Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

University of Pennsylvania Department of Medical Ethics and Health Policy

The ScattergoodEthics Program is dedicated to education, research, and resource development for the field of psychiatric, mental, and behavioral healthcare ethics. The program engages in scholarly research, trains and educates clinicians and scholars in mental and behavioral healthcare ethics, sponsors programs and public events, and promotes and advocates for greater attention to the ethical dimensions of diagnosis and treatment.  The ScattergoodEthics Program is funded by a grant from the Thomas Scattergood Behavioral Health Foundation and the Dean’s Office of the University of Pennsylvania School of Medicine.

Dominic A. Sisti, Ph.D


Date Project Title
07/2007 to 06/2013 Scattergood Ethics
06/2013 to 05/2019 Scattergood Program for the Applied Ethics of Behavioral Healthcare


Penn Ethicist Proposes New Category for Psychiatric Patients to Justify Instances of Compulsory Treatment

“Nonvoluntary treatment,” would distinguish psychiatric patients who refuse help but likely would have accepted it in a healthy state of mind from the traditional “involuntary treatment”   August 24, 2017   PHILADELPHIA — The “involuntary treatment” of unwilling psychiatric patients has long been accepted as necessary in some cases, for the sake of patients and society, though it can raise...

Commentary: Is President Trump Causing Toxic Stress?

Dominic Sisti & Cynthia Baum-Baicker   “The presidency is supposed to age the president, not the public.” And with that Jon Stewart, former host of the Daily Show and comic genius, touched on an overlooked but very serious public health question.    Is Donald Trump, with his daily Twitter harangues, impulsive and outrageous executive orders, and all around nastiness harming the health of...

Recovering Inside? Ethical Challenges in Correctional Mental Health Care

Commissioner Charles Ramsey speaking at the Recovering Inside Conference held on October 20,2016 at the National Constitution Center  in Philadelphia, Pennsylvania. Agenda

8:00-8:45am | Registration & Continental Breakfast

8:45-9:00am | Dominic Sisti: Welcome & Business

9:00-9:15am | Arthur Evans: Opening Comments & Introduction of Commissioner Ramsey


Psychosis Risk: What Is It and How Should We Talk About It?

By: Dominic A. Sisti, PhD, and Monica E. Calkins, PhD Abstract Schizophrenia and other psychosis spectrum disorders do not develop de novo but emerge from prodromal stages that are named and operationalized differently depending on the research group or consortium and its theoretical orientation. As a result, a complex lexicon now exists for characterizing individuals’ risk of subclinical...

Giving Asylum? The Ethics of Long-Term, Structured Care for People with Severe, Refractory Mental Illness

There are hundreds of thousands of individuals in the US who have serious mental illness. Most of these individuals thrive in the community, but there remains a population who do not. Because the number of long-term psychiatric hospital beds has largely evaporated over the past 50 years, they often cycle between homelessness, acute care, and prison. Of the 2.5 million individuals incarcerated in...

Diagnosing, Disclosing, and Documenting Borderline Personality Disorder: A Survey of Psychiatrists' Practices

Dominic Sisti, PhD1; Andrea G. Segal, MS1; Andrew M. Siegel, MD2; Rebecca Johnson, MA3; John Gunderson, MD4   1 Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 2 Department of Psychiatry, Perelman School of Medicine. 3 Department of Sociology, Princeton University, Princeton, New Jersey. 4 Harvard Medical School, Boston,...

From Alienism to ACOs: Integrating Psychiatry, Again

By: Dominic A. Sisti, Ph.D., Chethan Ramamurthy, M.D. View Author and Article Information at Abstract This column describes the gradual integration of psychiatrists into mainstream general medical care, from their exile as “alienists” in isolated asylums to their current roles in accountable care...

Halloween attraction dishonors mentally ill who lived at hospital

DOMINIC SISTI AND ANDREA SEGAL   The earliest psychiatric hospitals date back to 15th-century Spain, where they were conceived and constructed to give poor, homeless individuals with mental illness a safe place to live and, it was hoped, recover.   The next two centuries saw the degradation of asylums essentially into dungeons where mentally ill people were confined, living in chains and squalor...

A Debate on Treating Mental Illness: Should We Bring Back Asylums?

