National Practice Standards For Mental Health Workforce: Ethical And Legal Considerations

Applying Diversity and Cultural Competence Standards

Question:

Discuss about the Construction And Interpretation Of Vignette.

• Codes of practice

The National Practice Standards for the Mental Health Workforce (2013) deals with several ethical and legal considerations like rights, responsibility, safety and privacy of mental health consumers. This law is applicable in all organizations and is exerted via working in unison with people, families and carers in the recovery model. In individual practice, the nursing professionals are concerned with meeting the diverse needs of the people while marinating an individual planning format[1].

• Discrimination

Mental health practitioner must deliver quality care to the mental health patients irrespective of class, ethnicity and religion. This concept is applied in all nursing organizations. For examples the mental health professionals must work with aboriginal and Torres Strait Islander people, families and communities via reducing their barriers to access the mental health facilities. On individual level, they must work in culturally competent manner and via improving social and emotional wellbeing¹.

• Dignity of risk

The organization is required to respect the service user’s dignity of risk as long as it not negatively harming the organizations’ duty of care obligation. At individual level, dignity of risk includes physical, psychological and financial harm.

• Duty of care

There are several aspects of duty of care like legal, professional, organizational, community and personal. At organizational level, organization must anticipate the risk of its employees and then subsequently take care to prevent those risks from harming them. At personal level, duty of care suggests individual’s own beliefs and values[2].

• Human rights

At organization level, human right in relation to mental health in Australia and overseas is focused on carers’ and consumers’ rights and thereby promoting equity, social justice and compassionate society. At individual level, the person who is mental health consumers must be aware of his or her right of availing comprehensive mental health and it is the right of the caregiver not to discriminate patients on basis or ethnicity (Australian aboriginal or Torres Strait Islander)[3].

• Informed consent

It is the legal rights of all adult individuals to give consent or to refuse medical treatment and same thing applies for the mental health service. All the organizations are compelled to take signed consent from the patient before initiating the treatment. When the person is unable to provide consent (not in normal state of mind), the organization is supposed take consent from the family members[4].

• Mandatory reporting

The mandatory requirement before proceeding on the mental health programs includes patient confidentiality, proper focus on the past conducts and lack of national consistency.

• Practice standards

National Practice Standards for Mental Health Service, Australia deals with knowledge, skills and attitudes that are expected for the professionals those who work to deliver quality mental health service. It also deals with the setting in which the mental health has been provided.

• Privacy, confidentiality and disclosure

According to the Nursing and Midwifery Board of Australia, nurses must treat the personal information of the patients obtained during professional capacity as private and confidential. At organisational level the registered nurse is required to sign consent from in this regards before resuming the theory. Any bridging of this ethical regulation might lead to termination of service[6].

• Policy frameworks

Duty of Care and Risk Management

Mental Health Policy Framework deals with the legal norms, best practise evidence, reporting and process requirement that all the health service providers are required to comply. This helps in ensuring consistent and effective provision for mental health service[7].

• Records management

The process of record management deals with preparation of checklist to keep the medical records[8].

• Rights and responsibilities of workers, employers and individuals accessing the service

The right of the workers is to equal care to all the patients while keeping respect to culture, dignity and values. The individuals who are accessing the service must trust the service providers and perform their instructions accordingly¹

• Specific mental health legislation and its impact on individual workers

According to the Mental Health Legislation New South Whales, “An authorized medical officer may refuse to admit a person to a mental health facility as a voluntary patient if the officer is not satisfied that the person is likely to benefit from care or treatment as a voluntary patient”- It creates confusion among the workers and this act is subjective and dependent on the understanding and comparative evaluation of a particular health care professional[9].

• Work role boundaries – responsibilities and limitations

There lies professional boundary of relationship between patient and nurse. Thus the urse becomes confused regarding to what extent they will involve with the patients and the limitation is the boundary of the involvement is not strict or defined. However, within the zone of helpfulness, nurses are required to provide optimised care[10].

