Behavioral health centers base their service delivery towards improving the lives and mental capacity of the public. The increasing rates of mental disorders in the U.S. means that psychiatrists are becoming fundamental in the healthcare delivery. However, Hoffman and Koocher (2018) noted that the changing dynamics and increased requirement of the psychiatrists have not resulted in the change in the clinical or healthcare centers’ structures. The authors argue that the psychiatrists continue to work under physicians thus making their tasks challenging due to the lack of independence needed to serve their clients and maintain a high ethical standard (Hoffman & Koocher, 2018).
Sori (2006) concurs with these allegations, stating that the increased challenges in policymaking, structural and organizational cultures tend to increase the challenges for the psychiatrists to serve and undertake the special responsibilities while abiding by both the professional ethics and organizational code of conduct. Sori argued that the overlapping of ethical responsibilities and conflicting issues such as confidentiality and competing interests challenge the behavioral health centers to maintaining and enhancing their ethical code of conduct. Therefore, this study uses the Psychiatric Institute of Washington (PIW) to understand the challenges of structural and other ethical issues in the institution to help develop an ethical code of conduct guideline to solve the problems.
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Brief Background
Psychiatric Institute of Washington (PIW) is a nationally recognized inpatient treatment facility in Washington. PIW has been in operating since 1967 mainly as a psychiatric hospital. The hospital has 250 employees as of 2014. The hospital joined the Universal Health Service (UHS) that helps it to deal with the economic and insurance challenges that have seen the demise of many small clinics. PIW’s mission statement states, “PIW is people with integrity and willingness to share in the healing process and guide those we serve on the path to health” (Psychiatric Institute of Washington, 2015). The vision statement compliments the mission statement by demonstrating the hospital’s commitment to improving behavioral health care in the community through innovation and establishing partnerships with like-minded people and organizations to enhance behavioral healthcare delivery. Since this paper intends to provide an ethical guideline, it is essential to summarize PIW’s values or principles. The hospital claims that it works towards the provision of the highest quality in behavioral health services to the clients, enhancing responsibility, reliability and cost-effective service delivery. It also states that the hospital works to engage the community and improve the behavioral health of the public (Psychiatric Institute of Washington, 2015). Lastly, it ensures equality and fair treatment of all its employees.
However, lawsuits against PIW demonstrates that the institution needs to refurbish its principles to demonstrate that it undertakes its services in an ethical and legal manner. In 1993, the District of Columbia Commission on Human Rights mandated PIW to compensate Ric Birch, an employee at PIW, for damages after sexual harassment-hostile work environment over $900,000. The Commission’s judgment demonstrated poor working relationships that led to the sexual harassment from a supervisor to a junior staff. In another lawsuit filed in 2011, Plaintiff Lakeisha Jordan, mother of Y.F. who was a patient in PIW since she was seven years old, argued that the institution employed illegal forms of treatment on Y.F. The plaintiff argued that her daughter was subjected to restraints, physical holds, and seclusion among other psychotropic medications. Although the second case is still open, a website reviewing the institution demonstrated that most of the patients or people who have had relatives in the institution concur that the institution operations are unethical (" Lakeisha Jordan v. District of Columbia ," 2016). The reviews demonstrated unethical and rude staff-staff relations and staff-patient relationships. The organizational structure was difficult to find but based on the 1993 case it clear that the hospital has a hierarchal administration structure. Other issues such as holding group therapies with patients with emotional problems, which includes about ten interns, demonstrate that breach of confidentiality may be high. Therefore, based on these cases and reviews, it is evident that the behavioral institute requires enhancing its ethical code of conducts.
Creating an Ethical Code of Conduct Guideline
The aim of this paper was to offer a guideline to enhance the service delivery and eliminate the deprivation of human rights and confidentiality that diminishes the psychotherapy treatment calls for the use of APA policy. APA policy of professional practice guideline states that the guideline should limit unnecessary proliferation while creating the guidelines to ensure that it solves all the needed aspects of advocacy. The guideline should be more of an advocacy for efficiency and respect of human rights rather than scientific establishments (American Psychological Association, 2015). These documented guiding principles should consider the aspects of specific needs, intended stakeholders, and purposes. When formulating the guideline, it is vital to understand the legal system or laws, public benefits that may include the avoidance of harm, improved service delivery, better professional risk-management, protecting emerging vulnerable populations, among other factors and social improvements. It is also vital to ensure simplicity, flexibility feasibility, and compatibility when formulating the guidelines. Therefore, this paper uses the APA policy for guideline formation to document a professional guideline for PIW.
