_______________________________________________________________________ Ethics for Psychologists
4.05 Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law. (b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.) 4.06 Consultations When consulting with colleagues, (1) psychologists do not dis- close confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality.) 4.07 Use of Confidential Information for Didactic or Other Purposes Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable infor- mation concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so. Exceptions to Confidentiality There are basic exceptions to confidentiality based on the ideas of doing no harm and providing a benevolent relationship to the community in which a psychologist works. Breaches of con- fidentiality can produce feelings of betrayal and loss of trust in the therapeutic relationship, and such breaches are made only when it is necessary to do so. One exception to confidentiality is to ensure the safety of the person in treatment or any others. If a person divulges intent to harm or kill him- or herself, then it is the duty of the therapist to assist the patient in maintaining his or her safety. This may include breaching confidentiality to law enforcement, family members, hospital personnel, or treating physicians to ensure that no harm comes to the
patient. The APA Ethics Code notes, “Psychologists [should] take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable” [8]. Suicide and Self-Harm Out of the obligation of psychologists to minimize harm where it is foreseeable and unavoidable comes a duty to assist with civil commitment and involuntary hospitalization [18]. Suicide is a serious public health problem that affects people of all ages. For Americans, suicide is the 11th leading cause of death. It resulted in 48,183 lives lost in 2021 [19]. The top three methods used in suicides are firearm, suffocation, and poisoning [19]. More people survive suicide attempts than actually die. In 2020, 187,000 people received medical care for self-inflicted injuries at emergency departments across the United States [19]. Complicating evaluation and treatment is the issue of attempting to predict how likely persons expressing suicidal ideation are to actually harm themselves. Clinical assessment has relied almost exclusively on an individual’s self-report [20]. According to the Harvard Medical School Guide to Suicide Assess- ment and Intervention , “There is no psychological test, clinical technique, or biological marker sufficiently sensitive and specific to support accurate short-term prediction of suicide in an individual person” [21]. Risk management strategies are used to lessen the risk of suicide and strengthen the ethical and legal documentation of that evaluation. Several guidelines have been established for psychologists working with suicidal patients [3]: • Be familiar with the current literature regarding risk factors, epidemiology, and management of the suicidal patient. It is equally important for clinicians to be knowledgeable of the law of the jurisdiction and cur- rent developments in the field. • Take a complete patient history that includes indica- tors of suicide risk based upon diagnostic criteria and known risk factors for suicide. Throughout treatment, when risk is elevated the clinician should ask specific, forensically significant questions about depression and suicidal feelings and thoughts. • Obtain releases to consult with past therapists and secure the patient’s medical and mental health records. • Use the Diagnostic and Statistical Manual of Mental Dis- orders diagnostic criteria to accurately diagnose patients and guide treatment. • Recognize limitations (e.g., time restraints, appoint- ment availability), understand technical proficiencies (training, education, and experience), and be aware of emotional tolerance levels when working with suicidal patients.
41
EliteLearning.com/Psychology
Powered by FlippingBook