IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

{"title":"Is feeling left out? The role of emotion in decision-making and capacity.","authors":"Norella Broderick","doi":"10.1017/ipm.2026.10176","DOIUrl":"10.1017/ipm.2026.10176","url":null,"abstract":"<p><strong>Background: </strong>The introduction of the Assisted Decision Making (Capacity) Act in Ireland and developments in capacity law elsewhere prompt further consideration of our understanding of capacity and how we assess it.</p><p><strong>Methods: </strong>This is a perspective piece on the role of emotion in the decision-making process, and how this impacts on our understanding of capacity. Both normal and pathological emotional states are reviewed in terms of their influence on decision-making. Capacity assessments are then considered, and whether sufficient account is taken of emotions here.</p><p><strong>Results: </strong>The paper considers whether we need to change the legal test for capacity to take sufficient account of emotions, based on the foregoing discussion.</p><p><strong>Conclusion: </strong>Finally the paper makes recommendations for supporting capacity in light of our knowledge of the impact of emptions on decision-making.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"391-397"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health advance planning documents: complexities and considerations.","authors":"Alexander Ruck Keene","doi":"10.1017/ipm.2025.10137","DOIUrl":"10.1017/ipm.2025.10137","url":null,"abstract":"<p><p>This article addresses the questions of when mental health advance planning documents are created, the points when circumstances which they are intended to address arise and what consequences should flow when such a situation does arise. It addresses these points primarily from the perspective of what the law could/should be at a conceptual level. It looks at three stages: (a) creation of the document; (b) the period between the creation of the document and the point at which the intended circumstances arise; and (c) the point at which the intended circumstances arise. It does not purport to provide solutions at each stage, but rather to frame the dilemmas to aid discussion. In similar vein, it draws upon case studies from England & Wales, not to purport to dictate similarities of approach, but to flesh out dilemmas that have arisen to stimulate consideration.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"349-353"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insight and involuntary care.","authors":"Colm McDonald","doi":"10.1017/ipm.2025.10119","DOIUrl":"10.1017/ipm.2025.10119","url":null,"abstract":"<p><p>Impaired insight is a regularly documented clinical observation in patients undergoing involuntary care, but is easily misunderstood since it refers to different phenomena depending on the context. Within the context of psychotic illness, which comprises the majority of involuntary care, it is more accurately portrayed as unawareness of illness which intersects with the element of capacity related to the ability to appreciate information and weigh it up to make a judgement. Psychotic disorders associated with persistent unawareness of illness are negatively associated with illness outcome and attitudes towards clinical services. There is some evidence that metacognitive therapy can improve insight, but compassionate care which seeks to enhance therapeutic alliance more commonly engages such patients in successful recovery. When insight is substantially impaired, the apparent will and the stated preferences of patients often diverge, in which case involuntary care should not be considered \"against the will,\" but more accurately \"without the consent\" of the patient.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"386-390"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulysses looks back: a case report on the experience of using a mental health self-binding directive.","authors":"Lucy Stephenson, Matthé Scholten, Nuala Kane, Gareth Owen","doi":"10.1017/ipm.2025.10147","DOIUrl":"10.1017/ipm.2025.10147","url":null,"abstract":"<p><p>A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter 'bipolar') who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"333-342"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'The case for a pro-active approach to advance care planning in older person's mental health - insights from interdisciplinary mental healthcare professionals.","authors":"Jennifer Allen, Sarah Donnelly, Sarah Morton, Sinéad Murphy","doi":"10.1017/ipm.2026.10217","DOIUrl":"https://doi.org/10.1017/ipm.2026.10217","url":null,"abstract":"<p><strong>Introduction: </strong>Advance care planning (ACP) involves nuanced conversations to elicit an individual's beliefs, values, and preferences regarding future care. However, despite recognition of the positive impact, representative population surveys indicate low uptake of ACP, figures replicated internationally. Complex medical issues, including cognitive impairment, can interact with and exacerbate mental health challenges in later life, which can make decision-making more complex. ACP and Advance Healthcare Directives support people during periods of incapacitating mental illness. This paper reporting on the first stage of an action research study exploring ACP from the perspective of interdisciplinary mental healthcare professionals in the context of Older Person's Mental Health, took place in the dawn of the Assisted Decision-Making Capacity Act (2015), which has considerable implications for practice.