Class 9 - Mental Health & AI

Question 1

Digital revolution

Answer 1

dramatically different. Not a new invention, has been discussed for 30 years. Needs to be properly managed. Machine learning (ML) is changing transportation, commerce, security, and communication.

Question 2

Biggest fear with AI

Answer 2

JOB LOSS. New jobs could also be created, however.

Question 3

How is AI changing the future of medicine

Answer 3

AI is expanding the power of radiology and medical imaging.

AI will be able to triage, find things early → whereas it would take a human days to find a diagnosis.

Computers can run without sleep, continuously until they find the answer, they search the entire web of data.

Mostly for cancer

Doctors have 50 algorithms for finding cancer, but many unapproved

Many dx where the pt could pass away if not found right away (e.g., PE.)

ER setting: SOB, CHF, that’s it… as soon as it is detected in PET scan it would tell us right away (will not diagnose, will tell you to look out for this person, will increase the priority of the pt)

ALL AI will require a human to say whether they agree or disagree with the diagnosis → this would just make it easier for the human to focus on the specific/right area, and tx it faster.

Question 4

Artificial Intelligence

Answer 4

Generic term for techniques used to teach computers to mimic human-like cognitive functions, such as reasoning, communicating, learning and decision-making

Question 5

The goal of an AI hospital would be to ….

Answer 5

Goal of an AI hospital would be to reduce doctor, pharmacist, and nurse workload.

• Faster more accurate testing for cancer
• Highly sensitive blood test to detect cancer
• Real-time assessment of pt
• All aspects of pt care is connected
• Data management, language processing, –> drug delivery robot, → human transport robot, AI assisted driving Car.
• Robot that can engage in complex relationships with pt
• Communication robot, understands all languages
• Triage system

Question 6

Scenarios where AI may be implemented in your own healthcare (5)

Answer 6

Early detection: Great amounts of population data can be analyzed rapidly and individuals with particular risk factors can be identified earlier for primary prevention and screening.

Virtual chatbots: Given the gap in access to mental health professionals, what if an AI assisted chatbot is trained in Cognitive Behavioral therapy and can provide psychotherapy to scale. Or a virtual chatbot can provide screening and referrals based on protocols, such as with 811.

Drug discovery: AI tools are already being used widely in facilitating research into new therapies – which may increase the cadence of discovery.

Image analysis: AI has been found to be very successful in assessing images for abnormalities and may thus improve outcomes given faster interventions.

Virtual simulation for quality improvement: Continuous learning is an essential component for maintaining patient safety and quality healthcare. AI may be a useful tool to develop and facilitate virtual simulations in the healthcare environment for quality improvement.

Question 7

AI Ethics in Health

(10 principles)

Answer 7

Well-being principle
The development and use of artificial intelligence systems (AIS) must permit the growth of the well-being of all sentient beings.

Respect for autonomy principle
AIS must be developed and used while respecting people’s autonomy, and with the goal of increasing people’s control over their lives and their surroundings.

Protection of privacy and intimacy
Privacy and intimacy must be protected from AIS intrusion and data acquisition and archiving systems (DAAS).

Solidarity principle
The development of AIS must be compatible with maintaining the bonds of solidarity among people and generations.

Democratic participating principle
AIS must meet intelligibility, justifiability, and accessibility criteria, and must be subjected to democratic scrutiny, debate, and control.

Equity principle
The development and use of AIS must contribute to the creation of a just and equitable society.

Diversity inclusion principle
The development and use of AIS must be compatible with maintaining social and cultural diversity and must not restrict the scope of lifestyle choices or personal experiences.

Caution principle
Every person involved in AI development must exercise caution by anticipating, as far as possible, the adverse consequences of AIS use and by taking the appropriate measures to avoid them.

Responsible principle
The development and use of AIS must not contribute to lessening the responsibility of human beings when decisions must be made.

