WK 1 SOCW 6443 Discussion 2: Ethical Dilemas for Mental Health Professionals
WK 1 SOCW 6443 Discussion 2: Ethical Dilemas for Mental Health Professionals
Mental health professionals are charged with the task of assisting their clients efforts in obtaining the best care available to them. Often, this might mean making recommendations and referrals, teaming with other medical and mental health professionals, and developing and expanding competencies to meet the needs of their clients. Although there are strict limits to some mental health professional roles in reference to medication management, mental health professionals can serve a vital role in the process.
For this Discussion, review the media titled The Role of the Mental Health Professional in Psychopharmacological Intervention and the Learning Resources. Explore the limits of practice in psychopharmacological intervention. Search your professional practice code of ethics and consider how ethical dilemmas that arise in the course of treatment might be mitigated. Check actual final video
This is a discussion so questions in bold and then answers 300 to 500 words not including the questions
Post an explanation of how mental health professionals might prepare themselves to best work with medical professionals in the example you provided in this weeks Discussion 1 which is attached (include the need for using a signed release of information).
Next, identify a potential ethical dilemma for mental health professionals related to your example and explain why this could be a dilemma.
Then, provide the most effective strategy mental health professionals can use to mitigate the dilemma and justify your selection.
Finally, as a future mental health professional, explain some of the concepts in the field of psychopharmacology in which you would like to explore the role further to gain more knowledge.
Be sure to support your postings and responses with specific references to the Learning Resources.
Be sure to support your postings and responses with specific references to the Learning Resources. 7th addition APA format intext citing and full references
Resources
Preston, J. D., ONeal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.
Chapter 1, “Introduction” (pp. 314)
Chapter 2, “Integrated Models” (pp. 1527)
Running Head: PSYCHOPHARMACOLOGICAL INTERVENTIONS 1
PSYCHOPHARMACOLOGICAL INTERVENTIONS 2
Psychopharmacological Interventions.
Students Name:
Professors Name:
Date.
Post and describe one example of where psychopharmacological interventions are warranted in mental health practices.
Psychopharmacological interventions are the study of how the medication should be administered to treat and handle medical disorders. This study is so complex and therefore requires the professionals involved to remain engaged in ongoing and progressive studies to update themselves with sufficient knowledge on the new advancements and other upcoming disorder-related issues (PMC, 2020)). Currently, the most effective well-known treatments for attention include the use of stimulants and atomoxetine.
Psychopharmacological interventions are fully justified to be used in youth with a disorder known as Attention Deficit Hyperactivity because they are the first line of treatment in such complications in most children as it is believed to have an effectiveness of 80% (John D. Preston et al, 2017). Perhaps this attention is well known for its effectiveness in improving concentration, hyperactivity, and stereotyped movements. Although in the previous example the use of this type of drugs is entirely justified, it is essential to highlight that the role of the mental health professional who attends this type of case is of great importance since they must consider factors such as right dosage, time or length of time for treatment and the essence of carrying out complementary tests so as to avoid problems associated with the consumption of this type of drug.
Likewise, the specialist must analyze the appropriate time to withdraw the treatment; once the decision has been made to withdraw it. It is crucial to keep a close follow-up and plan a very gradual withdrawal from treatment. At this stage, it will be necessary to make clear to the child and his family what the first warning signs of a possible recurrence may be. Another aspect that the specialist in the prescription of psychotropic drugs in children with Attention Deficit Hyperactivity Disorder should consider is the side effects (John D. Preston et al, 2017). An example where psychopharmacological interventions are warranted in mental health practice can be when the patient proves to be in apprehension. The client concentration becomes challenging, limiting progress in mental health treatment. The client fails to attain daily goals.
Explain the mental health professionals role in the example that you provided.
The health professional’s role or would be to ensure the patients symptoms are understood. The causes of the mental challenge will be determined with the counselor through professional analysis. Psycho-pharmacological intervention is essential to a client to ensure drug-induced remedy the condition. Situations that would require Psychopharmacological intervention include when the client fails to achieve planned goals for the day due to mental illness (John D. Preston et al, 2017) When the client has a looming danger, they will be required to seek changes through Psychopharmacological intervention when the patient is powerless.