Purpose
This ethical guideline is aimed to offer a guideline for PIW governance, staffs and psychologists. The guideline is set to establish improved service delivery and reduce the confidentiality and human rights violation as stated in the case study.
Documentation of Need
According to Batra (2015), hospitals have a duty to protect patients’ rights. Batra argued that the continued negligence and irresponsibility among the practitioners and other paramedical staffs is the cause of the multiple injuries and even deaths of the patients. The study demonstrated that failure to provide vital information and engaging in the test or treatments that do not improve the patients result to distrust and dissatisfaction of the family members. Cover-ups and other unethical practices result in increased unethical practices with the hospitals trying to hide their unethical behaviors. Batra demonstrated that the failure of patients to understand their rights with under 4% of the patients fully aware of their rights is one of the main factors that result in negligence and unethical behaviors in the hospitals (Batra, 2015). However, psychologists’ code of ethics entails guidelines that prevent a psychologist or a healthcare practitioner from violating the rights of the patients.
According to the APA ethical principles of psychologists and code of conduct, psychologists should avoid harming the patients, students, organizational clients and others whom they work with and minimize the harm where it is predictable and inevitable. The psychologists should also not participate or engage in torture. According to the APA 3.04a, torture is any term, which causes severe pain or suffering either mental or physical among other inhuman or degrading behaviors. The AACAP code of ethics of 2012 concurs with the APA code against harm (American Academy of Child and Adolescent Psychiatry, 2014). The second principle claims that even in the societal pressures, among other pressures, a practitioner should base treatment of children and adolescent on the contemporary scientific knowledge that enhances and boost the welfare of these groups of people. According to the 2011 petition, Y.F. was under the CFSA’s custody after the District filed a petition for abuse and neglect of the minor against her mother. Y.F. was later admitted to PIW after her diagnosis with bipolar disorder but PIW engaged in the isolation, physical holding and restraining during her treatment.
The seclusion and continued restraining of Y.F. are against the APA regulations since it caused her to harm both mentally and physically. It demonstrates that PIW treatment mechanism is a strategy utilized in pre-modernized healthcare provision where the patients in mental hospitals were deemed as animals or non-human resulting in the inhuman treatments (American Academy of Child and Adolescent Psychiatry, 2014). The essence that PIW engaged Y.F. in continued emergency care treatment after failed treatment and continuous body harms means that the hospital knew that CFSA did not monitor the treatment process of Y.F. hence the inhuman treatment. However, AACAP calls for practitioners to use their knowledge in contemporary science and their experience in psychiatry to provide the best quality medication for their patients. The AACAP is clear that even in the societal pressures, whereby homeless children or adolescents are treated as misfits, the hospital should ensure that their treatments benefit the patients.
The plaintiff argued that PIW physicians prescribed medications such as Seroquel, Haldol, Zyrtec, Zyprexa, Clonidine, Risperidal, and Lithium (" Lakeisha Jordan v. District of Columbia ," 2016). The PIW stated that it sort consent to administer these medications for the CFSA’s Office of Clinical Practice (OCP). However, CFSA respondent that although the PIW claims were true, it only provided consent for some of the treatments thus demonstrating that PIW did not seek consent for most of the medications. The breakdown of communication between the CFSA and PIW is one of the ethical misconduct dominating mental healthcare institutions among other medical institutions (" Lakeisha Jordan v. District of Columbia ," 2016). According to Batra (2015), most physicians fail to provide detailed information about the treatment or medication they prescribe to the patients. The reasons for these miscommunications are based on the practitioners’ unwillingness to engage the family or guardians. The APA calls for the need to make informed consent to provide treatments to patients. The guideline demonstrates that children or adolescents who are below the age to make informed decisions should not make such decisions or the institution should not make those decisions without consent from the guardians.
