Abuse among rural mentally ill.

Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, and allocations of financial resources. The right to autonomous decision making is not limited to young or middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ill, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion. Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).