Health professionals are tasked with assisting the client in receiving adequate treatment. It is essential to consider the perspective of the client before making assertions. The role of mental health professionals will be to point out the cause of the psychological problem. Concerns that should be handled with the client will be identified with the mental health professional. The counselor will link the client with a psychiatrist to enhance effective treatment and recovery (PMC, 2020).
References
GoodTherapy. (2016, April 18).Psychopharmacology. GoodTherapy.org Therapy Blog.
https://www.goodtherapy.org/blog/psychpedia/psychopharmacology
John D. Preston et al,B. (2017, April 27).Handbook of clinical psychopharmacology for therapists, 8th edition : John D. Preston : 9781626259256. Book Depository: Free delivery worldwide on over 20 million books.
https://www.bookdepository.com/Handbook-Clinical-Psychopharmacology-for-Therapists-8th-Edition-John-D-Preston/9781626259256
PMC. (2020, January 26).A review of Psychopharmacological interventions post-disaster to prevent psychiatric sequelae. PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5274533/ The Role of the Mental Health Professional in Psychopharmacological Intervention
The Role of the Mental Health Professional in
Psychopharmacological Intervention
Program Transcript
[MUSIC PLAYING]
JASON PATTON: One of my clients needs psychopharmacological medication.
We’re counselors. Why would we support medication if we’re counseling?
There are a few major reasons why clients benefit from a combination of both
counseling and medication to treat their mental health symptoms. Medication
might provide the boost the client needs to get over that initial hump to really
begin the process of counseling. Additionally, a client may be a danger to him or
herself, or others. Clients may also be in such a debilitating state that medication
is the only way to turn their condition around.
Several diagnoses are so severe that medication is truly necessary. Clients
undergoing combined treatment often have better outcomes and longer lasting
treatment results. In order to meet our clients needs, therefore, clients must
collaborate with other mental health professionals in order to meet some of our
clients’ needs.
What does the term collaborative care mean? How about integrative care?
Essentially, these terms refer to efforts across medical, mental, allied, and other
health paradigms to meet the needs of patients and clients. Research suggests
that collaborative care meets clients health needs quickly, positively, and
effectively, with less follow-up care necessary.
Counselors serve important roles on these teams when clients have mental
health care needs that warrant medication management, hospitalization, or some
advanced level of care. Given the appropriate permissions, counselors have the
opportunity to learn information in the process of client treatment that might have
otherwise not have been available to mental health care professionals. Other
counselors are privy to information that clients might intentionally or
unintentionally fail to communicate to their other health professionals, as well.
For example, a client discusses abusing her or his anti-anxiety medication
without telling her or his doctor. Here, she might be afraid that the physician
would stop offering this prescription if they were to disclose that information. How
might a counselor act on one of these teams? She or he may be an organizer, a
participant, or a consultant.
In the most engaged of these scenarios, counselors may be present for every
meeting and facilitate every discussion involving the client. However, in most
cases, counselors engage one-on-one with psychiatrists, prescribing physicians,
2014 Laureate Education, Inc. 1
The Role of the Mental Health Professional in Psychopharmacological Intervention
psychologists, and social workers. One important part of this is the counselor’s
ability to speak the language of the constituents with whom she or he works. This
course represents an important step in the process of learning how to converse
with other professionals in this language.
As you move forward, pay particular attention to any areas in which you might
have had less experience and might be more likely to have blind spots. These
blind spots could potentially lead to some ethical issues. Remember, the most
important thing for you to learn about psychopharmacology relates to the limits of
your sphere of competence and scopes of practice. Good fortune as you move
forward.