</p><p><strong>Methods: </strong>The first action research stage consisted of three sub-stages combining quantitative and qualitative methods, with the findings of each sub-stage iteratively informing the development of the next.</p><p><strong>Results: </strong>The results of the study indicate that whilst overall ACP is largely viewed as positive by healthcare professionals, confidence, and experience levels vary in practice, with a strong desire for additional specific training and tools to support ACP engagement indicated. The study also revealed facilitators and barriers to ACP; and addressing existential anxiety, giving voice, person-centred approach, and push and pull factor themes.</p><p><strong>Conclusion: </strong>This study highlights some important implications for person-centred practice centring on the need to balance an active stance to ACP whilst also respecting the right not to engage for varying psychological and emotional reasons.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":"43 3","pages":"268-276"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance healthcare directives in psychiatry in Ireland: legal provisions, clinical challenges, and ethical issues in relation to self-harm and suicide.","authors":"Brendan D Kelly","doi":"10.1017/ipm.2025.6","DOIUrl":"10.1017/ipm.2025.6","url":null,"abstract":"<p><strong>Objectives: </strong>To explore current and potential upcoming legal provisions concerning advance healthcare directives in psychiatry in Ireland, with particular focus on clinical challenges and ethical issues (e.g., self-harm, suicide).</p><p><strong>Methods: </strong>Review and analysis of selected relevant sections of the Assisted Decision-Making (Capacity) Act 2015, Assisted Decision-Making (Capacity) (Amendment) Act 2022, Mental Health Act 2001, Mental Health Bill 2024, and Criminal Law (Suicide) Act 1993, and relevant publications from Ireland's Medical Council and Decision Support Service.</p><p><strong>Results: </strong>The Assisted Decision-Making (Capacity) Act 2015 outlined new procedures for advance healthcare directives. The Assisted Decision-Making (Capacity) (Amendment) Act 2022 specified that advance healthcare directives relating to mental health are binding for involuntary patients unless involuntary status is based on Section 3(1)(a) of the Mental Health Act 2001 (i.e., the 'risk' criteria). The Mental Health Bill 2024 proposes making advance healthcare directives binding for all involuntary patients. In relation to suicide and self-harm, the Criminal Law (Suicide) Act 1993 states that 'a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence', and the Decision Support Service advises that healthcare professionals are exempted from criminal liability if complying with a valid and applicable advance healthcare directive that refuses life-sustaining treatment, even where the directive-maker has attempted suicide.</p><p><strong>Conclusions: </strong>Considerable public and professional education are needed if advance healthcare directives are to be widely used. The ethical dimensions of certain advance directives require additional thought and, ideally, professional ethical guidance.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"343-348"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer workers as facilitators of psychiatric advance directives: a mixed-methods study on recovery.","authors":"Saphir Desvignes, Aster Harrison, Frédéric Mougeot, Mohamed Boucekine, Sandrine Loubière, Pascal Auquier, Aurélie Tinland","doi":"10.1017/ipm.2025.10116","DOIUrl":"10.1017/ipm.2025.10116","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether and how drafting psychiatric advance directives (PADs) with the support of a peer worker improves recovery outcomes for individuals with severe mental illness.</p><p><strong>Methods: </strong>A mixed-methods design was employed, combining quantitative data from a randomized trial with qualitative interviews. The trial included adults with schizophrenia, bipolar I disorder, or schizoaffective disorder who had experienced involuntary hospitalization in the past year. Participants either completed PADs with peer worker support or without specific facilitation. Recovery was assessed longitudinally using the Recovery Assessment Scale. Thematic analysis of interviews explored mechanisms underpinning the effectiveness of peer facilitation.