Week 7 Reflective Journal Entry 

 

Applying Reflection and Critical Thinking to Address Dilemmas of Mental health care 

Introduction 

The practice of mental health care ethics and professional dilemmas is quite common where the practitioner is faced with the conflict between respecting autonomy and the obligation of protecting vulnerable individuals. Rational thinking and cogitation is an important ingredient in making judgments that impact on safety, dignity and wellbeing. In this entry, I will refer to a case scenario of a mental health service user that refused medication even after being evidenced to act in a way that is dangerous to themselves and others. By applying Gibbs’ Reflective Cycle and critical thinking principles, I will explore how reflection can guide ethical problem-solving in mental health contexts (Peabody et al., 2022). 

 

The Dilemma 

On my time on placement at a mental health facility, I assisted an adult service user with a diagnosis of schizophrenia. The patient denied taking antipsychotic drugs as they were not needed and were harmful. This presented a conflict between the right of the person to make decisions on refusal of treatment, which is his right to autonomy, and the need to protect the person and not cause harm to others since the untreated psychosis may cause a relapse or a crisis. The case caused ethical conflict between encouraging independence and professional safeguarding and duty of care in accordance with the Mental Health Act (2007). 

 

Applying Reflection (Gibbs’ Reflective Cycle) 

Description & Feelings: I was ambivalent at the moment. I knew that the service user was worried about the side effects, but I also found it worrying the dangers of non-compliance. I got nervous as to how framing treatment as a positive process would dissolve trust, but I was also afraid not to take action. 

 

Evaluation: I have recognised how merely respecting the refusal without any further action can pose a threat to the wellbeing of the service user. According to when the therapeutic relationship may be compromised, autonomy may be infringed by attempting to force treatment. 

 

Analysis: I used Gibbs framework to analyse professional codes of practice, legal advice, and the contribution of my supervisor. The reflection assisted me in appreciating that an open dialog with the service user was very necessary-answering any concerns the patient had, discussing possible risks and considering other options. The less restrictive alternative should be the first choice when it comes to mental health care as cited to be the guiding principles of the Mental Health Act. 

 

Action Plan: This reflexion underpins the necessity of anticipating the refusal of medication. What I can do in future practice is develop a more solid communication skill that will facilitate a shared-decision making and providing the best information on services to the service users so that they can make informed choices. I will also expand my knowledge of the mental health law to be able to balance autonomy and protection with confidence. 

 

Applying Critical Thinking 

Critical thinking enabled me to evaluate the situation beyond immediate emotional responses. I considered three possible courses of action: 

·         Respect refusal entirely: Upholds autonomy but risks relapse and harm. 

·         Enforce treatment using Mental Health Act: Not only ensures safety but also might induce trauma and mistrust. 

·         Handling autonomy and protection through discussion and seeking options (e.g., treatment, dose adjustment): Allows maximizing presence of defense without discouraging independence as much as possible. 

·          

The process of questioning suppositions (i.e., that refusal of medication is a risk per se) and effectively taking into consideration ethical, legal, and practical consequences led me to the conclusion that the third approach is the most adequate one. Aryal (2022) also helped to inform my decision: by reflecting on my experiences as a student and comparing them to the experiences of the service user, I realized I felt uncomfortable; by reflecting on my experience as a colleague and discussing the issue with my supervisor, I considered the fears of the service user; and by considering the findings of scholars and medical professionals and reading research and policies advancing the principle of collaborative care in mental health treatment, I analysed the advantages of collaboration in mental health care. 

 

Conclusion  

The dilemma demonstrated how complex a task such as decision-making in mental health care is. Reflection enabled me to comprehend my feelings and work-related roles, and critical thinking made sure that I considered various approaches and solutions. I understood that respecting autonomy does not imply neglecting a danger, and safeguarding must get established in balancing with therapeutic communication. In the future, I will incorporate reflective models and critical frameworks of thought into my practice to help reinforce legal, ethical, and compassionate mental health work. 

 

 

 

References 

·         Peabody, M.A., Noyes, S. and Anderson, M., 2022. Permission to learn: Intentional use of art and object-mediated strategies to develop reflective professional skills. Journal of Occupational Therapy Education, 6(3), p.14. 

·         Simpson, M., 2024. Changing gears and buying time: a study exploring AMHP practice following referral for a Mental Health Act assessment in England and Wales. The British Journal of Social Work, 54(2), pp.797-816. 

·         Aryal, R., 2022, December. Critical self-reflective engagement to improve professional development for a teacher educator. In Mathematics Education Forum Chitwan (Vol. 7, No. 7, pp. 66-81). 

 

 

 

 

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