Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.
Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany.
BMC Med Ethics. 2023 May 15;24(1):31. doi: 10.1186/s12910-023-00910-3.
Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability.
We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability.
Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics.
Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability.
在关于 COVID-19 大流行负担的争论中，精神卫生保健使用者和患者被描述为一个特别脆弱的群体。这意味着什么以及可以从中得出哪些规范结论在很大程度上取决于脆弱性的基本概念。虽然传统的理解将脆弱性定位在社会群体的特征上，但情境和动态的方法则考虑社会结构如何产生脆弱的社会地位。在 COVID-19 大流行期间，不同心理社会环境中的使用者和患者的情况尚未根据情境脆弱性方面进行全面考虑和伦理分析。
我们展示了对德国一家大型地区精神卫生保健机构不同精神卫生保健设施中伦理挑战调查的回顾性定性分析的结果。我们使用动态和情境脆弱性理解对其进行伦理评估。
在不同的精神卫生保健环境中，实施感染预防措施存在困难，为了感染预防而限制精神卫生服务，社会隔离，对精神卫生保健使用者和患者的健康产生负面影响，以及在当地特定情况下实施国家和提供者层面的法规存在挑战，这些都是伦理上突出的问题。
应用情境和动态的脆弱性理解可以确定导致精神卫生保健使用者和患者的背景相关脆弱性增加的具体因素和条件。应在国家和地方法规层面考虑这些因素和条件，以减少和解决脆弱性。
