Ethical Justice

1
Ethical Justice

• Chapter Thirteen Ethical Issues for Treatment
  Staff in Forensic Settings

2
Ethical Issues for Treatment Staff in Forensic
Settings

• Correctional settings are visited by mental
  health practitioners under a variety of different
  employment circumstances, providing inmate
  evaluations and treatment.
• Some work as employees of the correctional
  agency, some are employed by a company contracted
  to the correctional agency, and others can be
  private practitioners that are contracted to a
  specific county or corrections system.

3
Practitioner Competence

• Mental health practitioners have an obligation to
  be competent when providing their services in
  general.
• This means they must not accept casework or seek
  employment placing them beyond their professional
  abilities.
• They also have an obligation to seek educational
  and credentialing from legitimate institutions
  and avoid unaccredited programs and diploma
  mills.

4
Role of Forensic Units

• Behavioral health care is provided either in a
  local county jail, a state or federal prison, or
  a detention facility.
• Federal and state correctional systems have
  access to forensic units where inmates requiring
  an inpatient level of behavioral health care will
  be sent.
• In these units, there are two types of
  evaluations that occur evaluation for the legal
  system and evaluation for the purpose of
  providing treatment.

5
Role of Forensic Units

• Dual Agency
• Forensic mental health (FMH) practitioners who
  are assessing an inmate for a strictly legal
  issue should advise the inmate that they are not
  there to treat them and that the information
  obtained in the course of the evaluation is not
  confidential.
• In some units, the same provider is expected to
  treat both an inmate and perform a forensic
  evaluation for the court. This is referred to as
  dual agency.

6
Role of Forensic Units

• Access to an Attorneys
• FMH examiners have an ethical obligation to
  inquire as to whether an arrested inmate has
  accessed an attorney and, if not, the arrestee
  must decide whether they wish to proceed without
  one or to consult with one first.

7
Correctional Culture

• FMH examiners must understand that the
  correctional setting belongs to law enforcement
  personnel mandated with maintaining the security
  of both inmates and non-inmate.
• Security will not be compromised to meet the
  needs of others. Because of the competing goals,
  there is often a tension between health care
  providers and jail security staff.

8
Evaluations

• The following are examples of different types of
  inmate evaluations
• Treatment evaluations
• Treatment evaluations are conducted in the same
  manner as in the community, with a heightened
  sensitivity to issues related to contraband, risk
  of suicide, predation, etc.
• Some correctional settings are well designed for
  these treatments but most are not providers
  often speak with inmates through cell doors, etc.
  
• Malingering mental illness is problematic,
  referring to feigning illness, often for
  medication, attention, or as the result of
  personal crises

9
Evaluations

• Competency to stand trial
• Competency to stand trial evaluations address the
  inmates current mental state and whether they
  are able to understand their charges and assist
  their attorney in their defense.
• These evaluations are conducted in the community
  and in a correctional setting.
• Criminal responsibility
• Criminal responsibility evaluations deal with the
  mental state of an offender at the time of a
  crime.
• This evaluation should not be done by a treating
  behavioral health provider.

10
Evaluations

• Dangerousness
• Once found not responsible due to mental disease
  or defect, the aquitee will undergo an evaluation
  to determine if they need to be transferred to a
  forensic unit, a civil psychiatric unit in the
  community, or outpatient treatment.
• These evaluations are characteristically done by
  psychiatrists employed by a state or the federal
  government and who work in a forensic unit.

11
Informed Consent//Confidentiality

• Inmate clients, as well as clients outside of
  correctional facilities, should be informed of
  the benefits and risks of any treatment and of
  any limits on confidentiality.
• There is a treatment-security dichotomy when it
  comes to breaching confidentiality. One approach
  to dealing with the dichotomy is four-pronged
• One must be aware of the ethical issues or
  concerns
• One must have an ethics-based priority paradigm
• There is hopefully a period of deliberation, even
  if brief, possibly including input from another
  professional
• One must make a decision and take responsibility
  for it.

12
Disciplinary Hearings

• The consensus among the forensic mental health
  community appears to be that behavioral health
  professionals should not participate in assessing
  the responsibility of inmates for violations of
  correctional regulations.
• Solitary confinement, usually called segregation,
  isolated inmates from others. The sensory
  deprivation can be problematic, especially when
  an inmate suffers from a major mental disorder.
  Inmates in segregation should have the same
  access to mental health care as those in the
  general population.
• Inmates are placed in restraints by correctional
  staff due to self-injurious or other directed
  violence. Behavioral health staff should assess
  the mental health needs of such individuals at
  and during the time of restrains.

13
Sex Offenders

• Treatment of sex offenders in a prison is
  ethical, although there are issues that arise,
  such as voluntariness and confidentiality in the
  treatment.
• It is important to note that it is a misuse of
  the behavioral health field professions to house
  sex offenders past the expiration of their
  sentence through civil commitment for dangerous
  sexual predators.

14
Physical and Sexual Assault Victims

• Behavioral health staff should cooperate in
  assessing the mental health needs of physical and
  sexual assault victims and help ascertain the
  need for protective custody, special cell
  arrangements, and even transfer to another
  facility.

15
Sexual Relationships

• Sexual contact with patients in the community is
  considered unethical because of the context and
  power differential.
• This is the same in correctional facilities or
  even more so because the power differential is
  much greater.
• Behavioral health providers in these settings
  need to be vigilant for attempts to entice them
  to engage in minor boundary violations by
  inmates.

16
Sexual Relationships

• The mental health community appears to be divided
  on the specific of the ethical issues pertaining
  to the death penalty.
• Some view the death penalty as separate from
  their role and others believe that it is
  unethical to treat an inmate in order to get them
  well enough to be tried for capital murder or
  have their death sentence carried out.

17
Release to the Community

• Behavioral health care workers should ensure that
  mentally ill inmates are not released without
  appropriate follow up arranged in the community.

18
Administrative Education

• Behavioral health staff in correctional settings
  have an ethical obligation to education and/or
  alert correctional staff and administration to
  issues interfering with the delivery of
  appropriate behavioral health care to inmates.
• Examples include housing conditions, food, or
  treatment by prison staff.