Mental health professionals rightfully experience significant anxiety regarding their duty to protect when working with potentially dangerous individuals. This work dispels myths and provides readers with a resource addressing the situations where a duty to protect may apply.

The ability to reason ethically is an extraordinarily important aspect of professionalism in any field. Indeed, the greatest challenge in ethical professional practice involves resolving the conflict that arises when the professional is required to choose between two competing ethical principles. Ethical Reasoning in the Mental Health Professions explores how to develop the ability to reason ethically in difficult situations. Other books merely present ethical and legal issues one at a time, along with case examples involving (...) "right" and "wrong" answers. In dramatic contrast, Ethical Reasoning in the Mental Health Professions provides you with the needed background in methods of ethical reasoning and introduces an innovative nine-step model of ethical decision-making for resolving ethical dilemmas. Ethical Reasoning in the Mental Health Profession discusses the ethical codes of both psychology and counseling. This interdisciplinary approach promotes a better understanding of the similarities and differences in the points of emphasis in the two codes, which, in turn, enriches your understanding of the range of ethical considerations relevant to the practice of the mental health professions. (shrink)

This unique text is organized around the most current ethical and legal standards as defined by the mental health professionals of psychology, social work, ...

Stay up-to-date on the ethical and legal issues that affect your clinical and professional decisions! Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards details the ethical and legal issues that involve mental health professionals. Respected authorities with diverse backgrounds, expertise, and professional experience discuss contemporary theories emphasizing professional ethics, the ramifications of professional actions and decisions, and ethical standards on teaching, training, research, and publication. (...) This informative handbook provides invaluable up-to-date information and guidelines vital for every mental health professional. This book is a thorough examination of ethical behavior which can be used as a reference source for the professional or a textbook for graduate students. The handbook itself is divided into five sections. The first section is a detailed introduction of ethics, law, and licensing. The second section presents general ethical principles like competence, integrity, and respect for individual rights and dignity. The third section examines confidentiality, privilege, consent, and protection. The fourth section focuses on general ethical standards in practice, including sexual contact, multiple relationships, and bartering. The fifth section presents the ethical principles and standards in teaching, training, and research. Appendices include the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002) and the Code of Ethics of the National Association of Social Workers (National Association of Social Workers, 1999). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards discusses: the history of basic approaches and issues in ethical philosophy five fundamental areas in the process of developing competence the necessary ingredients for the mental health professional's practice of integrity aspirational versus enforceable standards of ethics concern for the welfare of others as a core ethical principle the notion of social responsibility in the ethics codes of psychologists and social workers ethical principles, statutes, and case law protecting privacy and confidentiality issues involving the therapist-patient privilege the "duty to protect" doctrine and relevant legal issues the dynamics of multiple relationships and boundary violations sexualized dual relationships between psychologists and patients possible conflict of interest in bartering for services the requirements and implementation of maintaining patient records to avoid ethical and legal problems possible ethical dilemmas involving referrals and fees much, much more This Handbook is an essential resource for all mental health professionals, including psychologists, psychiatrists, social workers, counselors, therapists, and graduate students in mental health and the related fields. Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards is the first of three volumes under this title. The following volumes will focus on forensic settings and special populations/special treatment modalities. (shrink)

This book aims to elevate the education of future mental health professionals to a higher professional level and serve as a "vade mecum" of ethical and psychological reflection for practicing professionals. This book goes beyond merely offering a set of instructions; it encourages readers to actively engage in ethical reflection and cultivate ethical attitudes grounded in factual understanding.

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of (...) essential ethical principles and concepts, the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

This book draws on both the historical context & contemporary research evidence to present the roles of mental health social work, AMHP & BIA, within an ethical framework. Codes of practice & statutory legal requirements, such as the Mental Health Act, Mental Capacity Act & the Human Rights Act, are all considered.

Starting out : ethics issues in beginning a practice -- Clinical practice -- Documentation and record keeping -- Dealing with third parties and protecting confidentiality -- Financial decisions -- Staff training and office policies -- Advertising and marketing -- Continuing professional development -- Leaving a practice -- Closing thoughts.