The PIW sort consent for some but not all the medication thus demonstrating that it overlooked and violated the informed consent to therapy. These are some of the issues of abuse of power by mental institutions when dealing with the minors. According to Koocher and Keith-Spiegel (2016), consent relies on three separate aspects namely knowledge, voluntariness and capacity. The authors argue that for any decision to be consented, the practitioners must provide sufficient information in a language and the simplest way possible to ensure that the person granting the consent understands everything. The practitioner should provide all aspects of the treatment and should not hide details of adverse effects among other issues that may result in the person consenting to the treatment. The next aspects depict that the participant engages in the treatment voluntarily rather than through coercion. Finally, the legal and cognitive competence of the person making the decision is of paramount importance to ensure the validity of the consent. The simple explanation of the process of consent demonstrates that the institution failed to provide information on the treatment and their impacts on Y.F., it used the consent granted in other medications to deem their procedures humane but did not consider the essence ensure that the compassionate degree of their therapeutic procedures.
The issue of engaging in group therapies for the hospital’s interns overlooks two of the most essential values in medicine and psychotherapies. According to PIW intern info document, the institution engages in group therapies where ten to thirteen interns engage in supervised group therapies with patients with mental and emotional problems, which is against the APA and AACAP (American Academy of Child and Adolescent Psychiatry, 2014). Scholars agree that psychotherapy is dependent on the trust, whereby, the psychiatrists must create an environment to ensure that patient is willing to open up to them to enhance treatment (Koocher, & Keith-Spiegel, 2016 and Czarkowski, Kaczmarczyk & Szymańska, 2014). Failure of trust jeopardizes the success of psychotherapies because it prevents the patients to share their secrets. It is unclear to consider a child or teen from a religious and authoritarian family to share that they engage in sexual relationships or use drugs with his peers or sexual harassment in a group of ten interns. Studies on transgender youths demonstrated that teens facing the dilemma of changing their gender, the social stigmatization among other factors makes it difficult for the pubertal children to open-up to a psychologist whom they feel would not maintain their confidence.
Lastly, information regarding the organizational structure was minimum thus demonstrating that there was no hospital ethics committee (HEC) in the institution.
The essence that the company paid over $900,000 to Birch in 1993 demonstrates a constrained staff-staff relationship with conflict solution provisions limited to solve staff conflict and boost the working relationships. According to Czarkowski, Kaczmarczyk & Szymańska, 2014), HECs help in evaluating and creation of policies in health institutions. The study undertaken in Poland demonstrated that failure to implement HECs is one of the major reasons for unethical practices in medical and behavioral institutions. The HECs help in enhancing the interpersonal relations among hospital personnel, patients, and the families. It also noted that the constraints and workload in institutions increase the chances of conflict; therefore, HECs help resolve the issues and improve the interaction between the superiors and the inferior staffs (Czarkowski, Kaczmarczyk & Szymańska, 2014). The study noted that most of the HECs members in Poland were doctors or physicians thus limiting the inputs of the psychiatrists in decision-making processes, which affects the efficiency of the organizational policies in the relation to the ethical standards of the psychologists.
Guidelines
The term guideline refers to statements that suggest precise endeavor, professional behaviors, and conduct of the psychologists. The assumptions that guidelines are similar to standards is wrong because standards are mandatory and must be enforced, unlike the guidelines that provide direction to the psychologists (American Psychological Association, 2015). The purpose of guidelines is to facilitate competence and improve the service delivery.
Background
This ethical guideline development process was based on reviewing the evidence-based studies on behavioral health institutions mainly on ethical problems and their solutions. The reviewed articles and journals are noted down in the reference section of this paper. It is also important to note that there was no conflict of interest while formulating the paper. Using PIW as the focus behavioral institution does not hold any conflict between the writer of the document and the institution, but it is due to the need to use a real-world institution that has potential to eliminate the minor incompetence issues to enhance the behavioral treatments.
Guidelines
Psychologists must avoid human rights violation
The APA and AACAP code of conduct prohibits any form of treatment that violates the human rights of the individual. Hence, the formulation of standards that harms the mental or physical harm. The psychologists should work guided by the human dignity and serve to promote the existence of human life. It is vital to seek consent in treatment and research of minors, psychologists should respect the decision of the patients or their guardians (Koocher, & Keith-Spiegel, 2016). It is the mandate of the psychologists to maintain patient’s confidentiality at all costs since failure to observe these patient’s rights interferes with the profession values.
Responsibility and fidelity
Trust is the backbone of psychotherapeutic relations of the professional and using scientific responsibilities to society and their specific communities. Therefore, psychologists must seek to manage conflict of interest that results in exploitation and harm. It is the task of psychologists to ensure that they engage in the ethical compliance, seek to cooperate support and institutions in similar sectors to enhance their policies and ethical standards.