Sustainable development principle
The development and use of AIS must be carried out so as to ensure a strong environmental sustainability of the planet.

Question 8

Some Ethical Questions in Mental Health

Answer 8

Resource allocation / Social justice

Competence/Capacity and Consent (Autonomy)

Confidentiality and Privacy

Question 9

Ethical Questions: Resource allocation/equity/social justice issues

Answer 9

Patients are often some of the poorest, sickest, most disadvantaged members of society.

Clinical considerations sometimes take a backseat to urgent psychosocial needs.

The approaches to care are multi-disciplinary, multi-system, and therefore distanced from traditional bioethics.

We need different models and approaches to examine these issues in all their complexity.

We also need different benchmarks on which to evaluate care approaches and interventions.

Treatments are based on building relationships and trust, and there are few ‘quick fixes’ (e.g., pneumonia–> antibiotic)

They tend to not want to fund mental health issues because it is not quickly or easily ‘treatable’ like an infection for example

Other considerations re: chronicity: can one ever be ‘cured’ of their MI (mental illness) ? Remission? With consultations on including MI in MAiD, can a MI ever be considered end-stage, or palliative?

Implications of the deinstitutionalization movement: 1950s first psychotropic drugs, deinstitutionalization 1960s, CLSCs 1970s

In 1960s a lot of mental institutions closed their doors and shift of resources to community

Long-acting antipsychotics offering better treatment options, but still lacking services, patients falling through the cracks.

Question 10

Ethical Questions: Competence/Capacity/Consent issues

Answer 10

Significant power imbalances in patient care

Concerns raised by MH concerns bring out questions of the capacity to consent to care (and even refuse care)

Do they even have the capacity to refuse or consent to care?

Frail elderly with major neurocognitive disorders, suicidality: one area of health care where, by virtue of your diagnosis, clinicians can routinely petition courts to override consent, question capacity, use coercive approaches to force treatment, or confinement, use physical and chemical restraints restraints

Suicide precautions

As you saw in your reading: we can routinely restrict patients’ rights in the name of protecting them, even when it comes at the cost of their self-determination (e.g. Bill, Edna, Eric: cases in your reading)

Restricting of rights and decision making

Question 11

Ethical Questions: Confidentiality

Answer 11

Because treatments cross the boundaries of the clinic or the hospital, and because patients often need psychosocial support (help with access to housing, basic necessities), often they rely on public curators to help manage different aspects of their daily life.

If you were a nurse helping a patient find housing, how much would you disclose to a landlord? An employer?

In the clinical setting, how much do you disclose to your colleagues to maintain confidentiality while also promoting safety?

E.g., requesting suicide precautions and surveillance in hospital, how do you instruct PABs? How do you promote dignity in these vulnerable moments? In a way that maintains pt confidentiality?

Question 12

More than any other field in health care, MH (mental health) struggles with the issue of

Answer 12

stigma

Question 13

Stigma as a concept was first described by

Answer 13

American sociologist Erving Goffman in the 1960s.

Question 14

There are so many misconceptions in mental health, and the XX has been particularly inflammatory around perceptions of MH

Answer 14

media

Question 15

MI can affect everyone, but who is at bigger risk?

Answer 15

• Low income earners, underemployed, single mothers
• Children & adolescents exposed to violence & aggression
• Workers who do repetitive work & have little decision-making power
• Women who have been victims of sexual or domestic violence
• Frail elderly who live at home

Indigenous populations are at even higher risk

Question 16

what Canadian legal document - speaks specifically to nursing issues with regards to patients with mental health issues, including use of chemical and physical restraints, and forcible confinement.

Answer 16

Canadian Charter of rights and freedoms, entrenched in the Constitution of Canada

Question 17

Mental healthcare legislation in most countries permits what (hint think of breaching human rights)

Answer 17

detention, interference of privacy, restriction of freedom of movement, and the use of forced medication that may alter the patient’s thinking.

