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Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services- improving patient-centered care

Wale, Joyce B; Belkin, Gary S; Moon, Robert
The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use.
PMID: 21841927
ISSN: 1552-5767
CID: 802152

Mental health and the development agenda in Sub-Saharan Africa

Jenkins, Rachel; Baingana, Florence; Belkin, Gary; Borowitz, Michael; Daly, Anthony; Francis, Paul; Friedman, Jed; Garrison, Preston; Kauye, Felix; Kiima, David; Mayeya, John; Mbatia, Joseph; Tyson, Stewart; Njenga, Frank; Gureje, Oye; Sadiq, Sabah
This article synthesizes the views of participants in two roundtables that were convened in Nairobi (March 2007) and London (July 2008) to identify key challenges to the prioritization of mental health in Africa and possible solutions. Participants included leading development experts and policy makers from head and country offices of international donors, national directors of mental health for several African countries, key mental health and public health professionals, epidemiologists, and an international nongovernmental organization. The challenges they identified to mainstreaming mental health include lack of understanding of the contribution of mental disorders to morbidity and mortality, competition for limited resources within health reform efforts, poor distribution of interventions and lack of inclusion of mental health among core generic health indicators, lack of economic research evidence, lack of a strategic approach to human resources planning, lack of partnerships with the social development sector, and mental health professionals' need for public health skills to effectively conduct national advocacy. Potential solutions include further investment in economic research, better strategic identification of the levers and entry points for integrating mental health into health sector reform plans, more vigorous engagement of mental health professionals in general health sector reforms, strengthening the linkage between mental health and social development, and intensive resource mobilization. In summary, partnerships, underpinned by collaborative training, research, and mutual dialogue with other health and nonhealth sectors, are needed
PMID: 20194398
ISSN: 1557-9700
CID: 134417

Misconceived bioethics?: The misconception of the "therapeutic misconception"

Belkin, Gary S
Bioethics needs to include study of the social and historical context in which ethical meanings in medical encounters make sense. It needs to do this in order to remain relevant, vibrant, and aware of how it might unwittingly facilitate the agendas of others. As an illustration, this paper critiques some of the accepted meanings and purposes of the idea of the Therapeutic Misconception (TM) which has been an increasingly attractive concept with which to organize thinking about experimentation ethics. By considering the history of alternative viewpoints against which TM was offered as a replacement, this paper suggests that TM, and bioethics more generally, may contribute to increasingly technocratic and standardized practices in medicine
PMID: 16413057
ISSN: 0160-2527
CID: 66997

Internationalism and the future of academic psychiatry

Belkin, Gary S; Fricchione, Gregory L
PMID: 16141117
ISSN: 1042-9670
CID: 61420

Moving beyond bioethics: history and the search for medical humanism

Belkin, Gary S
From both within and without bioethics, growing criticism of the predominant methods and practices of the field can be heard. These critiques tend to lament an emphasis on logically derived rules and philosophical theories that inadequately capture how and why people have the moral attitudes they do, and they urge the use of more empirically grounded social sciences--history, sociology, and anthropology--to draw attention to the complex factors behind such attitudes. However, these critiques do not go far enough, as they do not question why debate over ethical categories should have such a central role in voicing concerns about medicine.The importance of using other forms of inquiry, especially that of history, to examine aspects of medical practice and the emergence of bioethics itself is not simply to refine bioethical moral analysis. Instead, history can be employed to counter the preoccupation with translating concerns about medicine into moral terms and to move towards what is more sorely needed: a true medical humanism
PMID: 15247503
ISSN: 0031-5982
CID: 46111

We are all historians: Thoughts about doing psychiatry

Chapter by: Belkin, GS
in: Clio in the Clinic: History in Medical Practice by
pp. 236-247
ISBN: 9781442673014
CID: 2169212

Brain death and the historical understanding of bioethics

Belkin, Gary S
In a 1968 Report, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death promulgated influential criteria for the idea and practice known as 'brain death.' Before and since the Committee met, brain death has been a focal point of visions and nightmares of medical progress, purpose, and moral authority. Critics of the Committee felt it was deaf to apparently central moral considerations and focused on the self-serving purpose of expanding transplantation. Historical characterizations of the uses and meanings of brain death and the work of the Committee have tended to echo these themes, which means also generally repeating a widely held bioethical self-understanding of how the field appeared-that is, as a necessary antidote of moral expertise. This paper looks at the Committee and finds that historical depictions of it have been skewed by such a bioethical agenda. Entertaining different possibilities as to the motives and historical circumstances behind the Report it famously produced may point to not only different histories of the Committee, but also different perspectives on the historical legacy and role of bioethics as a discourse for addressing anxieties about medicine
PMID: 12938717
ISSN: 0022-5045
CID: 75165

Hard questions in court culture and psychiatry on trial [Comment]

Belkin, Gary S
PMID: 12899465
ISSN: 0165-005x
CID: 75166

Self-restraint, self-examination: a historical perspective on restraints and ethics in psychiatry

Belkin, Gary S
PMID: 12045300
ISSN: 1075-2730
CID: 75167

Causation about what? Relevant to whom?: Linking psyche and society. A commentary on Nissim Mizrachi's "from causation to correlation." [Comment]

Belkin, G S
PMID: 11680479
ISSN: 0165-005x
CID: 75169