Patient and Caregiver Perspectives on Ethical Issues in Mental Health Care: an Exploratory Study from India

Ethical viewpoints about the correct course of action in a clinical situation can vary across individuals. The views of patients and their caregivers are also important considerations while exploring solutions to ethical dilemmas. This study aimed to ascertain the perspectives of patients and caregivers on ethical issues in mental health care. This vignette-based study included patients with psychiatric disorders and their caregivers. Patients were included if they were in clinical remission determined by psychiatric rating scales. Caregivers were included if they resided with the patient for the last 1 year. Both patients and caregivers were in the adult age group. The vignettes pertained to confidentiality and coercive care and elicited a yes or no type of responses. Ten short vignettes were presented to the patient caregiver dyad. The types of responses and agreement between the patients and their caregivers were assessed. Responses were available from 160 dyads of patients and their caregivers. The mean age of the patients was 35.6 years while that of the caregivers was 40.5 years. A slight majority of the patients and caregivers were males and were educated above high school. There was considerable variation in the views about correct course in a particular clinical situation. The responses from patients and caregivers endorsing disclosure of confidential information or coercive treatment varied from about 50% to more than 90% depending upon the clinical situation. The responses of patients generally had a fair agreement with responses of the caregivers (kappa values largely between 0.21 and 0.40). Viewpoints of patients and their caregivers provide an important stakeholder insight in approach to resolving ethical dilemmas. In the present cultural context, patients and caregivers were amenable to disclosure of confidential information in for a variety of clinical situations.