Medical Ethics, vol. 36, no. 6, pp. 353-357.

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