Epistemic injustice and the mental health service user.

Source: (2010) International Journal of Mental Health Nursing. 19(3): 151-153.

John Rawles (2004, p. 230) famously asserted that ‘Justice
is the first virtue of social institutions, as truth is of systems
of thought’. Truth and justice, he argued, are not to be
compromised, and laws and institutions must be abolished
or reformed if found to be unjust. Nevertheless,
justice tends not to be the first principle of appeal or
consideration in ethical deliberations in mental health
care. For example, breaching people’s autonomy through
involuntary or coercive treatment, or containment
through the use of practices, such as seclusion (reviewed
by Happell in this edition), are common but profoundly
ethical problems within mental health services. Such
practices are typically justified with reference to the principle
of beneficence, that they are in the person’s best
interests, and/or non-intervention would lead to harm to
the individual or others. Justice does not typically enter
the equation, except in the sense of ‘procedural justice’,
that is, ensuring that people are seen to be dealt with
fairly by having access to second opinions, timely reviews,
and otherwise competent treatment. There are, however,
other important conceptions of justice that are at least as
relevant to mental health service provision. (Excerpt).