The Criminal Justice System
When working in the criminal justice systems, mental health professionals must take care to clarify their obligations and define their roles to the various parties involved. This may include the judicial system, the client, as well as society as a whole. Keeping the best interests of all involved may prove ethically challenging to mental health professionals. For example, maintaining a client’s confidentiality may be difficult in a prison setting, such as if a client discloses he is planning an escape attempt. Much forethought is required to adequately identify and explain the limits of confidentiality in such a setting.
The American Correctional Health Services Association (ACHSA) and the American Association for Correctional and Forensic Psychology (AACFP) have developed codes of ethics to provide mental health care professionals a clinician-derived guide for ethical clinical practice within correction settings. These specialized codes complement existing general ethical principles in decision making for correctional mental health providers. The major foci of these codes include client welfare, informed consent, competence, dual relationships, confidentiality, and social responsibility.
Working in community agencies can be ethically challenging, as well. For example, there is often limited funding available to these agencies (as they depend on local government support for funding). Mental health professionals may be squeezed to provide extra services or extra sessions in order to minimize costs. Of course, when people are overworked or they feel underpaid, they may result to cutting corners or begin to suffer from burnout. Ultimately, this may have a negative effect on the quality of treatment. Additionally, budget constraints may require agencies to pick and choose which clients are most likely to benefit the most from their services. For example, agencies may have to pick between providing services to two clients who would both benefit from counseling, but one client may benefit more. Mental health professionals may be called upon to determine which client would benefit the most; thus, denying services to another client who would also benefit—albeit, perhaps, less.
Business and Industry
The juncture at which the mental health profession meets business and industry is rife for ethical challenges for the mental health professionals involved. The main motive of business tends to be driven by money and profit. If money is the main motive, the rights and interests of clients involved my fall to the wayside.
Additionally, psychologists may be asked by companies to give evaluations of employees that could determine if they receive further employment or are promoted. Of course, the psychologist is serving the interests of the company and not the person being evaluated. It is important for psychologists to keep in mind who the actual client is and inform all parties involved who the client actually is. This is essential to avoid confusion and ethical pitfalls.
Working within medical settings often requires that mental health professionals interact with those from different educational and training backgrounds. This includes nurses, medical doctors, counselors, etc. Often, mental health professionals must become familiar with the various approaches to treatment of those from different backgrounds. Additionally, mental health professionals must take caution to not subservient themselves to others who may consider themselves as “holding a higher rank.” For example, psychiatrists may run the risk of assuming that they are above all others in the mental health field; thus, they may assume that they can give orders to all others.
Ethical pitfalls that may result for working in independent practice may be the result of isolated work environment. Those who work in private practice may be more likely to engage in unethical behaviors, since they are not directly observed or monitored by supervisors or colleagues. The financial burden of running a private practice may lead one astray, as well. For example, counselors in private practice do not have the luxury of paid vacation or sick leave. Therefore, they may stretch themselves by overbooking in order to earn extra money to compensate for the days when they are not working.
The qualifications of those doing pastoral counseling may not always be apparent. It’s possible to have clinically trained mental health professionals who engage in pastoral counseling, although there are many doing so with questionable training. For example, Koocher notes a textbook intended for those training to be pastoral counselors with the title, Counselor’s Guide to the Brain and its Disorders: Knowing the Difference between Disease and Sin. At times the mix of teachings from Holy Books and mental health texts may be incompatible. Depending on which teachings one is willing to adapt to his or counseling approach, could lead to ethical violations.