The Role of the Mental Health Professional in
Psychopharmacological Intervention
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Ethics & Behavior
ISSN: 1050-8422 (Print) 1532-7019 (Online) Journal homepage: https://www.tandfonline.com/loi/hebh20
Ethical Care for Vulnerable Populations Receiving
Psychotropic Treatment
Darren R. Bernal, Rachel Becker Herbst, Brian L. Lewis & Jennifer Feibelman
To cite this article: Darren R. Bernal, Rachel Becker Herbst, Brian L. Lewis & Jennifer Feibelman
(2017) Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment, Ethics &
Behavior, 27:7, 582-598, DOI: 10.1080/10508422.2016.1224187
To link to this article: https://doi.org/10.1080/10508422.2016.1224187
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Ethical Care for Vulnerable Populations Receiving
Psychotropic Treatment
Darren R. Bernal, Rachel Becker Herbst, Brian L. Lewis, and Jennifer Feibelman
Department of Psychology
University of West Florida
The increasing use of pharmacotherapy raises specific ethical concerns for psychologists working
with vulnerable populations. Due to a shortage of trained specialists, professionals without training
in mental health, such as primary care providers, are increasingly prescribing and monitoring
psychotropic medications. Vulnerable populations (e.g., older adults, people currently low in social
status, immigrants, and racial/ethnic minorities) face additional barriers to mental health treatment
and are at heightened risk when these factors intersect. Hence, these patients experience unique
barriers to receiving optimal psychopharmacological care and are differentially vulnerable to dele-
terious outcomes associated with misdiagnosis and overmedication. Taken together, these factors fuel
inequities in the access, quality, and utilization of mental health care. Psychologists working with
these patients are ethically mandated to protect patients from harm and ensure equitable care across
patient populations. Specifically, psychologists must respond to the dilemma of how to effectively
treat patients within these vulnerable populations who have been misdiagnosed or poorly medicated
while remaining within the bounds of their competence. This article recommends pathways to
address these dilemmas through education, training, research, and advocacy.
Keywords: socioeconomic status, elderly, immigrants, ethics, psychotherapy
PSYCHOPHARMACOLOGICAL TREATMENT OF VULNERABLE POPULATIONS
Mental health treatment in the United States has evolved to include professionals from multiple
fields, both within and outside of psychology. Many patients receive psychopharmacological
interventions in conjunction with psychotherapy. As a result, psychologists may face ethical
dilemmas when patients in their care receive suboptimal treatment from other sources, such as
when psychotropic medications are prescribed by nonpsychiatrists. Populations such as the
working poor or racial/ethnic minorities have risk factors that leave them vulnerable to adverse
This article was accepted under the previous editor, Gerald P. Koocher.
Rachel Becker Herbst is now a Pediatric Psychologist at the Department of Physical Medicine and Rehabilitation,
Childrens Hospital Colorado. Brian L. Lewis is now in independent practice in Roanoke, Virginia. Jennifer Feibelman is
now with the Graduate Student Department of Psychology at University of West Florida.
Correspondence should be addressed to Darren R. Bernal, Department of Psychology, University of West Florida,
11000 University Parkway, Pensacola, FL 32514. E-mail: [emailprotected]
ETHICS & BEHAVIOR, 27(7), 582598
Copyright 2017 Taylor & Francis Group, LLC
ISSN: 1050-8422 print / 1532-7019 online
DOI: 10.1080/10508422.2016.1224187
mailto:[emailprotected]
side effects from psychotropic medications. This increased risk likely results from a confluence
of factors such as marginalization, interpersonal bias (Levine & Ambady, 2013), inadequate
treatment (Alegria et al., 2008), and providerpatient communication difficulties (Verlinde, De
Laender, De Maesschalck, Deveugele, & Willems, 2012; Zolnierek & DiMatteo, 2009). In
addition, the likelihood that psychologists will treat members of vulnerable populations is
increased by growth among these populations and increasing prevalence of psychotropic treat-
ment. Due to changes in health care professionals rolesespecially concerning psychopharma-
cological prescriptionsit is important for mental health professionals to build competence to
respond to the needs of vulnerable populations. This article introduces ethical concerns for
treating vulnerable populations and offers guidelines for mental health professions working with
these populations.
