Bonner and Vandecreek illuminated a specific ethical dilemma related to confidentiality. In the example, an offender had been sexually assaulted in a prior correctional facility and was seeking psychotherapy for emotional trauma from a correctional clinician. However, the assault case had been accepted for prosecution, and the investigator wanted therapy records for the victim to assist with prosecution of the case (Bonner & Vandecreek, 2006). The necessity for the clinician to ask the inmate client for consent to disclose information complicates treatment in terms of a potential for aversive circumstances or emotions to result. Various ethical principles can be applied to this dilemma to formulate a resolution.
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According to the ethical principles of the American Correctional Health Services Association (ACHSA), all medical information is to be kept confidential (ACHSA, 2013). This includes maintaining confidentiality in regards to therapy information (Bonner & Vandecreek, 2006). In agreement, the American Psychological Association (APA) asserts psychologists should respect the dignity, worth, and rights of clients, which included maintaining privacy and confidentiality (APA, 2013). Release of such information requires the clinician to obtain consent from the client to release information for investigative purposes. The ethical principles of the American Association for Correctional and Forensic Psychology (AACFP) assert the necessity to avoid psychological harm to a client by releasing information without consent within Section B of the ethics code (Bonner & Vandecreek, 2006). Breaching confidentiality without consent could result in psychological harm and further suffering of the client, as well as causing the client to feel betrayed by the clinician (Bonner & Vandecreek, 2006). Based on the ethical principles discussed the mental health professional should obtain consent from the client to disclose information for investigative purposes in order to avoid psychological harm and further suffering from the client (Bonner & Vandecreek, 2006). In addition, the mental health professional should assist the client with preparing for potential aversive circumstances and emotions that could result from disclosing information (Bonner & Vandecreek, 2006).
Another ethical dilemma encountered by mental health professionals within a forensic setting is dual role conflicts. These professionals have the responsibility of maintaining safety and security along with the responsibility of treating clients and engaging in ethical practice (Springer & Roberts, 2007). Similarly, Bonner and Vandecreek (2006) assert maintaining ethical practice for clinicians is a compelling challenge due to the necessity to balance control and security of a correctional environment with providing mental health care to offenders. The ethical principles of the ACHSA and AACFP do not support the engagement in custodial duties by health care providers (Bonner & Vandecreek, 2006). According to the ethical principles of the AACFP, doing so could hinder or detract from the mental health professionalsââ‚¬â„¢ ability to provide optimal mental health care (Bonner & Vandecreek, 2006). However, the AACFP allows a mental health provider to engage in custodial duties in emergency situations. Emergency situations would be if the safety and welfare of offenders or staff are in jeopardy, which would require the assistance of all correctional staff to gain control of the situation (Bonner & Vandecreek, 2006).
In relation to the dilemma of dual responsibility, Bonner and Vandecreek (2006) described a scenario in which a mental health clinician was asked by the captain to report to work as a correctional officer within a housing unit because the assigned officer had called in sick. The mental health clinicianââ‚¬â„¢s primary job within the institution was to conduct intake psychological assessments of offenders (Bonner & Vandecreek, 2006). In this regard, the clinician cannot be performing their required assessments if they are performing the work of a correctional officer. However, all staff are considered correctional officers first within the agency. This contradicts policies related to mental health care workers, which states custodial duties should only be performed by health care providers in emergency situations (Bonner & Vandecreek, 2006). The dual responsibility of mental health professionals within forensic settings complicate treatment because they could be asked to perform other roles unrelated to treatment. In turn, this can detract from the treatment they are supposed to be providing (Bonner & Vandecreek, 2006).
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Resolving the ethical dilemma requires the mental health professional to consider their role and applicable codes of conduct. Principle 12 of ACHSAââ‚¬â„¢s code states clinicians should not participate in custodial functions (ACHSA, 2013). Correspondingly, Section B of AACFPââ‚¬â„¢s code conveys the obligation for clinicians to resist pressures and not engage in custodial duties that would detract from providing optimal mental health care (Bonner & Vandecreek, 2006). In a situation in which a clinician is asked to perform a duty as a custodial worker, the clinician should inform the captain making the request and his or her supervisor that custodial work outside of an emergency situation is a violation of their professional ethics (Bonner & Vandecreek, 2006). In addition, the clinician should inform the individual of policy related to mental health professionals that states custodial duties by a mental health professional is only allowed in emergency situations (Bonner & Vandecreek, 2006). The mental health professional should also explain they have a legal obligation to maintain the quality of the mental health services they provide and fulfilling custodial duties would detract from that quality. This response to the ethical dilemma corresponds to the APA guidelines for resolving ethical issues. In relation to section 1.03 of ethical code, APA suggests the psychologist clarify the nature of the conflict and convey his or her commitment to professional ethics when attempting to resolve an ethical conflict (APA, 2013).
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