Legal and Ethical Issues for Mental Health Professionals
Gregory Lee Baize, Sr.
Video presentation: The video clip was quite interesting I found it to be very educational as to the legal obligations of therapists in the mental health field. There were issues that were brought up that were quite important, such as therapists need to understand confidentiality, privileged information, and a therapists responsibility related to reporting suspected child abuse, elder abuse, and/or suicidal ideations, and possibly the most important of them all is a therapists duty to warn. The first case they were focusing on was the case related to a child that was presented in the ER and seen by Nurse Brown and now because she did not report any suspected child abuse she was charged with a crime. The statement that the character Constance Brandis made was quite succinct; Nurse Brown noted “the child was brought in unconscious and undiagnosed or undetermined distress. She notes bruises, she asked foster mother about them, she gets an explanation, and she buys it. Remember, this is a licensed foster care mother. The boy is treated at the hospital, recovers and then goes home” (Psychotherapy, 2008). After this statement the question that this character had was definitely the appropriate question she said “is Nurse Brown a criminal who might be put in jail was she breaking the law should she be punished”(Psychotherapy, 2008).
There was further in-depth discussion related to the young boy by the name of Dominic and the actions or an action of Nurse Brown. The lady playing the part of the Judge stated “if the law wants to protect Dominic it must still do so constitutionally and Nurse Brown may have a point. She has raised an issue about the constitutionality of the statute” (Psychotherapy, 2008). Here we are told that “Nurse Brown has challenged the constitutionality of the child abuse reporting law by saying that it’s too vague” (Psychotherapy, 2008). As they continued their discussion the character by the name of Joseph went into great detail about statements being void for vagueness. His comment went something like this, “healthcare professionals who had reasonable cause for an inkling that a child was being abused must make a report. Too vague?” (Psychotherapy, 2008) It is obvious that this statement is a prime example of something that would be considered vague.
One thing that caught my attention and found to be quite interesting was the example given by the character by the name of Nellie she remarked about a situation that she claimed really happened “there was a young mother from Denmark visiting with her infant baby. It was a winter’s day, cold but nice. She stopped for lunch and did what they do in Denmark. She parked the baby in the carriage, all wrapped up in warm, and she went inside the restaurant into the seat by the window where she could watch the carriage”(Psychotherapy, 2008). This little vignette story that she told brought to my mind things that we are now seen in our community.
Then they went into discussion about mandated reporters and the difficulties that these individuals face related to determining what is reportable and what is not. The character that was playing the judge by the name of Constance went into a discussion about a Michigan case. And how Michigan decided that based on the therapists clinical judgment the choice not to credit our believe the child’s report of abuse may have been valid, but the states view as it is of high interest to the state to protect children from abuse the decision came down that the therapist should have reported despite whether she believed child or not.
The characters then went into great discussion about privilege or better stated the ideal of privilege. Nellie said “I got the idea of privilege very
clear. It’s simply a law. It’s a law that protects specific confidential conversations from disclosure by the legal process. It means simply certain things can be subpoenaed” (Psychotherapy, 2008). I then learned that each state basically has the same laws related to privilege and confidentiality with only slight differences. Their discussions continued about confidentiality and privilege talk about things such as automobile accidents where an individual sues the driver and owner of the vehicle, once the lawsuit is placed then that driver has the privilege to view any and all medical records as the injured party is requiring that they pay the bills. I paid particular attention to their discussion related to therapists being subpoenaed as part of a court action related to one of their clients. This discussion continued as the character Nellie relayed a story about a therapist friend that thought she might have smelled alcohol on her client as he was leaving that appointment to go and pick up his child. They discussed whether this therapist was mandated to report this information as this man would’ve been endangering his child if he was driving while intoxicated. They continued their discussion about couple individuals that had a fender bender when the female and former therapist that the accident was not that big of a deal but wanted to continue in therapy to address anxiety and marital problems. This is why the man involved in this accident but have the right to view her records from the therapist before paying for them if this was covered in the notes these therapy sessions would not have to be paid for by this individual.
