Search

Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals' judgments of stigma, empathy, and compassion. We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, empathy, and compassion. Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others. [ABSTRACT FROM AUTHOR]

Researchers and advocates have argued that people living with severe mental illnesses are a vulnerable group and should be prioritized for COVID-19 vaccines. People living with severe mental illnesses, including substance use disorders, bear an elevated burden of intersecting risk factors related to the social determinants of health and medical comorbidities leading to greater COVID-19 morbidity and mortality. This increased risk is based on several intersecting factors, including the likelihood of living in unstable and crowded living conditions such as shelters, group homes, or institutions; unsafe working conditions; high rate of comorbidities; and marginalization and stigmatization. Nonetheless, many of the initial iterations of vaccine allocation frameworks internationally did not prioritize people living with severe mental illnesses. Moreover, people with severe mental illness who are long-stay inpatients in psychiatric institutions were left off of vaccine priority setting lists that included long-term care facilities and other congregate settings. In this commentary, we question why people living with severe mental illnesses -- particularly those who are institutionalized -- were not initially considered a priority for vaccine access given the supposed vulnerability. We describe how people are made vulnerable by intersecting aspects of systematic disadvantage such as stigma, poverty, and racism. We suggest that the lack of attention given to intersectional factors in vaccine prioritization compromises health equity for people living with mental health and substance use disorders. We end the commentary by suggesting how vaccine distribution and allocation could be more equitable by including people with lived experience of mental illness in designing and implementing vaccination strategies. Understanding how people with mental illnesses have experienced structural vulnerability and intersecting risk factors throughout the pandemic can help inform the creation of effective and ethical vaccine-related responses to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers' perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the introduction and acceptability of MAiD MI-SUMC; this study aimed to fill this gap. Thirty adults, residing in Ontario, Canada, who self-identified as living with mental illness participated. A semi-structured interview including a persona-scenario exercise was designed to discuss participants' views on MAiD MI-SUMC and when it could be acceptable or not. Reflexive thematic analysis was used to inductively analyze data. Codes and themes were developed after extensive familiarization with the dataset. A lived-experience advisory group was engaged throughout the study. We identified six themes: The certainty of suffering ; Is there a suffering threshold to be met? The uncertainty of mental illness ; My own limits, values, and decisions ; MAiD MI- SUMC as acceptable when therapeutic means, and other supports, have been tried to alleviate long-term suffering ; and Between relief and rejection. These themes underline how the participants' lived experience comprised negative impacts caused by long-term mental illness, stigma, and in some cases, socioeconomic factors. The need for therapeutic and non-therapeutic supports was highlighted, along with unresolved tensions about the links between mental illness, capacity, and suicidality. Although not all participants viewed MAiD MI-SUMC as acceptable for mental illness, they autonomously embraced limits, values, and decisions of their own along their search for relief. Identifying individual and contextual elements in each person's experience of illness and suffering is necessary to understand diverse perspectives on MAiD MI-SUMC. • People with lived experience discuss medical assistance in dying in mental illness. • Suffering elicited by mental illness can only be understood by those living with it. • Contextual and social elements that can exacerbate suffering are identified. • Healthcare decisions are viewed as built on individual limits and values. • Medical assistance in dying can be acceptable under specific circumstances. [ABSTRACT FROM AUTHOR]