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Clinical and Social Contexts of Ethical Issues in Mental Health Care

Hi! 
Perhaps you’ve wondered why we even need to include information about ethics when dealing with mental health care. Practitioners are very well trained and probably wouldn’t do anything to hurt their clients (which might end up hurting themselves, too), right?! Wrong! Practitioners are human beings and sometimes make judgmental errors and end up getting swept away by their feelings. They’re fallible, just like the rest of us. They may even have their own mental health issues.
 
So, developing and enforcing ethical rules is a very important practice, as this protects both the client and practitioner by outlining behavior that is appropriate (for the practitioner). In this way, everyone stays safe, and clients receive good quality care. However, there are practitioners who, despite their knowledge and efforts, still violate these rules. Ethics not only needs to be taught, but also needs to be enforced by appropriate governing entities. 
 
What are Ethical Issues in Mental Health?
 
The study of ethics is actually part of the discipline of philosophy which delves more deeply into moral aspects of human existence and the things we do. Ethics in any profession has its roots in research of situations that occur during the practice of one’s profession. Also, ethics has roots in professionalism – or what is appropriate behavior and demeanor for practicing professionals. Some ideals included under the banner of professionalism are truthfulness, respect for the dignity of one’s patients or clients, and humility. These are clearly issues of morality. Practicing professionals need to have moral standing and conduct themselves appropriately, which means that patients and clients should be able to trust them.
 
Also, in the context of different mental health issues, counselors and therapists come across some very sensitive subjects, which inevitably leaves clients in a position of vulnerability. The study and practice of ethics helps and guides practitioners to never take advantage of this vulnerability. Clients can thus be reassured that they will receive high quality care and they will not be compromised.
 
What are ethical issues in mental health overall and mental health practice? One example of an ethical issue in mental health care would be coercive treatment of individuals being admitted to treatment in an involuntary or non-voluntary manner; this means they are admitted without their consent. Another example revolves around protecting people who are mentally ill or perhaps even just frail (elderly) from abuse and neglect. Is a person treated with dignity? If not, this becomes a serious issue in mental health. Is a family member who is taking care of an elderly person not behaving ethically, legally, and morally? There also exist challenges in programs for addiction treatment and how practitioners might treat their clients ethically, especially due to the need for more research in this area.
 
Ethical Issues & Mental Health: Right to Treatment, Informed Consent, and Confidentiality.
 
One important ethical issue in mental health is client rights, and three of the main issues under this banner are client confidentiality, client’s right to treatment, and informed consent. As to confidentiality, clients have the right to speak with their practitioner in confidence, although some exceptions exist. The second one, having the right to treatment, means basically that practitioners have a legal, moral, and ethical duty to provide treatment that will benefit the client. The third right, informed consent, means the practitioner shares enough information with the client in a way in which the client can understand, so that the client can make an informed decision about participating in treatment. In this way, clients are empowered, and autonomy is promoted, an important goal of mental health treatment. 
 
What are Ethical Issues in Making a Mental Health Diagnosis?
 
Even with the advancements made in the field of treating individuals with mental health issues, there is still – worldwide – a pronounced stigma attached to being labeled with a mental health diagnosis. Stigma within the context of mental health means that people view them in a negative way; many people look down upon those with mental health diagnoses, and this turns into a negative stereotype, and often influences others to see them in the same way. This translates to people holding negative attitudes and beliefs toward a person who has a mental health disorder, which then makes the job of getting well again even more difficult than it already is.
 
Discrimination can be overt (very obvious) or covert (subtle, in hiding so to speak). This usually leads to harm. Individuals with some type of mental illness are subjected to mistaken media representations, and this exacerbates an already difficult situation. There are several types of stigma, public (what others think), self (what you think or feel, such as shame), and institutional (policies of organizations like government that limit opportunities, such as funding for treatment).
 
What all this means is that many people do not reach out for help, and their symptoms will usually get worse over time. People may lose hope, think poorly of themselves and their ability to function at a higher level, and they may have difficulty with social relationships and at work. In fact, if people stigmatize themselves, they are less likely to recover from their illness.
 
This needs to change. The world needs to become more educated on exactly what mental illness is and is not.
 
Ethical Issues in Mental Health Assessments. 
 
When a person is going to be assessed because this individual has shown signs of mental health issues, this means they have certain rights. These rights include being treated with respect and kindness regardless of age, disability, gender, religion, sexual orientation, etc. It also means that they are tested using professional standards which are appropriate for them. For example, there are age-appropriate assessments for teenage mental health issues and certainly ones for children, since there are ethical issues in mental health practice for kids.
 
Some ethical issues to ponder are whether the psychologist who is conducting the assessment is competent enough to do so, and whether the assessment instrument which is being used is reliable and valid for this particular purpose. At times, when test scores over time are different this may be due to measurement error or other mitigating variables like fatigue or illness. Another potential ethical issue may be that test materials are not kept in a secure space, and this could violate client confidentiality rights. After a diagnosis is reached, largely based on the test results, the disorder is going to have a name (i.e., it is labelled), and hence, there will unfortunately be a stigma attached to this label.
 
How Does Lack of Sleep Affect Both Physical and Mental Health Issues?
 
Sleep – or lack thereof – can be a “make it or break it” factor in how healthy a person is able to be. Human beings were created to have a healthy sleep cycle…a time of restoration, healing, refreshing, and even elevating a person’s mood. Deficiencies in sleep may be a factor associated with depression, suicide, one’s ability to function socially, and may also contribute to mood swings.
 
Not getting both enough sleep in terms of hours plus quality can negatively impact one’s productivity at work or school, in terms of taking longer to get things done, experiencing a slowed reaction time to events, and just in making mistakes, especially ones that normally are not made.
 
One dangerous factor is that a person may not feel sleepy and judge themselves to be able to drive, for example. Drivers being sleepy is a major factor in thousands of car accidents and may result in 1500 deaths each year. This does not only apply to driving – this affects healthcare workers, pilots, and many others. In professions where accuracy can be a life or death matter, it is even more important to have enough sleep. Would you want a surgeon working on you without a good night’s sleep?
 
Benefits of good sleep lie in healing/repairing of the cardiac system, supporting a healthy balance of hormones, normal insulin levels, ability to fight germs and illness, and decreases one’s overall risk of health issues like blood pressure, obesity, and strokes. Further, getting a good night’s sleep can help improve one’s learning and ability to solve problems, keeping one attentive and supporting one’s creativity.
 
***
 
Mental health issues are increasing, especially over the last few years as the COVID pandemic has been raging. Some common mental health issues are depression and anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), eating disorders, neurodevelopmental disorders, and more.
 
Further, types of mental health issues can be found in anger, anxiety and panic attacks, depression, dissociative disorders (think multiple personality), eating issues, and more.
 
While research is still underway to discover more about what causes mental health issues, we already know that childhood abuse, trauma, neglect, social isolation, experiencing stigma, poverty, grief, severe stress, etc. play major roles in the development of mental health issues.
 
It is therefore critical to continue to delve into ethical issues in mental health counseling, looking at ethical issues in mental health rehabilitation, and also pay close attention to ethical issues in mental health research, which supports the practice of helping people. Overall, the ethical and social issues involved in mental health are very important to address effectively.
 
Remember – knowledge is power so take charge of your health.
 
And, as always, please have a happy, holistically healthy day!
 
Dr. P

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