Wed, Jul 22 2015 Dominic Sisti, Ph.D., Assistant Professor of Medical Ethics/Health Policy and Psychiatry, University of Pennsylvania; Principal Author, “Improving Long-term Psychiatric Care: Bring Back the Asylum,” Journal of the American Medical Association Renee Binder, M.D., Psychiatrist, University of California, San Francisco; Incoming President, American Psychiatric Association Dr. Gloria...

Bill a good start in reforming mental-health care

Posted: Thursday, July 2, 2015, 1:08 AM By Dominic A. Sisti and Arthur Caplan   The mental-health-care system in the United States too often neglects the needs of Americans living with serious mental-health conditions and addiction. The system is fragmented and underfunded, and treatment is often provided in nontherapeutic places like jails and prisons.

U.S. Rep. Tim Murphy (R., Pa.) is ready...

Dominic Sisti Talks "Bringing Back the Asylum"

  LEE STABERT | TUESDAY, JUNE 16, 2015 Earlier this year, the Journal of the American Medical Association (JAMA) released a short paper by a group of ethicists at the University of Pennsylvania. Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care, an enterprise housed at Penn, co-authored this provocative piece entitled "Improving Long-term Psychiatric...

Two Recent Commentaries on 'Improving Long-term Psychiatric Care: Bring Back the Asylum'

Commentary: Bring Back Mental Health Asylums? Published in the Chaska Herald By Gary Norman

“Terry” has been sitting at the hospital’s emergency department for three days. We met Terry on a Sunday afternoon and conducted a mental health assessment with him.

It was determined that he needs care but doesn’t need to be hospitalized in a psychiatric unit. However, he does need supervised...

Shocking Pseudoscience: Anti-ECT protesters are wrong and dangerous

By: Amy S.F. Lutz the author of Each Day I Like It Better: Autism, ECT, and the Treatment of Our Most Impaired Children and president of the EASI Foundation and Dominic A. Sisti, PhD, Director, The Scattergood Program for Applied Ethics of Behavioral Health Care, University of Pennsylvania

Is electroconvulsive therapy (ECT) controversial? Google certainly thinks so: a search for those...

Letters to the Editor- JAMA Improving Long-Term Psychiatric Care: Bring Back the Asylum

The JAMA Edition published on May 5, 2015 (Volume 313, Number 17) included five thoughtful letters to the editor in response to article Improving Long-Term Psychiatric Care: Bring Back the Asylum published in the January 20, 2015 edition.  

Letters to the Editor: Expanding Long-term Care Options...

Scattergood Ethics Program Director on Voices in The Family

Forty years ago, we thought closing psychiatric hospitals was the humane action. But was it? In a recent article Penn bioethicists have called for a return to asylums– not surprisingly to some opposition. What’s in the best interest of the severely mentally ill? We talk to one of the authors of the article,...

The Tarasoff Rule: The Implications of Interstate Variation and Gaps in Professional Training


By: Rebecca Johnson, MA, Govind Persad, JD, and Dominic Sisti, PhD

Recent events have revived questions about the circumstances that ought to trigger therapists’ duty to warn or protect. There is extensive interstate variation in duty to warn or protect statutes enacted and rulings made in the wake of the California Tarasoff ruling. These duties may be codified in...

Battling Demons? When it Comes to Mental Illness, Language Matters

The following is an excerpt from the Philadelphia Inquirer on August 26th, 2014. 

Dominic Sisti, PhD & Andrea Segal, MS of the Department of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania  

We’ve seen it written dozens of times in the past week: Robin Williams was battling demons. What does this mean, anyway...


Wednesday, March 19 2014 8:30 am - 4:00 pm

What is the relationship between mental illness and violence? When is a person with a mental illness a danger to self or the public? What are the professional responsibilities of behavioral healthcare practitioners in determining dangerousness and committing patients to treatment?  In the wake of several national tragedies, these questions loom...

Ethics and Mental Health Journalism: The Difficult Case of Borderline Personality Disorder

November 18, 2013

By Dominic Sisti, Penn Department of Medical Ethics & Health Policy

Emotions run high in interviews with clinicians about patients with borderline personality disorder (BPD). Many doctors are not comfortable treating patients with BPD.  Some are...

