Ethical Governance and Legal Accountability in Mental Health and Psychiatric Nursing: Challenges for Professional Practice

Abstract

Mental health and psychiatric nursing is a complicated professional practice arena in which ethical governance and legal accountability are vital to the safety of patients, nurses, families and health care organisations. Psychiatric nurses routinely care for patients whose decision-making ability may be impaired by mental illness and face difficult issues of autonomy, informed consent, confidentiality, privacy, involuntary treatment, restraint, seclusion, and the duty to protect patients and others from harm. Ethical governance provides a framework for ensuring that therapeutic judgements are guided by the values of autonomy, beneficence, non-maleficence, justice, dignity and respect for human rights and legal accountability establishes criteria against which professional conduct can be judged. Psychiatric nurses, however, are working in increasingly complex environments, with staff shortages, limited mental health resources, over-crowded facilities, stigma, changing legislation, conflicts of professional roles, technological developments and balancing patient rights with public safety. These issues are further worsened in many low- and middle-income countries including Nigeria by inadequate specialist services, restricted access to legal and ethical guidance and gaps between mental health legislation and clinical practice. This article explores the relationship between ethical governance and legal accountability in mental health and psychiatric nursing, discusses the major challenges to the profession, and offers strategies to enhance ethical decision-making, professional accountability, human rights, continuing education, institutional governance and multidisciplinary collaboration. Ethical and legal structures must be strengthened for safe, compassionate, equitable, and rights-based psychiatric nursing practice