• Work health and safety

Under work health and safety, mental health care professional are required to work in a culturally competent manner.

• Recovery

According to the Australian Government, Department of Health, “recovery is not synonymous with cure”. Recovery in case of mental health deals with retaining or gaining of hope while understanding one’s disabilities and abilities. It also deals with the internal conditions of a person like hope, social identity, engagement in active form of life, personal autonomy[11].

• Recovery oriented practice

The recovery oriented practise of Australian Government Department of Health always try to ensure that the health services related to mental health must be delivered in such a way that it supports the recovery mode of the consumers of mental health. The principles of recovery oriented practice are dependent on uniqueness of the individuals, the real choices, attitudes, rights, dignity, respect, partnership and communication of the consumers of mental health. The model also promotes continuous evaluation process of the applied therapy¹¹.

• Health promotion and prevention

Health promotion and prevention falls under the standard 12 of the national practise standard for the mental health workforce (2013) of Australian Government Department of Health.  According to this standard, mental health promotion is regarded as an integral pillar of all work related to mental health. Here the practitioners of mental health need to apply primary prevention principles along with the use of mental health promotion in order to provide quality care. The mental health practitioner must also value the establishment of resilience in groups, communities and individuals in order to reduce the negative impact of mental illness[12].

• Holistic approach

According to the Australian Government Department of Health, a holistic approach along with person-centred treatment and care is recommended to provide rehabilitation, psychological and recovery support to the mental health consumers. The core principles of holistic care deal with acknowledging people preferences along with centrality of the people with lived experience in order to support their own recovery model. This model also acknowledges several elements that modulate the well-being of an individual like cultural background, personal beliefs, education, employment, housing and physical health[13].

• Empowerment/disempowerment

Human Rights and Mental Health

Australian Government, Department of Health promotes empowering of the consumers of the mental health and their families through active participation and partnerships. It is a part of their recovery model designed in order to prevent further episodes of mental illness or monograph. It values the right of information of a person with mental illness and provide necessary in information so that he or she can participate in informed decision making[14].

• Access and equity

The concept of accept and equity is extremely significant in case of providing quality mental health care to the Australian aboriginals and Torres Strait Islander. According to the Australian Human Rights Commission, human right based approach is required to be undertaken via the access and equity strategy while acknowledging the importance of non-discrimination, participation, equality and inclusion. Such that the accessibility of the issues experienced by the aboriginals and Torres Strait Islander peoples while availing comprehensive mental health care must be taken into consideration[15].

• Early intervention

The early intervention and prevention of mental health complications have been stringently framed by the Australian Government, Department of Health for young people and children because as per the national mental health reform (2011-12), childhood is the best time to prevent the susceptibility of mental disorders. The main values of the early interventions is to generate awareness among the school and the early childhood services in order to remove the burden of the suicide case among young Australians arising (especially men) due to untreated mental illness[16].

• Rights

The mental health statement of rights and responsibilities tries to make sure that the carers, consumers, service providers and the members of the community are aware of the of the existing and relevant rights of responsibilities framed by the Australian Government under the domain of mental health. Such awareness will help make them confident in exercising their own rights. According to the mental health right, all the Australians are expected to receive high-quality and safe health-care in a timely manner. Moreover, the mental health consumers deserve the right of individualised care planning, support and treatment[17].

• Social justice and inclusion

People with mental illness should be able to enjoy same economical, social and educational opportunities just like anyone else. Australian Government, Department of Health has highlighted education, housing, transport, employment, income and health care are the main social determinants of health[18].

• Citizenship

Citizenship is defined to highlight a person’s strong connection with the 5 Rs (rights), roles, responsibilities, resources, rights and relationships. However, according to the latest report published in The Guardian, people may be denied Australian citizenship or may have their citizenship revoked over drug abuse and mental illness[19].