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client? How can clinicians refuse costly gifts from clients without damaging the therapeutic relationship? Should a therapist disclose a client's suicidal intent to the authorities? In Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice, these and other real-life scenarios constitute a comprehensive and definitive ethics casebook for (...) mental health professionals. Inspired by the many difficult situations they themselves have faced, an eminent group of accomplished mental health clinicians provide first-hand accounts of ethical problems that defy boilerplate solutions. Each chapter begins with a compelling and ethically complex case followed by an illustrative yet succinct analysis of the key ethical issues present and a personal reflection on the case itself, along with the process of ethical reasoning used to arrive at a final decision. Every case concludes with key recommendations for promoting ethical practice within an often challenging work setting. Highlighting the human aspect of ethics in mental health practice through the use of mesmerizing narratives while also provoking the reader to reflect upon what is the "right" thing to do, Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice offers trainees and seasoned professionals alike invaluable informative models for dealing with ethical dilemmas, as well as the inspiration to confront seemingly insurmountable clinical problems. (shrink)

Creative Ways to Learn Ethics is an accessible, easy-to-read guide that compiles a variety of ethics trainings to help professionals stimulate their minds, relieve stress, and increase engagement and memory retention. The book uses a range of experiential and thought-provoking approaches, including contemplative exercises, expressive arts, games, and media. Each chapter contains objectives, detailed procedures, adaptations for different audiences, and handouts. Trainers, educators, clinicians, and other mental health professionals can use these exercises in various settings and (...) modify them to meet the needs of their clients. (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client?

Values in dialogue offers a practical and theoretical model for ethics in care, that has grown from experience and research. The foundation of this ethical model is laid in the care relationship and in relational personalism. It consists of three pillars: values, dialogue, and attitudes. On this basis, a practical model for ethical reflection is developed. The aim is to empower professionals in their own ethical reflection and responsibility in concrete care situations. The model is applied on several topics, (...) such as collaboration between professionals, collaboration with clients and significant others, restriction of freedom and use of coercion, and exchange of information and confidentiality. 'Values in dialogue' is written for care professionals in their daily practice and in ethics commitees, but also for teachers and students in ethics courses. It focuses in particular on mental healthcare, support for people with mental disabilities, and care for elderly persons. (shrink)

Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated. This article presents a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: formal coercion, informal coercion, uncertainty related to the (...) Norwegian legislation on coercion and professional role and identity. Some ethical challenges did not fit into these categories. Only 36% of the ethical challenges were related to the use of formal coercion or the interpretation of the health law. Conclusion Even within coercion regulated by law, weighing different moral values remains important to reflect upon the appropriateness of the possible use of coercion. (shrink)

William F. Doverspike, PhD, is a licensed psychologist who holds a Diplomate in Clinical Psychology (ABPP) and he is also board certified in Neuropsychology (ABPN). He is an Associate Faculty member of the Georgia School of Professional Psychology, where he teaches graduate courses in professional ethics. As an independent practitioner, he maintains privileges at several local hospitals. He is a member of the Ethics Committee of the Georgia Psychological Association. Dr. Doverspike is Editor of the Georgia (...) Psychologist magazine and has authored over 50 articles and chapters. He conducts seminars on ethics, risk management, and diagnostic consultation. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, (...) Sjöberg, Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. (...) Sadler describes the manifold kinds of values and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

Postmortem reproduction refers to normally unnatural situations that are made possible by modern medical technology. It's a definition that applies to a situation in which one parent of an offspring is dead at the time of conception of the offspring or at the time of birth of the offspring. It is a situation which raises complex and multifactorial dilemma as with most issues that concern decisions over human life; accordingly, this discussion of its ethical ramifications is not intended to be (...) exhaustive, but illustrative. (shrink)

Little is known about how health care professionals deal with ethical challenges in mental health care, especially when not making use of a formal ethics support service. Understanding this is important in order to be able to support the professionals, to improve the quality of care, and to know in which way future ethics support services might be helpful.

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. (...) Most participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

This paper explores the topic of military ethics, what we mean by that term, what it covers, how it is understood, and how it is taught. It suggests that the unifying factor that makes this a coherent subject beyond individual national interpretations of it is the core idea of military professionalism. The paper draws out the distinction between training and education and draws on research conducted by a number of different people and agencies, including the International Committee of the (...) Red Cross, to establish what factors contribute to effective pedagogy and the inculcation of appropriate attitudes and behaviours. The paper concludes by looking at the way military ethics contributes to military outcomes from protecting civilians and the vulnerable to building resilience in our own military personnel to protect their mental health, through to the strategic costs of losing the moral high ground if behaviour is seen to fall short of that expected from military professionals. (shrink)

We assessed the attitudes, perceptions, and stereotypes toward Latino immigrants among 247 mental health professionals across 32 U.S. states. We also randomly presented two versions of an attitude measure that varied in their references to immigrants. Participants reported that they did not agree with the anti-immigration law Arizona SB 1070 and other similar bills. Also, greater multicultural awareness was related to positive attitudes and fewer stereotypes toward immigrants. Furthermore, participants who were asked to think about “undocumented immigrants” viewed (...) Latino immigrants more positively than those who were asked think about “illegal aliens.” Findings show the continued need for multicultural awareness and competence training for mental health professionals, which align with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. Limitations and future directions for research are discussed. (shrink)

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers (...) and patients, proposing that ‘liberal’ approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust. (shrink)

Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that (...) health institutions can better improve patient safety and employees’ well-being by implementing an organizational policy of “speaking up” when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing m.. (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were interviewed. The (...) interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

Psychiatrie und Psychotherapie sind Bereiche medizinischer Praxis, die in besonderer Weise ethische Fragen aufwerfen. Die Beiträge des Bandes hierzu werden durch zwei übersetzte Beiträge des polnischen Psychiaters Antoni Kępiński (1918-1972) erweitert. Diese eröffnen neue Perspektiven in der Diskussion um ethische Fragen in der Psychiatrie.