Releasing mental health care from prison

By: Andrea Segal and Dominic Sisti, Penn Department of Medical Ethics & Health Policy

Mental health care in America is a sad state of affairs. As we described in a previous post,  prisons are, unimaginably, our largest and most utilized mental health treatment facilities. Making matters worse, not only is the treatment provided to inmates often medically inadequate, it is also not cost...

'Orange is the New Black' says a lot of what we need to hear about prison

By: Andrea Segal and Dominic Sisti, Penn Department of Medical Ethics & Health Policy

Have you seen Netflix’s new critically acclaimed series Orange is the New Black?

If you haven’t, you should.

The series, based on the real life experiences of Piper Kerman, who served over a year in federal prison for her involvement in a drug trafficking scheme, offers a gripping...

Borderline Personality Disorder: A Costly Label

By Dominic Sisti, PhD, Director of the Scattergood Program for Applied Ethics in Behavioral Health Care at the University of Pennsylvania

To being to examine the true cost of personality disorders, and since May is Borderline Personality Disorder (BPD) awareness month, we will focus on BPD in a series of blog posts.

Personality disorders are a group of mental...

Sixth JEMH Conference on Ethics in Mental Health November 28-30, 2012 Peterborough, Ontario, Canada


Theme: "Sentenced to Ethics" Date: November 28-30, 2012, Wednesday (all day), Thursday (all day), Friday (half day) City: Peterborough, Ontario, Canada (1.5 hours northeast of Toronto, 3 hours west of Ottawa) Location: Market Hall (Wednesday & Friday)
Galaxie Cinemas (Thursday) Hosted by: The "...

What should a doctor do with a patient like James Holmes?

By Arthur Caplan and Dominic Sisti

We now know that James Holmes, who was charged this week in the Colorado movie theater shooting, had been seeing a psychiatrist, though no one besides his doctor knows how often he was seen or what he said during treatment. According to one report, the psychiatrist warned University of Colorado officials about Holmes, but no further action was taken...

Patient-Doctor Confidentiality Versus Public Safety

Over the past few days new details have emerged about James Holmes, the suspected shooter in the Aurora movie theatre massacre. Included is the fact that Holmes was seeing a psychiatrist named Dr. Lynne Fenton prior to the shooting, and that Holmes sent a package to her that his defense team wants handed over.

But should Dr. Fenton, or any psychiatrist for that matter, be required to...

Delaware Summer Institute on Substance Abuse & Mental Health


MONDAY July 30,  6 – 9:30 p.m. 

Workshop 1546: Biomedical Ethics Primer 
Dominic A. Sisti, Ph.D. 

This workshop will provide participants with a survey of the history of biomedical ethics with a specific focus on key cases that have defined the field. These cases will include several research scandals involving...

From IV to 5: The Ethical Implications of the New DSM

Event Date: Wednesday, June 20 2012 2:00 pm - 5:00 pm

Location: Society for Psychotherapy Research, 43rd International Meeting, Virginia Beach, VA, USA

Marna Barrett, PhD
Dominic Sisti, PhD
The Scattergood Program for Applied Ethics of Behavioral Healthcare
University of Pennsylvania Department of Medical Ethics & Health...

What is Recovery? Ethical Challenges & Clinical Transformations

FRIDAY, MAY 18, 2012. The development and operationalization of the concept of recovery has been transformative to the way behavioral healthcare is delivered. In this workshop, we will ask a fundamental question— “What is recovery?”—in order to understand the ethical complexities and implications of recovery-directed care delivery....

American Psychiatric Association 2012 Annual Meeting: Ethics Track

Event Date:  Saturday, May 5 2012 - Wednesday, May 9 2012 Location:  Pennsylvania Convention Center, Philadelphia PA

A Collaboration between the APA, The Scattergood Program for the Applied Ethics of Behavioral Healthcare, The University of Pennsylvania Department of Medical Ethics and Health Policy, and The Thomas Scattergood Behavioral Health Foundation


University of Pennsylvania Department of Medical Ethics and Health Policy

The Scattergood Program for the Applied Ethics of Behavioral Healthcare (ScattergoodEthics) is based within the Department of Medical Ethics & Health Policy at the University of Pennsylvania Perelman School of Medicine. The ScattergoodEthics Program is dedicated to education, research, and resource development for the field of psychiatric, mental, and...