Historical, current and emerging models of understanding mental illness in Australia and internationally

Government of South Australia has initiated research on evidence-based recovery of mental health problems. Such research mostly centers ON the individuals unique and personal journey towards the mental wellness program[20]. According to the National Health and Medical Research Council (NHMRC), evidence is important however, nor adequate in framing recommendations for the treatment. Examining the evidence on the basis of criteria of quality, level, relevance and strength and then moving it into clinically significant recommendations is inclined on the experience and judgment of the expert clinicians whose role is to design treatment guidelines[21].

Consent and Confidentiality

There are several mental health programs designed by the Department of Health, Australia two of the notable ones among them are Australian Child and Adolescent Trauma and Grief Network and Better Success to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule[22].

The mental health services in Australia offers several services to the people who are suffering from mental complications like: Mental Health Support Services, Psychiatric Disability Support Services, specialist Homelessness Services, Specialist Homelessness Services, Personal Helpers and Mentors and Access to Allied Psychological Services[23].

Mental Health Australia, the registered charity under government of Australia provides numerous supports to the people who are suffering from mental health complications. They helpline numbers in order to increase the mental health awareness among people like depression, reduction in stigma and anxiety[24].

Strength-based approach on mental help enables the health care professionals to acknowledge that every person has unique mode of strength and abilities so that she or he and depend on it to overcome the problem. These kinds of approaches encourage individual to cultivate their identity, interests while building their own strengths in order to pursue their goals[25].

Reflective practise helps in the promotions of authentic engagement and thereby building mutually respectful and collaborative relationships. Such collaborative relationships help in the upliftment of partnership-based relationships with the people who are suffering from mental health and also help them to lead their lives in a way they want. The reflective relationship varies from person to person and thus it an ongoing process and is regarded as a good practise in the domain of mental health[26].

• Active listening, Attending skills, use of body language, non-verbal communication

Active listening in mental health helps in the development of therapeutic relationships between the service users and providers. In order to listen actively the concerns and the thoughts of the people with mental illness, one needs to keep their mid focused and stay attentive[27]. They are also need to work on their body language application of non-verbal communication as these help in setting the expectations from the very beginning. However, non-verbal communication do not have same meaning for all culture and people and this needs to be understood by the mediator in case the client is using non-verbal communication to express their feelings[28].

• Paraphrasing, Reflecting feelings

Paraphrasing and reflective feelings belong to the art of listening, which is: making sure that the client knows that their story is being listened attentively. Importance of paraphrasing is, it helps in the generation of connection here the counselor needs to repeat back certain part of the client story in their story in order to make the client feel that they have actually listened and gave importance to their story.  Reflecting is showing the client that the counselor has not only “hard” the story of the client has feels for them and this help in the generation of sympathy and the client feels loved and generates a sense of security.

• Open and closed questioning or probing

Open ended questions have no options while close-ended questions have options like “yes”/ “No”/ “May be”. Such probing helps in the critical identification of the client’s dilemma and his or her state of mind[29].

• Summarising, Reframing, Exploring options

Record Management and Policy Framework

Summarising, Reframing and exploring emphasize on the importance of collating the main points of the conversation raised by the client before conducting the next round of counseling. It also helps in the restatement of the ideas into positive terms or in a non-judgmental way[30].

• Normalising statements

People at times find it difficult to volunteer certain information related to their problem if they are embarrassed about it. One approach of reassuring patient is use of normalising statement. Such normalization will assure that they are not the only person who has experienced this issue[31].

References

Access And Equity: Inquiry Into The Responsiveness Of Australian Government Services To Australia’S Culturally And Linguistically Diverse Population | Australian Human Rights Commission”. 2018. Humanrights.Gov.Au. https://www.humanrights.gov.au/access-and-equity-inquiry-responsiveness-australian-government-services-australia-s-culturally-and.

Department Of Health | Administrative Record Keeping Guidelines For Health Professionals”. 2016. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/content/admin-record-keeping-guide.

Department Of Health | Early Intervention And Prevention, And Mental Health Services For Children And Youngpeople”. 2011. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/nmhr11-12~nmhr11-12-challenges~earlyintervention.