The hospital's clinical ethics committee sought to gauge health-care professionals’ level of knowledge and usage of the Mental Capacity Act 2005 within the hospital trust. The hospital's personnel were asked to complete a 10 part questionnaire relating to the basic contents of the Act. Four hundred questionnaires were distributed and 249 (62%) were returned completed and valid for analysis. A ‘pass-mark’ of 70% (7/10) was assumed; the results showed that 48% of respondents scored ≤50% (≤5/10), 74% (...) of respondents scored <70% (<7/10) and only 24% of respondents scored ≥70% (≥7/10). It was concluded that the Mental Capacity Act 2005 was not being effectively implemented within the Trust. Measures to increase the awareness and usage of the Act have subsequently been instigated. We believe that these measures will improve the awareness and knowledge of the Mental Capacity Act 2005 within the hospital Trust lead to its better utilization. (shrink)

When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues.

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify (...) and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy. (shrink)

Attendance at 12-step programs has become part of the orthodoxy of treating clients with substance abuse disorders. However, concerns have been raised about the assumptions on which 12-step programs are based. I argue that antirepresentationalism is the moral principle that underpins such concerns. After clarifying the principle of antirepresentationalism, I explore strategies for reconciling antirepresentationalism with 12-step programs. However, all the strategies I try fail. Consequently, I adopt an alternative way of thinking about antirepresentationalism that leaves mental health (...) professionals free to refer clients to 12-step programs. However, such referrals can continue only at the cost of accepting objectionable assumptions about motivation, spirituality and human agency. Therefore, it might well be time to find an alternative to 12-step programs. (shrink)

Global mental health in a changing world -- Contemporary humanitarianism -- Humanitarian ethics -- Professional and personal challenges in humanitarian work -- Managing ethical challenges in global mental health -- Aspirational guidance : principles of humanitarian assistance -- Operational guidance : IASC guidelines -- Ethical dilemmas : damned if you do and damned if you don't -- Ethically questionable practices -- Safety imperative and self-care -- Values-based ethical framework and core competencies in global (...) class='Hi'>mental health -- Ethical considerations for refugee mental health providers in the United States -- Conclusion and future directions. (shrink)

This work provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in ...

Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional ‘beneficence-autonomy’ approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major (...) changes in compulsory psychiatric care - community orders and care for patients with untreatable severe personality disorders - further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives. (shrink)

Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients to harm (...) and force psychologists to make disclosures that violate patients’ rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards. (shrink)

How are we to make sense of madness and psychosis? For most of us the words conjure up images from television and newspapers of seemingly random, meaningless violence. It is something to be feared, something to be left to the experts. But is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs, but is this actually so? There is no convincing evidence that the brain is (...) disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. So, how do we make sense of this situation? Postpsychiatry addresses these questions. It involves an attempt to rethink some of the fundamental assumptions of mental health work, showing how recent developments in philosophy and ethics can help us to clarify some of the dilemmas and conflicts around different understandings of madness. Throughout, the authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice. This new direction emphasises the importance of cultural contexts in understanding madness, placing ethics before technology in responding to madness, and minimising 'therapeutic' coercion. (shrink)

In spite of numerous studies of program outcomes finding little or no positive effect on violent behavior, the Duluth model remains the most common program type of interventions with perpetrators of domestic violence. In addition, Duluth model programs often ignore serious mental health and substance abuse issues present in perpetrators. These and other issues of possible threat to mental health professional ethics are reviewed in light of the court-mandated, compulsory nature of most Duluth model (...) programs and client and victim expectations for program efficacy. (shrink)

This article is the second one in a series dealing with mental health ethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to the interests of clients, their personal interests, and the interest of the state. These conflicts are related to power differentials among clients and professionals, professionals from various disciplines, (...) and professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics. (shrink)

As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mental health professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by (...) a set of professional values but by a specific set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America. (shrink)