Constance then led them in a discussion related to this statement, “in making a custody decision, is supposed to take into account each parents mental and physical abilities to parent. To do that, the information from a treatment provider can be most helpful. So if the information from a provider doesn’t make its way to the court by way of direct testimony, in defense to the confidentiality issues, it may do so through a guardian or evaluators interview with the provider. But in most cases, one way or another information from a counselor and his or her records will find its way to the judge who needs it” (Psychotherapy, 2008).
These three characters in this vignette brought up many good questions related to confidentiality, mandated reporting privileged information, and the Therapists responsibility related to reporting suspected child abuse, elder abuse and/or suicidal ideations, and the Therapists responsibility to warn third parties if it is apparent that they are in imminent danger. Constance states she believed the victim should be allowed to win in this case as they failed to avoid an avoidable harm. In so saying it is obvious to me that confidentiality cannot be an absolute, nor do we work in a perfect world. So as one goes forward working as a therapist and the mental health field it is important to understand the standards of our profession and how it is important for us to know whether a victim is in peril and that we always have the duty to warn or protect individuals in our care are affected by those that we provide mental health care for (Psychotherapy, 2008).
Summarization of Kentucky Board of marriage and family therapy code of ethics: In relation to the vignette that I just viewed, I find addressed in the following. Immediately as you look at the code of ethics that have been established for the Kentucky Board of marriage and family Therapists one notes that in section 1 it speaks of the Therapist’s responsibility to the client. Starts off with section 1a advance and protect the welfare of his client goes on under B respect the rights of persons seeking his assistants and C make reasonable efforts to ensure that his services are used appropriately number two speaking to the activities of an marriage and family therapists associate that there should be no exploitation of the trust and dependency of a client be no engagement in dual relationships see engage in a sexual relationship and many other areas are covered under the responsibility to clients.
Section 2 Confidentiality states directly here that a therapist or a therapists associate show respect and guard the confidences of each individual client. Further it states that a marriage and family therapist and a marriage and family therapist associate shall not disclose a client confidence except as mandated or permitted by law to prevent a clear and immediate danger to a person or persons. In section 2C further states that the therapist and therapist associate is a defendant in a civil, criminal, or disciplinary action arising from the therapy, confidence may be disclosed only in the course of that action; or is covered by section 2D if a waiver has been obtained in writing confidential information shall be reviewed only in accordance with the terms of the waiver.
Also covered under confidentiality 3 states a marriage and family therapist our marriage and family therapists associate shall not reveal any individual’s competence to others in the client unit without the prior written permission of that individual. To further protect the confidentiality of the clients records it states that a marriage and family therapist or marriage and family therapists associate shall store or dispose of client records so as to maintain confidentiality.
So basically as outlined by 201KAR 32:050 code of ethics for the profession of Marriage and Family Therapists, we note that sections 1 and 2 address immediately the therapists responsibilities to their clients and the issues of confidentiality. Further communicating the importance of these two sections and the therapists need to know and understand the sections explicitly (Kentucky Board of Licensure for Marriage and Family Therapists, 2011).
The American Counseling Association: addresses the issues that were covered in the video vignette under section B confidentiality, privileged communication, and privacy. Section B1a starts off with respecting client rights in relation to multicultural and diversity considerations, with section B1b covering respect for privacy. Then we come up on section B1c respect for confidentiality further states that counselors do not share confidential information without client consent or without sound legal ethical justification. Find it quite interesting and enlightening that this has been addressed in such a succinct manner. Section B1d gives us explanation of limitations, with section B2 speaking to the exceptions. As in section B2a danger and legal requirements through section B2b contiguous life-threatening diseases, section B2c court ordered disclosure, including section B2d covering minimal disclosure.