Increasing Prescription Rate
Prescription of psychotropic medications such as antidepressants has undergone a dramatic change
in the past 25 years (Pincus et al., 1998) with usage increasing in American adults from 6.1% to
11.1% between the years 19881994 and 19992002 (Paulose-Ram, Safran, Jonas, Gu, & Orwig,
2007). Although research indicates that the use of antidepressants may have peaked in the early
2000s (Harman, Edlund, & Fortney, 2009), the prescription of antidepressant medications has shown
a continued increase in certain populations such as the elderly (Hanlon, Handler, & Castle, 2010),
older nursing home residents (Maguire, OReilly, Hughes, & Cardwell, 2011), and some racial/
ethnic minority groups including African Americans and Latinos (Paulose-Ram et al., 2007). The
role of psychopharmacology has become increasingly relevant in light of the declining use of
psychotherapy. Between 1998 and 2007 the reported rate of psychotherapy use decreased from
53.6% to 43.1% per 100 persons receiving outpatient treatment for depression (Marcus & Olfson,
2010; National Alliance of Professional Psychology Providers, 2010). This approximately 10% drop
in psychotherapy utilization was accompanied by an increase in prescription of psychotropic
medication (Marcus & Olfson, 2010). Despite this prescription increase, research on the use of
these medications with vulnerable populations is generally lacking in adequate drug trials. Thus,
there is an increased demand for and an expansion of medications, but there is insufficient informa-
tion about prescribing effectively in vulnerable populations. This is of particular concern, as the role
of the primary care provider has evolved from gatekeeper to direct and sole provider of mental health
care for many patients with depression.
Decreasing Referrals
Historically, primary care providers conducted assessments and referred patients to specialists when
needed, such as when psychological problems were suspected. However, the primary care setting has
emerged as the most common avenue to psychotropic treatment, thus disrupting the traditional
referral pathway to psychologists. The use of psychotropic medications as the first line of defense
(Gray, Brody, & Johnson, 2005; National Alliance of Professional Psychology Providers, 2010) is
not inherently problematic, as they are valuable for treating mental health concerns; however, several
factors complicate the treatment process. Due to greater demand for psychological skills in primary
care settings, existing gaps in treatment and training have become more pronounced. Deficiency in
psychological skills and increased medication prescription compound with risks particular to
VULNERABLE POPULATIONS, PSYCHOTROPICS, AND ETHICS 583
vulnerable populations and further increase risks. Because members of vulnerable populations are
underrepresented in clinical trials and because primary care providers may not be well versed in
multicultural mental health considerations, there is more risk for error in prescribing psychotropics to
members of vulnerable populations.
Psychiatrists maintain that there has been a long-standing problem of insufficient mental
health training for primary care providers and this is an area in need of improvement (Hodges,
Inch, & Silver, 2001). As a result of increased time pressures and inadequate training, primary
care providers often rely on brief screening methods, and residents have reported feeling
underprepared to deal with the psychosocial problems of their patients (Duke, Griffith, Haist,
& Wilson, 2001). In addition to feeling underprepared, primary care providers are not substitutes
for psychologists, as they are not trained to provide therapy. This undesirable situation may
present a larger disservice to the patient or provider.
Despite these concerns, primary care providers in the United States have been found to
prescribe up to 70% of antidepressants (National Alliance of Professional Psychology Providers,
2010), which belong to the second most prescribed class of drugs in America, preceded only by
antihypertensives (Lindsley, 2015). This increase of psychotropic medication prescription by
primary care providers is disconcerting, given these providers documented difficulty in
accurately identifying mental health problems (Furedi, Rozsa, Zambori, & Szadoczky, 2003;
Jones, Badger, Ficken, & Leeper, 1987; Von Ammon Cavanaugh & Elliott, 1988; Watts et al.,
2002) and their propensity to prescribe psychotropic medications without consistently making a
formal diagnosis (Beardsley, Gardocki, Larson, & Hidalgo, 1988). Studies using the NIMH
Diagnostic Interview Schedule found a low detection rate of mental health concerns by general
practitioners in their patients (Jones et al., 1987), as well as a low level of agreement between the
general practitioners diagnosis and standardized measures for diagnosis (Furedi et al., 2003),
with increased diagnostic accuracy when patients presented a lack of somatic complaints. The
purpose of highlighting these discrepancies is not to criticize primary care providers for making
diagnostic errors in the area of mental health, but rather to raise awareness among psychologists
of an ethical concern, as these errors have implications for our field and our patients. An
additional concern is the need for continued monitoring for some psychotropic medications
due to deleterious side effects. In a small number of cases, primary care providers may not able
to provide consistent monitoring of mental health and psychotropics due to lack of patient
follow-up.