Including physical and chemical restraints

Question 18

Article 1: All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 3: Everyone has the right to life, liberty and security of person.

Article 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

*no memorization required

Answer 18

Human Rights Declaration

Question 19

Article 7: Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

Article 9: Everyone has the right not to be arbitrarily detained or imprisoned.

Article 12: Everyone has the right not to be subjected to any cruel and unusual treatment or punishment

*no memorization required

Answer 19

Canadian Charter of Rights and Freedoms

Question 20

Article 1: Every human being has a right to life, and to personal security, inviolability and freedom. He also possesses juridical personality.

Article 3: Every person is the possessor of the fundamental freedoms, including freedom of conscience, freedom of religion, freedom of opinion, freedom of expression, freedom of peaceful assembly and freedom of association.

Article 4: Every person has a right to the safeguard of his dignity, honor and reputation.

Article 9.1: In exercising his fundamental freedoms and rights, a person shall maintain a proper regard for democratic values, public order and the general well-being of the citizens of Québec. In this respect, the scope of the freedoms and rights, and limits to their exercise, may be fixed by law.

*no memorization required

Answer 20

Quebec Charter of Human Rights and Freedoms

Question 21

the Quebec Civil Code’s Act Respecting the Protection of Persons Whose Mental State Presents a Danger to Themselves or Others
outlines the legal rights and obligations for people who:

Answer 21

pose a danger to themselves or others
psychiatric examination
preventive and temporary confinement
court ordered confinement
forced treatment

Question 22

Do the OIIQ and CNA code of ethics discuss mental health?

Answer 22

don’t have any particular provisions that relate specifically to mental health, but the MSSS did publish guidelines in 2002 on the use of chemical and physical restraints as well as the use of confinement

Question 23

MHC is a unique moral practice for what 6 reasons, according to a systematic literature review

Answer 23

Reason 1: Forced admission & forced treatment

Reason 2: Refusal of care

Reason 3: Inherently moral as illness impacts self behaviors, etc.

Reason 4: Imbalance of power and institutional history

Reason 5: Differences in treatment modalities and ideologies

Reason 6: Moral distress

Question 24

Coercion Defined

Formal vs. Informal vs. Perceived

Answer 24

‘Formal coercion’ is formally regulated, decided and documented, while ‘informal coercion’ includes any other type of coercion and use of power, control or manipulation. ‘Perceived coercion’ may overlap with both and is defined by the individual subject’s perception of being coerced or not

Question 25

Coercion – as a spectrum of pressures

Answer 25

Our spectrum of pressures is as follows:
(1) persuasion;
(2) interpersonal leverage; (3) inducements;
(4) threats;
(5) compulsory treatment (in the community or as an inpatient).

Question 26

Do we actually use coercion in health care?

Answer 26

Coercion: using a credible force of harm to induce someone to do something, eliciting fear → we do not exactly do this in health care

Question 27

who can decide to use implement use of restraints?

Answer 27

Loi modifiant le Code des professions et d’autres dispositions législatives dans le domaine de la santé (2002) réserve cette activité aux médecins, ergothérapeutes, physiothérapeutes et infirmières selon leur champ d’exercice respectif, et ce, sans restriction de lieux.

Question 28

what is a restraint?

Answer 28

restraint is defined as a control measure that is to prevent or restrict a person’s freedom of movement by the use of force human or mechanical means, or by depriving it of a means that it uses to overcome a disability

Question 29

what is the nurse’s responsibility surrounding restraints?