</p><p><strong>Results: </strong>A total of 118 participants completed PADs, 84 with peer support. Mixed-effects regression analysis revealed significantly higher recovery scores for those supported by peer workers (coefficient = 4.77, <i>p</i> = 0.03). Qualitative findings highlighted two key mechanisms: peer workers' boundary role fostering trust and relational symmetry and their facilitation practices promoting critical reflexivity and addressing past psychiatric trauma. Participants emphasized the flexibility and empathy of peer workers, which enabled deeper reflection and empowerment.</p><p><strong>Conclusions: </strong>Peer facilitation enhances the drafting of PADs, significantly contributing to recovery through trust, critical reflection, and trauma-informed approaches. These findings support the integration of peer workers into PAD frameworks and emphasize the need for tailored training and systemic reforms to maximize their impact.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"292-302"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"People, process, and power: implementing advance choice documents for Black people in mental healthcare.","authors":"Abigail Babatunde, Jonathan Simpson, Steve Gilbert, Alan Simpson, Lucy Stephenson, Gareth Owen, Kia-Chong Chua, Alex Ruck Keene, Shubulade Smith, Claire Henderson","doi":"10.1017/ipm.2025.11","DOIUrl":"10.1017/ipm.2025.11","url":null,"abstract":"<p><strong>Objectives: </strong>Advance Choice Documents (ACDs) have been recommended for inclusion in new mental health legislation for England and Wales based on evidence they reduce compulsory psychiatric admission, with particular benefit for Black people. As Black people disproportionately experience compulsory psychiatric admission in the UK, our aim was to explore potential barriers and enablers to effective ACD implementation for Black people with previous experience of compulsory admission.</p><p><strong>Methods: </strong>Six stakeholder workshops and one consensus workshop were held with: Black service users who had previously been involuntarily admitted, carers/supporters of Black service users, and mental health staff. Thematic analysis was conducted on workshop transcripts.</p><p><strong>Results: </strong>Participants were service users (<i>n</i> = 13), carers/supporters (<i>n</i> = 7), service users and carers/supporters (<i>n</i> = 3), and staff (<i>n</i> = 18). Thematic analysis identified themes of 'training', 'completion', 'access', and 'use' concerning ACD implementation. Stakeholders highlighted the importance of understanding the racialised experience of Black service users for effective ACD implementation. Strong communication between and amongst stakeholders and helpful systems for access were also emphasised. Stakeholders also recommended joint training and independent facilitation of ACDs to address Black service user-staff power imbalances.</p><p><strong>Conclusions: </strong>Known enablers and barriers to ACD implementation are important when considering ACDs for Black people, as is explicitly engaging with their experiences holistically, including racialised historical and individual experiences that underline some treatment preferences. Independent facilitation and shifts in service user-staff power dynamics present as key to realising the potential of ACDs to empower Black service users in relation to their care, and in turn to potentially reduce coercive care.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"303-313"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of attitudes and knowledge about advance healthcare directives amongst inpatient psychiatry service users in Ireland.","authors":"Maria Redahan, Catherine Rock, Michal Grudzien, Brendan Kelly","doi":"10.1017/ipm.2025.26","DOIUrl":"10.1017/ipm.2025.26","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland.</p><p><strong>Methods: </strong>A survey was completed among adult inpatient psychiatry service users (<i>n</i> = 47) in Tallaght University Hospital, Dublin.</p><p><strong>Results: </strong>Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked 'if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?', over two thirds responded either 'definitely yes' (34%) or 'probably yes' (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%).</p><p><strong>Conclusions: </strong>There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"254-260"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance healthcare directives - their importance within Irish health services: the lived experience perspective of a service user, advocate, and campaigner.","authors":"Rosy Wilson","doi":"10.1017/ipm.2025.10094","DOIUrl":"10.1017/ipm.2025.10094","url":null,"abstract":"","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"251-253"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}