“Need Help?”. 2017. Mental Health Australia. https://mhaustralia.org/need-help.

A Nurse’S Guide To Professional Boundaries. 2010. Ebook. Melbourne: Nursing and Midwifery Board of Australia.

Bodie, Graham D., Andrea J. Vickery, Kaitlin Cannava, and Susanne M. Jones. “The role of “active listening” in informal helping conversations: Impact on perceptions of listener helpfulness, sensitivity, and supportiveness and discloser emotional improvement.” Western Journal of Communication79, no. 2 (2015): 151-173.

Department Of Health | 6.1 Duty Of Care Issues”. 2004. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-wk-toc~drugtreat-pubs-front11-wk-secb~drugtreat-pubs-front11-wk-secb-6~drugtreat-pubs-front11-wk-secb-6-1.

Department Of Health | Capability 2A: Holistic And Person-Centred Treatment, Care, Rehabilitation And Psychosocial And Other Recovery Support”. 2018. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-2~mental-pubs-n-recovgde-app-2-a.

Department Of Health | Capability 3C: Collaborative Relationships And Reflective Practice”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-3~mental-pubs-n-recovgde-app-3-c.

Department Of Health | Capability 5A: Supporting Social Inclusion And Advocacy On Social Determinants”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-5~mental-pubs-n-recovgde-app-5-a.

Department Of Health | Empowering Consumers And Their Families And Carers Through Participation And Partnerships”. 2006. Health.Gov.Au. https://health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-p-mono-toc~mental-pubs-p-mono-inc~mental-pubs-p-mono-inc-emp.

Department Of Health | Mental Health Programs”. 2015. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/content/mental-progs.

Department Of Health | Principles Of Recovery Oriented Mental Health Practice”. 2017. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri.

Department Of Health | Standard 12: Health Promotion And Prevention”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-wkstd13-toc~mental-pubs-n-wkstd13-3~mental-pubs-n-wkstd13-3-12.

Evidence-Based Psychological Interventions In The Treatment Of Mental Disorders: A Literature Review. 2017. Ebook. 3rd ed. The Australian Psychological Society. https://Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review.

Fernando, Sunera. “Communication skills and counselling.” Sri Lanka Journal of Obstetrics and Gynaecology 34, no. 2 (2012).

Hughes, Rhidian, and Meg Huby. “The construction and interpretation of vignettes in social research.” Social Work and Social Sciences Review 11, no. 1 (2012): 36-51.

Human Rights”. 2015. Mental Health Australia. https://mhaustralia.org/tags/human-rights.

Informed Consent To Medical Treatment | ALRC”. 2015. Alrc.Gov.Au. https://www.alrc.gov.au/publications/10-review-state-and-territory-legislation/informed-consent-medical-treatment.

Lüllmann, Eva, and Tania M. Lincoln. “The effect of an educating versus normalizing approach on treatment motivation in patients presenting with delusions: An experimental investigation with analogue patients.” Schizophrenia research and treatment 2013 (2013).

Mandatory Reporting Under The Health Practitioner Regulation National Law”. 2017. Http://Www.Health.Nsw.Gov.Au. https://Mandatory reporting under the Health Practitioner Regulation National Law.

Medhora, Shalailah. 2014. “Mental Illness May Be Used To Deny Australian Citizenship Under New Bill”. The Guardian. https://www.theguardian.com/australia-news/2014/nov/25/mental-health-may-be-used-to-deny-australian-citizenship-under-new-bill.

Mental Health Policy Framework”. 2018. Health.Wa.Gov.Au. https://www.health.wa.gov.au/circularsnew/frameworks/Mental_Health.pdf.

Mental Health Statement of rights and responsibilities. 2012. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/Content/E39137B3C170F93ECA257CBC007CFC8C/$File/rights2.pdf

Mental Health Support Services”. 2016. Mhsa.Aihw.Gov.Au. https://mhsa.aihw.gov.au/support/.