Shifting Prescription Rights and Professional Roles
The number of health care professionals with prescription rights may compound the problem
of pharmacotherapy without adequate monitoring capacity. In addition to primary care provi-
ders, about one fourth of advanced practice psychiatric nurses have the ability to prescribe
independently in 15 states as of 2003 (Feldman, Bachman, Cuffel, Friesen, & McCabe, 2003).
In addition, nurses can collaborate with providers to prescribe in another 27 states (Feldman
et al., 2003). These nurses are often in the position to see vulnerable populations due to their
potentially lower billing rate and location in rural areas. This additional prescription authority
represents another health professional with whom psychologists may collaborate in order to
provide optimal services to their patients.
584 BERNAL ET AL.
Further complicating the treatment process, psychiatry, a discipline that is typically
associated with psychology, has a personnel shortage (Lipzin, 1979; Thomas, Ellis,
Konrad, Holzer, & Morrissey, 2009). The current data indicate a shortage of psychiatrists
in 96% of American counties (Thomas et al., 2009), and this overall trend is expected to
continue until at least 2020, according to the U.S. Department of Health and Human
Services (2006). This shortage also increases the difficulty of finding psychiatrists who
have expertise in areas underrepresented in research, such as treatment of specific immigrant
cultures. Not having enough psychiatrists to meet the demand puts an additional burden on
the primary care providers to address mental health needs.
With a shifting psychopharmacological atmosphere, it is important to define the roles of
psychologists in treatment of medicated patients (McGrath & Rom-Rymer, 2010). A psycholo-
gist may have prescription rights or may work more indirectly by advocating for patients and
collaborating with other health care professionals. Psychologists must assess whether they have
the competence required for collaborating on medication prescription decisions and must decide
if their input regarding medication prescription is to the benefit of the patient. Factors that may
influence these decisions include the number of clientele taking psychotropic medications,
consideration of medications side effects, age of patients, race and ethnicity of patients, and
severity of patients illness or symptoms. Currently, there is a gap within the health care delivery
system, with a large proportion of psychotropic medication prescriptions being ordered by
primary care providers who have not had extensive mental health care training. Similarly,
most psychologists have not had extensive biological or medical training. Psychologists can
close this gap by collaborating with providers, by advocating for their patients, and by serving as
consultants for other health care professionals.
THE ROLE OF THE PSYCHOLOGIST
Vulnerable populations may receive substandard health care, which can result in increased,
rather than decreased, suffering. Patients receiving substandard pharmacotherapy while engaged
in psychotherapy may misattribute their side effects. For example, patients may attribute
increased mood fluctuation or depressed mood to their participation in psychotherapy if they
are not properly informed about their medications. The advent of integrated care, increased use
of psychotropic medications, and the burgeoning size of vulnerable populations such as Latinos
and the elderly in the United States (U.S. Census Bureau, 2012) have combined to create a new
frontier in the treatment of mental health concerns. Psychologists are thus faced with a new role
and new challenges, and this is particularly true when helping marginalized populations.
To address psychologists role of working with pharmacotherapy, the American Psychological
Associations (APAs) ethics task force concluded that issues related to prescriptive authority were
addressed under current sections of the Ethical Principles of Psychologists and Code of Conduct
(APA, 2010) and did not require a special section (Resnick & Norcross, 2006). Therefore, the
current Code of Conduct (APA, 2010) lacks specific guidance on potential ethical dilemmas
associated with psychotropic medication; however, it does provide a framework from which to
approach these ethical concerns. In this section, we discuss the broad application of this framework
to the psychologists role in working with patients from vulnerable populations who are receiving
VULNERABLE POPULATIONS, PSYCHOTROPICS, AND ETHICS 585
pharmacotherapy. We build upon this foundation in subsequent sections, where we present
considerations specific to different vulnerable populations.
The Code of Conduct (APA, 2010) has two principles and one standard that are particularly
salient to ethical dilemmas posed by working directly with vulnerable populations who are being
prescribed psychotropic medications. The first relevant principle is Principle E: Respect for
Peoples Rights and Dignity. This principle states, Psychologists try to eliminate the effect on
their work of biases based on those factors, and they do not knowingly participate in or condone
activities of others based upon such prejudices (APA, 2010, p. 4). The vulnerable populations
discussed in this may have been subjected to biases such as those based on age, language, race,
and social statusbiases that could affect the accuracy of their evaluations for psychotropic
prescription. If the psychologist suspects that his or her patient may have been misdiagnosed and
subsequently may have received suboptimal treatment, Principle E becomes pertinent. The
implication is that the psychologist must take action to avoid condoning the less than optimal
treatment that may stem from bias against these vulnerable populations.
