Crisis Application Assignment 1

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Chapter Fifteen: Legal and Ethical Issues

Introduction

Crisis intervention presents intriguing ethical dilemmas and challenges for mental health workers

Ethical guidelines should be honored

Crisis situations create impossible situations to follow ethical guidelines

Ethical codes do not specifically address crisis intervention services

Workers are left to make decisions based on reflection and consultation

Nuances matter

The legal and ethical questions of a crisis situation can change quickly

Ethical and Legal Interface with Crisis Intervention

Misconceptions regarding ethical decision making

Decision-making models are practical

Time to consult

One correct answer

The role of the mental health professional

Safety

Calming

Self and collective efficacy

Connectedness

Hope

The Confluence of Beliefs, Emotion, Morality, and Values

Vulnerability and resiliency are dynamic

Crisis workers need to understand their reasons for doing crisis work

Understand personal values, beliefs, and background

Reflection

Supervision

Nonrational factors influence ethical decision-making

Context

Perceptions

Relationships

Emotions

Learning processes

Laws and Ethical Codes Are Living Documents

Laws are mandatory

Ethical codes are aspirational

A good “bedside manner” is the best risk management strategy

Legal requirements and ethical codes can conflict

Often no single right answer

Consult an attorney

Choose the least harmful option

Consider the effect on the community over the individual

Confidentiality and Privacy

Confidentiality—the legal duty to protect client’s private communication

Privacy—client’s righto to choose what to say and when to say it

Privileged Communication

Legally prevents disclosure of confidential information

Laws differ by location

Limited in certain circumstances

When a reasonable practitioner has the duty to protect clients or others from serious and foreseeable harm

Duty to Warn, Protect, and Report (1 of 2)

Duty to warn rules are location specific

Tarasoff v. Regents of the University of California

Duty to warn holds across counseling modality and venue

Tarasoff mandated conditions for warning

Must be a special relationship (e.g., client-therapist)

Must be a reasonable prediction of dangerous conduct

Must be a foreseeable victim

Duty to Warn, Protect, and Report (2 of 2)

Guidelines for action when a clear threat of violence is made

Clearly state the limits of confidentiality

Special rules may apply for minors

Consult and document

Warn identified potential victims

Warn despite threats of reprisal

Negligence and Liability

Negligence—the unintentional breach of duty one person owes another

Practitioner has a duty

Duty has been breached through an unprofessional act or omission

Client sustained physical or emotional harm

Practitioner’s behavior caused the harm

What is the professional standard of practice?

Areas of vulnerability

Practicing outside one’s scope

Incompetence

Failure to use most beneficial techniques

Failure to obtain informed consent

Failure to protect from harm

Clinical Supervision of Crisis Workers

Vicarious Liability--Supervisors may be liable for supervisee’s actions

Supervisors have the authority to direct supervisee’s work

Extent of vicarious liability affected by various factors

Presence of an employment relationship

Extent of authority supervisor holds

Number of supervision levels present

Which supervisor has the most direct contact with supervisee

Moral Principles of Ethical Decision-Making

Autonomy

Client’s right to self-determination

Beneficence

Working for the good of the client and society

Fidelity

Keeping one’s promises and commitments

Justice

Fostering fairness, equality, and equitable access to care

Nonmaleficience

Avoiding actions that cause harm

Using Ethical Decision-Making Models

Benefits

Allow crisis workers time to consider legal and ethical facets of a situation and make the best decision

Limits

Time is often short in a crisis situation

Cultural aspects often left out of models

Not always a right answer available

Discernment

Worker’s ability to perceive a course of action amid the chaos

Affect Heuristic

Decision-making primarily based on personal biases, relationships, and context

Becoming a More Effective Crisis Worker

Reflective Practice-- Process of thinking about:

Being a crisis responder

One’s clinical interventions

How to improve your clinical skills

Self-care

Respect for one’s dignity and self-worth

Recognition that self-care is how individual workers prepare to provide care for others during crisis situations