Promote Integrity
Proficiency, competence, and efficiency of psychologists are based on the willingness and determination of the psychologists to promote accuracy, truthfulness, and honesty through science teaching and service delivery. The focus on integrity limits the misrepresentation of facts, cheat, subterfuge, or fraud. Psychologists must learn that a single violation of integrity results in a chain of continued violation, which cause unethical culture in their profession and institution thus resulting in credibility issues.
Studies demonstrate that of the psychologists lack the ability to separate the personal emotions and challenges while undertaking their tasks. The study demonstrates that the continued failure to separate the professional and personal life jeopardizes the level of service delivery Sori, 2006 and Pietkiewicz, & Skowrońska-Włoch, 2017). Sori (2006) argued that psychologists should focus on improving their personal lives due to the nature of their tasks and the great pressure to engage in honest and responsible vocational psychotherapies. Therefore, it is the duty of psychologists to learn to live honest, truthful personal lives to ensure that personal issues do not distract the ability of the psychologists to engage in their tasks.
Knowing the legal and justice system
It is vital for professionals to understand the changing aspects of the laws and legal systems in the locations they operate in to limit the continuous conflicting interests or disparities in service delivery. The boundaries of competences, reasonable judgment and elimination of potential biases lead to unethical practices. Therefore, it is the duty of psychologists to promote equality and engage in politics to restrict the unethical policies proposed by local, states or national governments. Psychologists should seek to enhance cooperation and association links to ensure that they influence key policies that will benefit the psychologists and the patients with mental conditions.
Consequences of Violating the Code of Ethics
The violation of the Code of Ethics is a critical issue that can result in distrust of the institution. Therefore, the establishment of the HEC in the institution is vital to determine the manner of the violation and determine the disciplinary action that is suitable for the psychologist or other employees in the institution. The HEC follows the APA and legal guidelines to determine the nature of the violation of the Code of Conduct and Conduct Guidelines and reduce the chances of the hospital incurring huge costs in the court of law. It is essential for psychologists to understand that violation of any of the ethical codes or guidelines will result in harsh measures and the institution is not ready to suffer for individual violations. Hence the need to formulate policies that state the disciplinary actions that range from a reprimand to dismissal.
If the psychologist or employee knowingly violates the trust of the patient or engages in an unprofessional relationship with the patient, the hospital dismisses the psychologists and ensure his or her license is revoked. This disciplinary action ensures that the psychologists do not knowingly violate the code of conduct.
If the psychologist violates a code of conduct unknowingly or through a difficult dilemma situation, the HEC will ensure formal investigation of the matter before making a decision that can result in probation or warning to the psychologist. This lenience ensures that psychologists feel the sense of belonging to motivate them to seek help from the commission before making complex decisions.
Violation of the legal code of conduct will result in the psychologist facing legal measures as defined by the state and federal constitution. The scope of the violation determines the penalty, for instance, fines, and revocation of the licenses or incarceration.
Understanding the consequences ensures the psychologists know their fate if they infringe the guidelines they will face harsh penalties. The harsh consequences reduce the chances of violating the code of conduct thus maintain high morals.
Ethical Dilemma
The world is changing and the political aspects in states and at the national levels continue to stigmatize and subject people in devious or inhuman treatments. For instance, PIW is located in the District of Columbia whereby involuntary psychotherapies are under the state’s laws (Zur, 2017). It the guideline demonstrates that psychologists must ensure that respect of personal dignity and human rights are observed. However, engaging in involuntary psychotherapies results in forcing patients to engage in treatments that they do not want to engage in the treatments. The involuntary treatments, for instance, the mandatory court order for murder prisoners who are deemed unfit mentally to face the death penalty are required to engage in involuntary psychotherapy and medication to ensure that they are fit to be executed (Erdmane, 2010). Such rules create a dilemma for the psychologists and the guideline has no specific regulation to solve the issue.
The question of whether to respect the law and provide the healthcare needed to improve the prisoner’s conditions would lead to the deprivation of the right to life of the prisoner or whether to work to the best interest in the prisoner’s right to life. It is important to note that psychologists’ like other health practitioners must serve the patients and improve their lives. Therefore, it is essential to note that failure to treat the patient also fails to work to the interest of the prisoner to acquire quality healthcare but that does not make the task easier for the decision of treating mental illness to result in execution (Erdmane, 2010). Therefore, psychologists, as detailed in the guideline, should focus on the joining and link in associations to eliminate rules that increase ethical dilemmas that are too challenging to solve. However, using ethical theories such as Kantian theory, it is possible for the psychologist to solve the dilemma, but the existence of different theories that yield different results in the same situation means that the theories only result in added ethical dilemmas.