When faced with a member of a vulnerable population who is receiving suboptimal psychotropic
treatment based on membership in that group, a psychologist may choose to help the patient work more
effectively with his or her primary care provider or obtain consent to cooperate directly with the primary
care provider. It may be advantageous for potential prescriber collaboration to be covered in the initial
informed consent for treatment. The second relevant APA guideline, Principle B: Fidelity and
Responsibility, reads, Psychologists consult with, refer to, or cooperate with other professionals and
institutions to the extent needed to serve the best interests of those with whom they work (APA, 2010,
p. 3). Although psychologists typically do not have the training necessary to be competent in the
prescription of psychotropic medication, it could be argued that some working knowledge of the usage
and effects of these medications is necessary for competently treating patients where these medications
are(or should be) used.Indeed,courseworkonpsychopharmacologyisarequired curricular component
of some doctoral programs in counseling and clinical psychology and are available through continuing
education. So when faced with a patient who is having adverse effects or potential misdiagnosis, is it
within the scope of competence to take action?
The APAs (2010) Code of Conduct 2.01: Boundaries of Competence states, Psychologists
provide services, teach, and conduct research with populations and in areas only within the
boundaries of their competence, based on their education, training, supervised experience, consulta-
tion, study, or professional experience (p. 4). Reassessing or working with psychotropic medication
is beyond the scope of competence of most psychologists; however, diagnosing psychopathology in
vulnerable populations is within the scope of competence. If the psychologist finds himself or herself
frequently faced with the dilemma of patients who may not be receiving optimal treatment due to
inappropriate medication, additional efforts to develop competence in this area are warranted. The
section titled Boundaries of Competence further states that in the absence of standards, psychologists
must take reasonable steps to ensure the competence of their work and to protect patients and
others from harm (APA, 2010, p. 5). Additional training in this case would not be to obtain
prescription rights but merely to make the psychologist a better advocate for the patient and
collaborator with prescription writers such as the primary care provider.
Social justice is also a component of a psychologists interaction with patients who receive poor
mental health care based on classism, ageism, or racism. Social justice is integral to the APA
principles (e.g., justice, beneficence, and nonmaleficence). By refraining from intervening, a psy-
chologist may be causing harm. Psychologists are in a difficult position when addressing this
586 BERNAL ET AL.
injustice because they do not possess the training. However, they are in a position to help their
patients receive and understand the psychopharmacological information patients deserve. When
necessary to protect the welfare of the patient, psychologists can act as intermediaries, provided that
informed consent is obtained beforehand. Acting as an intermediary may be useful if the patient is an
inconsistent reporter of symptoms or situation. In the spirit of social justice, however, it is preferential
to empower the patient to relay the information directly.
VULNERABLE GROUPS
Psychologists are ethically bound by their responsibility to act in their patients best interest and
to ensure that their patients rights to optimal care are maintained. Factors placing patients at a
heightened risk of receiving substandard care due to bias or underrepresentation compels
psychologists to possess the knowledge, skills, and awareness to identify these potential
dilemmas and intervene according to an ethical decision-making framework. Therefore,
psychologists need foundational knowledge about populations vulnerable to these risks: older
adults, people of low social status, immigrants, and racial/ethnic minorities. For increased
understanding and readability, we present the literature for distinct categories of vulnerable
populations. However, we acknowledge that intersectionality exists, such that members of one
group (e.g., low social status) may also belong to another group (e.g., racial/ethnic minorities).
In such cases, the intersection of factors, such as ethnicity and unemployment, may result in an
accumulative risk for mental health issues (Mallett, Leff, Bhugra, Pang, & Zhao, 2002). Thus,
reducing the complexity of an individual to one factor, such as social status, and then grouping
that individual in a vulnerable population based on that factor is inherently problematic. Such a
practice has great potential to miss
