Mental Illness and Public Health Care

Is the involuntary commitment of the mentally ill morally proper? How can we determine proper psychiatric care in a managed health care system? And can a mental health professional violate a patient's confidentiality when they believe that patient is a threat to someone? These are the ethical, legal, and medical questions at the heart of the nineteenth annual volume of Biomedical Ethics Reviews, Mental Illness and Public Health Care. In six nonideological essays, leading bioethicists, including one with practical experience in medical administration, search for clear moral and legal guidelines for dealing with the complex issues presented when treating mentally ill patients. Regarding involuntary commitment, Theodore Benditt and Gerard Elfstrom take radically different approaches, but come to quite similar conclusions against the practice. David Malloy, Thomas Hadjistravopoulos, and Wade Robison all stress the need to incorporate ethical values into the operation of managed health care systems in order to ensure that patients will receive the most beneficial treatment. Mark Meaney confirms this approach with an actual case of a public sector managed behavioral health care corporation using the services of an ethics center to implement a system-wide corporate ethics program. Finally, Pam Sailors examines the deficiencies of, and proposes modifications to, the so-called Tarasoff laws requiring psychotherapists to break patient confidentiality under certain circumstances.§Objective and readily understandable, Mental Illness and Public Health Care illuminates for the educated reader some of the key ethical issues facing mental health care professionals and provides convincing practical conclusions with real moral import.