Context: In most jurisdictions where medical-aid-in-dying is available, this option is reserved for individuals suffering from incurable physical conditions. Currently, in Canada, people who have a mental illness are legally excluded from accessing MAiD. Methods: We developed a questionnaire for mental health care providers to better understand their perspectives related to ethical issues in relation to MAiD in the context of severe and persistent suffering caused by mental illness. We used a mixed-methods survey approach, using a (...) concurrent embedded model with both closed and open-ended questions. Findings: 477 healthcare providers from the province of Québec completed the questionnaire. One third of the sample were nurses, one quarter psychologists and one quarter psycho-educators. Nearly half of the respondents considered that people with a severe mental illness should be granted the right to opt for MAiD as a way to end their suffering. Respondents were more likely to feel comfortable listening to the person and participating in discussions related to MAiD for a mental illness than offering care or the means for the person to access MAiD. Most reported that they had not received adequate/sufficient training, education or preparation in order to address ethical questions surrounding MAiD. Conclusions: The findings highlight how extending MAiD to people with a mental illness would affect daily practices for mental healthcare providers who work directly with people who may request MAiD. The survey results also reinforce the need for adequate training and professional education in this complex area of care. (shrink)

(2003). Ethical and Professional Demands for Forensic Mental Health Professionals in the Post-Atkins Era. Ethics & Behavior: Vol. 13, No. 1, pp. 3-9.

The Approved Mental Health Professional (AMHP) has a pivotal role in a decision to detain an individual under the Mental Health Act 1983. This article is a reflective account demonstrating how a solution-focused approach can enable an AMHP to engage constructively with the person being assessed and apply the values of anti-oppressive practice. Using a solution-focused approach enables a creative and empowering discussion of risk and may lead to a less restrictive outcome. These techniques should (...) be part of the training and ongoing education of AMHPs. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried (...) out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

Although Australia has comparatively few individuals seeking asylum, it has had a mandatory detention policy in place since 1992. This policy has been maintained by successive governments despite the overwhelmingly negative impact mandatory detention has on mental health. For mental health professionals working in this environment, a number of moral, ethical, and human rights issues are raised. These issues are discussed here, with a focus on dual loyalty conflicts and drawing on personal experience, the bioethics and (...) human rights literature, and recent parliamentary inquiries. For those who continue to work in this environment, future directions are also discussed. (shrink)

This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a (...) transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments. (shrink)

Background Maternal mental health during the peripartum period is critically important to the wellbeing of mothers and their infants. Numerous studies and clinical trials have focused on various aspects of interventions and treatments for perinatal mental health from the perspective of researchers and medical health professionals. However, less is known about women’s experiences of participating in perinatal mental health research, and the ethical issues that arise. Aim To systematically review the literature on the (...) ethical issues that emerge from pregnant and/or postpartum women’s experiences of taking part in perinatal mental health-related research. Methods Systematic review of nine bibliographic databases, from inception to July 2021. Qualitative, quantitative and mixed method studies were included if they reported on ethical issues experienced by perinatal women. Research ethical issues encompassed any issue relating to women’s experiences of being offered study information, recruitment, consent, retention and respect for autonomy. Titles, abstracts and full text screening, appraisal of the methodological quality of included studies, and data extraction, were conducted independently by two reviewers. Ethical considerations Ethical approval was not required for this systematic review. Findings A total of 9830 unique citations was retrieved. Six studies met the inclusion criteria. Studies were clinically and methodologically heterogenous, and only one was purposively designed to explore women’s experiences. The key finding was the establishment of trust between the researcher and participant in all stages of the research process. Findings are presented according to recruitment and consent processes, participation and retention, and study follow-up and completion. Conclusion The establishment of trust between the researcher and perinatal women leads to a dynamic with research ethical implications relevant to all stages of perinatal mental health-related research. Further research on the research ethical issues experienced by perinatal women is required because of the limited literature. (shrink)

Ensuring confidentiality is the cornerstone of trust within the doctor–patient relationship. However, health care providers have an obligation to serve not only their patient’s interests but also those of potential victims and society, resulting in circumstances where confidentiality must be breached. This article describes the attitudes of mental health professionals when patients disclose past crimes unknown to the justice system. Twenty-four MHPs working in Swiss prisons were interviewed. They shared their experiences concerning confidentiality practices and attitudes towards (...) breaching confidentiality in prison. Qualitative analysis revealed that MHPs study different factors before deciding whether a past crime should be disclosed, including: the type of therapy the prisoner-patient was seeking, the type of crime that is revealed, and the danger posed by the prisoner-patient. Based on this study’s findings, risk assessment of dangerousness was one of the most important factors determining disclosures of past crimes, taking into consideration both the type of therapy and the crime involved. Attitudes of MHPs varied with regard to confidentiality rules and when to breach confidentiality, and there was thus a lack of consensus as to when and whether past crimes should be reported. Hence, legal and ethical requirements concerning confidentiality breaches must be made clear and known to physicians in order to guide them with difficult cases. (shrink)