National Practice Standards For The Mental Health Workforce. 2013. Ebook. Melbourne: National Mental Health Strategy.  https://www.health.gov.au/internet/main/publishing.nsf/Content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf

Professional Boundaries and Recovery-oriented Practice

Nursing And Midwifery Board Of Australia – Home”. 2017. Nursingmidwiferyboard.Gov.Au. https://www.nursingmidwiferyboard.gov.au/.

Pawlikowska, Teresa, Wenjuan Zhang, Frances Griffiths, Jan van Dalen, and Cees van der Vleuten. “Verbal and non-verbal behavior of doctors and patients in primary care consultations–How this relates to patient enablement.” Patient education and counseling 86, no. 1 (2012): 70-76.

The Framework For Recovery-Oriented Rehabilitation In Mental Health Care, Mental Health & Substance Abuse Division. 2018. Ebook. 1st ed. Adelaide: Government of South Australia. https://www.sahealth.sa.gov.au/wps/wcm/connect/c17e5f804eb00bcaac5aeee39488de5b/Rehab+Recovery+Framework-mental+health-20130108.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-c17e5f804eb00bcaac5aeee39488de5b-lITywZA.

Xie, Huiting. “Strengths-based approach for mental health recovery.” Iranian journal of psychiatry and behavioral sciences 7, no. 2 (2013): 5.

[1] National Practice Standards For The Mental Health Workforce. 2013. Ebook. Melbourne: National Mental Health Strategy.  https://www.health.gov.au/internet/main/publishing.nsf/Content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf

[2] Department Of Health | 6.1 Duty Of Care Issues”. 2004. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-wk-toc~drugtreat-pubs-front11-wk-secb~drugtreat-pubs-front11-wk-secb-6~drugtreat-pubs-front11-wk-secb-6-1.

[3] Human Rights”. 2015. Mental Health Australia. https://mhaustralia.org/tags/human-rights.

[4] Informed Consent To Medical Treatment | ALRC”. 2015. Alrc.Gov.Au. https://www.alrc.gov.au/publications/10-review-state-and-territory-legislation/informed-consent-medical-treatment.

[5] Mandatory Reporting Under The Health Practitioner Regulation National Law”. 2017. Http://Www.Health.Nsw.Gov.Au. https://Mandatory reporting under the Health Practitioner Regulation National Law

[6] Nursing And Midwifery Board Of Australia – Home”. 2017. Nursingmidwiferyboard.Gov.Au. https://www.nursingmidwiferyboard.gov.au/.

[7] Mental Health Policy Framework”. 2018. Health.Wa.Gov.Au. https://www.health.wa.gov.au/circularsnew/frameworks/Mental_Health.pdf.

[8] Department Of Health | Administrative Record Keeping Guidelines For Health Professionals”. 2016. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/content/admin-record-keeping-guide.

[9]NSW Legislation”. 2008. Legislation.Nsw.Gov.Au. https://www.legislation.nsw.gov.au/#/view/act/2007/8/chap2/sec5.

[10] A Nurse’S Guide To Professional Boundaries. 2010. Ebook. Melbourne: Nursing and Midwifery Board of Australia.

[11] Department Of Health | Principles Of Recovery Oriented Mental Health Practice”. 2017. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri.

[12] Department Of Health | Standard 12: Health Promotion And Prevention”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-wkstd13-toc~mental-pubs-n-wkstd13-3~mental-pubs-n-wkstd13-3-12.

[13] Department Of Health | Capability 2A: Holistic And Person-Centred Treatment, Care, Rehabilitation And Psychosocial And Other Recovery Support”. 2018. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-2~mental-pubs-n-recovgde-app-2-a.

[14] Department Of Health | Empowering Consumers And Their Families And Carers Through Participation And Partnerships”. 2006. Health.Gov.Au. https://health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-p-mono-toc~mental-pubs-p-mono-inc~mental-pubs-p-mono-inc-emp.