Answer 29

• Given the risks of significant harm associated with its application, the restraint is an exceptional measure of last resort.
• Therefore, everything must be made to limit its use. Thus, the nurse must first implement strategies to prevention and alternative measures that are effective, efficient and respectful of the person and their loved ones, their autonomy and their environment.
• In order to take in consideration all possible avenues to avoid the use of restraint measures, he or she will also essential to conduct an interdisciplinary analysis of the situation, including the person and his or her loved ones, in order to develop an individualized intervention plan

Question 30

What are the three reasons for why - Stigma can be seen as a fundamental cause of population health inequalities

Answer 30

(1) influences several physical and mental health outcomes that affect millions of people (…) through multiple mechanisms,

(2) disrupts or inhibits access to multiple resources—structural, interpersonal, and psychological—that could otherwise be used to avoid or minimize poor health, and

(3) enables the creation of new, evolving mechanisms that ensure the reproduction of health inequalities among members of socially disadvantaged populations.

Question 31

what are some of the main challenges for patients in mental health nursing (5)

five

Answer 31

In general medical settings, lack of dignity and caring (according to pt and families)

Nurses held commonly held stereotypes that society has – fear, blame and hostility (based on media-generated misrepresentations)

Attribution Theory – Weakness of morals (i.e., laziness, lack of self-control, etc) as the cause of illness

Devaluing of needs of patients with mental illness (barrier to obtaining caring treatment)

In-ward stigmatization(ostracizing and even shunning of nurses who have mental illness; devaluing of psychiatric/mental health nurses’ status within the profession)

Question 32

Equity Oriented Healthcare consist of what (3 things)

Answer 32

• Trauma and Violence Informed care (TVIC)
• Harm Reduction
• Cultural Safety and Ani-Racism

Question 33

Practice that takes into account an understanding of trauma in all aspects of service delivery and places priority on the individual’s safety, choice, and control.

Answer 33

Trauma-informed care

Question 34

what is the focus of trauma-informed care

Answer 34

understanding the pervasiveness of trauma and its effects and how it plays out in terms of behaviors. It is not about treating the trauma itself.

Question 35

Why is TVIC important from a nursing ethics perspective?

Answer 35

First, it highlights understanding and awareness that violence and trauma experiences are common, impact various dimensions of development through the lifespan, and folks may adapt as they can based on what they have experienced in the past.

Second, there is a clear emphasis on building trust and safety

The focus is not on treating the trauma itself, but on creating an environment or conditions that is not re-traumatizing – thus promoting non-maleficence and beneficence.

Question 36

Trauma and Violence Informed Care Principles
(4)

Answer 36

Understand impact (trust)

Create Safety

Foster C’s (choice, collaboration, connection)

Support Resilience (Empowerment)

*ALSO (she says later down that these are the principles)
*
Trauma Awareness

Emphasis on Safety & Trust

Opportunity for Choice, Collaboration, and Connection

Strengths-Based and Skill Building

Question 37

TVIC builds on TIC principles and focuses on these tenets or principles
(5)

Answer 37

Understand trauma and violence and their impacts on peoples’ lives and behaviors

Create emotionally and physically safe environments for both clients and service providers

Foster opportunities for choice, collaboration, and connection

Provide strengths-based and capacity-building approaches to support client coping and resilience.

Utilizing a trauma-informed approach does not necessarily require disclosure of trauma. Rather, services are provided in ways that recognize the need for physical and emotional safety, as well as choice and control in decisions affecting one’s treatment. Trauma-informed practice is more about the overall essence of the approach, or way of being in the relationship, than a specific treatment strategy or method.

Question 38

CENTRAL TO Trauma-Informed Care
are (2 things)

Answer 38

Central belief that people can recover

Grounded in Hope

A central belief of trauma-informed practice is that people can recover, and the approach is grounded in hope and the honoring of each individual’s resiliency.

Question 39

The Loneliness Epidemic and Technology
(positive)

Answer 39

• Staying in touch
• Social participation
• Finding community - especially for individuals who are pushed to margins
• Information/advice
• Emotional support

Question 40

The Loneliness Epidemic and Technology
(negative)

Answer 40

• Displaces in person engagement (Big effect)
• Monopolized attention
• Reduces quality of interactions
• Diminished self esteem
• FOMO
• Online harassment