Section B3 information shared with others is covered in this area starting with section B3a subordinates, B3b treatment terms, B3c confidential settings, B3b third-party payers, B3e transmitting confidential information, B3f deceased clients. Next we note that section B4 addresses groups and families and the confidentiality required their no longer referring to the designations as laid out in the ACA code of ethics we see group work, couples and family counseling covered in this small section. Section B5 clients lacking capacity to give informed consent, is covered in sections such as responsibility clients, responsibility to parents and legal guardians, release of confidential information. Section B6 covers records, starting with confidentiality of records, permission to record, permission to observe, client access, assistance with records, disclosure or transfer, storage and disposal after termination, and reasonable precautions.
Thanks we note section B7 which covers research and training notably in the following sections institutional approval, adherence to guidelines, confidentiality of information obtained in research, disclosure of research information, and agreement for identification. Last noted in the ACA code of ethics under confidentiality and other aspects of practice we note section B8 consultation, covering all areas needed in cases of consultation such as agreements, respect for privacy, and disclosure of confidential information. As noted those are the areas covered by the ACA code of ethics related to client protection confidentiality privilege communication and the clients privacy all noted to be in line with the discussion viewed on the vignette. Looking back quite interesting how it appears that each and every section of the ACA code of ethics were covered (American Counseling Associate, 2005). Response: Despite the many years that I have worked in mental health there were moments that my knowledge was expanded and added to related to individual client protections, confidentiality, and duty to report. I think as it was noted and discussed amongst the actors in the vignette that mental health professionals carry out much larger burden in their attempts to protect their clients and their confidentiality and knowing just when to break those confidences for the safety and sake of their clients and others.
Most medical professions noted through an outward observational format. Have a much easier task as related to patient confidentiality, and other issues related to ration care and sharing of information with other peers to provide better care for their patients. Unless a medical doctor was caring for an individual with a psychiatric diagnoses it appears to me that they would have little cause to have as many issues related to confidentiality, privilege, and duty to warn among the few issues faced by therapist every day. One thing that I did glean from this vignette was the importance and detail that must be put into protecting, and caring for our clients in the best way possible. One must remain alert and on their toes as it is my experience within the mental health community that these issues will come up daily. With this new gain knowledge there are certain steps that I believe I’m going to slow down and make sure I cover each and every aspect of protection for the clients that will be under my care. Action: After viewing this vignette it has become quite evident to me that I must stay abreast of the Kentucky state board a marriage and family therapists code of ethics, the ACA code of ethics, and the AACC code of ethics as well. I have printed out all these codes of ethics and put them in my briefcase for continuous review at any time so that I may remain knowledgeable about my requirements as a therapist. Plus as I go forward in this educational process during my observation and internship with a marriage and family therapist I plan to ask and seek information as to how they ensure that all these issues are protected at all times.
One thing I have gained from this class already is that our biggest area of importance is the protection and care of clients who have entrusted their lives to our care. All clients are going to be given an informed consent for counseling so they too understand their protections by the law and my approach to psychotherapy. They also will be requested to sign a release of information and given a hip a notice during their first meeting with myself. I must say in closing this vignette has given me many tools to use and things to ensure that I think constantly about the safety care and privacy of those under my care.
American Counseling Association (2005). ACA code of ethics: as approved by the ACA governing council. Retrieved September 15, 2013, from www.counseling.org/Resources/aca-code-of-ethics.pdf Kentucky Board of Licensure for Marriage and Family Therapists (2011). Code of Ethics.
Retrieved September 22, 2013, from www.lrc.ky.gov/kar/201/032/050.htm Psychotherapy.net (Producer), & Greg Summers (Director). (2008). Legal and Ethical Issues for Mental Health Professionals, Vol 2: Dual Relationship Boundaries, Standards of Care & Termination. Available from http://ctiv.alexanderstreet.com.ezproxy.liberty.edu:2048/view/1779008