Lastly, psychologists are faced with the obligation to ensure that confidentiality of the teens or children. However, they are also obliged to seek consent from the parents or guardians. For instance, the psychologist should maintain the confidentiality of a transgender child who needs to engage in irreversible gender transition to create trust with the teen (American Psychological Association, 2015 and Hiriscau, Stingelin-Giles, Wasserman & Reiter-Theil, 2016)). However, the teen is not regarded as having a mental capacity to make such a decision and the parents must consent. What should the psychologist do? The psychologist must work to serve the best interest of the teen but must respect the law. Therefore, the psychologist should seek parental consent even if doing so will result in distrust (Cave, 2017). According to Shumer and Tishelman (2015), the essence that the minor’s lack the capacity to make defined decisions and the requirement for the psychologists to maintain secrecy and confidentiality creates an ethical dilemma. The study demonstrated that failure to engage in informative and dialogue before revealing vital information create distrust among the client. Therefore, the psychologists should weigh the impacts of the silence and help the client understand his or her role in ensuring that the parent or guardian is willing to support the teen.
The paper provided a psychologists professional guideline and depicted two ethical dilemmas and tried to use the guidelines to solve these ethical issues. It was evident that ethical dilemmas are challenging to solve but by understanding the legal framework, integrity, taking responsibility and increased association that help in lobbying will enhance the ability of the psychologists to prevent the complex ethical situations. This guideline is effective for PIW for 10 years but needs to be accredited by the APA.
References
American Academy of Child and Adolescent Psychiatry. (2014). Code of Ethics. Retrieved August 19, 2018, from https://www.aacap.org/.../AACAP/.../aacap_code_of_ethics_2012.pdf
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist , 70 (9), 832-864.
American Psychological Association. (2015). Professional practice guidelines: Guidance for developers and users. American Psychologist , 70 (9), 823-831.
Batra, S. (2015). Duty of Hospitals in Protecting Patients’ Rights. ASCI Journal Of Management , 44 (2), 31-35.
Cave, E. (2017). Protecting Patients from their Bad Decisions: Rebalancing Rights, Relationships, and Risk. Medical Law Review , fww046.
Czarkowski, M., Kaczmarczyk, K., & Szymańska, B. (2014). Hospital Ethics Committees in Poland. Science And Engineering Ethics , 21 (6), 1525-1535.
Erdmane, A. (2010). Liberty behind closed doors …? Involuntary placement and medical treatment in psychiatric institutions from the human rights perspective. ICL Journal , 4 (1).
Hiriscau, E., Stingelin-Giles, N., Wasserman, D., & Reiter-Theil, S. (2016). Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study. International Journal Of Environmental Research And Public Health , 13 (5), 489.
Hoffman, J., & Koocher, G. (2018). Strategies for ethical practice in medical settings. Practice Innovations , 3 (1), 43-55.
Koocher, G. P., & Keith-Spiegel, P. C. (2016). Ethics in psychology and the mental health professions: Professional standards and cases (4th ed.). New York, NY: Oxford University Press.
Lakeisha Jordan v. District of Columbia,. (2016). Retrieved August 19, 2018, from https://www.gpo.gov/fdsys/pkg/USCOURTS-dcd-1_11-cv-01642/pdf/USCOURTS-dcd-1_11-cv-01642-1.pdf
Pietkiewicz, I., & Skowrońska-Włoch, K. (2017). Attitudes to professional boundaries among therapists with and without substance abuse history. Polish Psychological Bulletin , 48 (3), 411-422.
Psychiatric Institute of Washington. (2015). Psychiatric Institute of Washington Pre-Doctoral Internship Program. Retrieved August 19, 2018, from https://psychinstitute.com/wp.../01/Internship-info-for-website.pdf
Sori, C. F. (2006). Ethical and legal considerations when counseling children and Ffamilies. In L. L. Hecker & C. F. Sori (Eds.), Engaging children in family therapy: Creative approaches to integrating theory and research in clinical practice (pp. 159-174). New York: Routledge/Taylor & Francis.
Zur, O. (2017). Multiple relationships in psychotherapy and counseling: Unavoidable, common, and mandatory dual relations in therapy . New York, NY: Routledge.