[15] Access And Equity: Inquiry Into The Responsiveness Of Australian Government Services To Australia’S Culturally And Linguistically Diverse Population | Australian Human Rights Commission”. 2018. Humanrights.Gov.Au. https://www.humanrights.gov.au/access-and-equity-inquiry-responsiveness-australian-government-services-australia-s-culturally-and.

[16] Department Of Health | Early Intervention And Prevention, And Mental Health Services For Children And Youngpeople”. 2011. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/nmhr11-12~nmhr11-12-challenges~earlyintervention.

[17] Mental Health Statement of rights and responsibilities. 2012. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/Content/E39137B3C170F93ECA257CBC007CFC8C/$File/rights2.pdf

[18] Department Of Health | Capability 5A: Supporting Social Inclusion And Advocacy On Social Determinants”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-5~mental-pubs-n-recovgde-app-5-a.

[19] Medhora, Shalailah. 2014. “Mental Illness May Be Used To Deny Australian Citizenship Under New Bill”. The Guardian. https://www.theguardian.com/australia-news/2014/nov/25/mental-health-may-be-used-to-deny-australian-citizenship-under-new-bill.

[20]The Framework For Recovery-Oriented Rehabilitation In Mental Health Care, Mental Health & Substance Abuse Division. 2018. Ebook. 1st ed. Adelaide: Government of South Australia. https://www.sahealth.sa.gov.au/wps/wcm/connect/c17e5f804eb00bcaac5aeee39488de5b/Rehab+Recovery+Framework-mental+health-20130108.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-c17e5f804eb00bcaac5aeee39488de5b-lITywZA.

[21] Evidence-Based Psychological Interventions In The Treatment Of Mental Disorders: A Literature Review. 2017. Ebook. 3rd ed. The Australian Psychological Society. https://Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review.

[22] Department Of Health | Mental Health Programs”. 2015. Health.Gov.Au. https://www.health.gov.au/internet/main/publishing.nsf/content/mental-progs.

[23] Mental Health Support Services”. 2016. Mhsa.Aihw.Gov.Au. https://mhsa.aihw.gov.au/support/.

[24] “Need Help?”. 2017. Mental Health Australia. https://mhaustralia.org/need-help.

[25] Xie, Huiting. “Strengths-based approach for mental health recovery.” Iranian journal of psychiatry and behavioral sciences 7, no. 2 (2013): 5.

[26] Department Of Health | Capability 3C: Collaborative Relationships And Reflective Practice”. 2013. Health.Gov.Au. https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-recovgde-toc~mental-pubs-n-recovgde-app~mental-pubs-n-recovgde-app-3~mental-pubs-n-recovgde-app-3-c.

[27] Bodie, Graham D., Andrea J. Vickery, Kaitlin Cannava, and Susanne M. Jones. “The role of “active listening” in informal helping conversations: Impact on perceptions of listener helpfulness, sensitivity, and supportiveness and discloser emotional improvement.” Western Journal of Communication79, no. 2 (2015): 151-173.

[28] Pawlikowska, Teresa, Wenjuan Zhang, Frances Griffiths, Jan van Dalen, and Cees van der Vleuten. “Verbal and non-verbal behavior of doctors and patients in primary care consultations–How this relates to patient enablement.” Patient education and counseling 86, no. 1 (2012): 70-76.

[29] Hughes, Rhidian, and Meg Huby. “The construction and interpretation of vignettes in social research.” Social Work and Social Sciences Review 11, no. 1 (2012): 36-51.

[30] Fernando, Sunera. “Communication skills and counselling.” Sri Lanka Journal of Obstetrics and Gynaecology 34, no. 2 (2012).

[31] Lüllmann, Eva, and Tania M. Lincoln. “The effect of an educating versus normalizing approach on treatment motivation in patients presenting with delusions: An experimental investigation with analogue patients.” Schizophrenia research and treatment 2013 (2013).