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PSYCH205: Clinical Psychology

Unit 9: Issues and Ethics in Psychological Intervention   This final unit does not deal directly with mental disorders, but rather with other important issues directly tied to the effectiveness of mental health interventions. The unit will begin by discussing the role of culture in therapy and current inequities in treatment. Next, it will cover the importance of confidentiality without which clinical and counseling psychologists might not be effective. At the close of this unit, you should have a general sense of the ethical issues involved with treatment both in respects to equality of treatment across cultural groups and in the ethical issues surrounding confidentiality.

Unit 9 Time Advisory
Completing this unit should take you approximately 1.75 hours.

☐    Subunit 9.1: 0.75 hours

☐    Subunit 9.2: 1 hour

Unit9 Learning Outcomes
Upon successful completion of this unit, you will be able to:
- demonstrate an awareness of the role of culture in therapy; and
  - discuss the ethical considerations related to confidentiality in the practice of psychotherapy.

9.1 Culture and Psychology   - Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness” Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness” **(PDF)
 
Instructions: Read the section titled “Overview of Cultural Diversity and Mental Health Services.” Please note that the pages in the PDF bar at the top of the document do not match the pages in the table of contents section on the first page.

 This reading will also cover the topics outlined for Subunits
9.1.1–9.1.5, which collectively address the intersection between
culture and psychology. This reading will highlight the
discrepancies in the quality of mental healthcare across cultural
groups.   
    
 Reading this text and taking notes should take approximately 45
minutes.  
    
 Terms of Use: This material is part of the public domain. 

9.1.1 Introduction to Cultural Diversity and Demographics   *Since the U.S. mental health system is not well equipped to adequately meet the needs of racial/ethnic minorities, several issues arise in terms of cultural diversity and mental health services. There are problems with classifications and identification with culture/cultural identity, differences in economic/social/political status, and various coping styles regarding life problems.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness,” pages 80–83 for additional information.*

9.1.2 Family and Community as Resources   *Many individuals use family and community as resources for managing mental health and mental illness. However, there are racial/ethnic differences in family solidarity and support systems, and also group disparities in treatment.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness,” pages 83–86 for additional information.*

9.1.3 Barriers to Treatment Delivery   *There are many treatment barriers racial and ethnic minority groups encounter when seeking assistance for mental health and mental illness management. Barriers result from cultural, financial, organizational, and diagnostic differences, as well as help-seeking behavior, mistrust, stigma, cost, and clinician bias.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness,” pages 86–88 for additional information.*

9.1.4 Improving Treatment for Minority Groups   *Given there are numerous barriers for minority groups seeking mental health support and mental illness treatment, improvements must be made in order to adequately assist minority groups. Treatment programs should engage in ethnopsychopharmacology, offer minority-oriented services, and understand cultural competence.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness,” pages 88–91 for additional information.*

9.1.5 Rural Mental Health Services   *In addition to minority-group barriers to seeking mental health and mental illness treatment, there are also issues regarding rural mental health services. In comparison to urban mental health services, rural individuals experience geographic, cultural, and political barriers that can interfere with their receiving of mental health treatment.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 2: The Fundamentals of Mental Health and Mental Illness,” pg. 92 for additional information.*

9.2 Confidentiality   - Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): "Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues" Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999):** "Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues" (PDF)
 
Instructions: Read Chapter 7 titled “Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues.” 

 This reading will also cover the topics outlined in Subunits
9.2.1–9.2.7.  
    
 Reading this text and taking notes should take approximately 1
hour.  
    
 Terms of Use: This material is part of the public domain. 

9.2.1 Ethical Issues Regarding Confidentiality   *There are many standards regarding confidentiality and ethical practices involved in mental services treatment. It is important to understand that confidentiality is not an absolute value and many policies and laws provide support for ethical considerations involving confidentiality.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 437–439 for additional information.*

9.2.2 Values Underlying Confidentiality   *The values underlying confidentiality examine reducing stigma, fostering trust, and protecting privacy as principles of confidentiality.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 439–440 for additional information.*

9.2.3 Research on Confidentiality and Mental Health Treatment   *Research on confidentiality and mental health treatment supports underlying assumptions that individuals seeking treatment may be less likely to ask for help or disclose sensitive information for fear of privacy not being kept.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 440–441 for additional information.*

9.2.4 Current State of Confidentiality Law   *The current state of federal and state confidentiality laws illustrates the need for change. At present, there is a lack of legal framework/national standards for confidentiality of health care information. Likewise, there are differences in state laws.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 441–442 for additional information.*

9.2.5 Exceptions to Confidentiality   *Given that there are differences in state confidentiality laws, each state can thus create exceptions to confidentiality. These exceptions may include consent by individual in treatment, disclosure to client/other providers/payers/families/law enforcement agencies/third parties, and disclosure for reporting and research.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 442–445 for additional information.*

9.2.6 Federal Confidentiality Laws   *Any individual seeking mental health or mental illness treatment risks discrimination, invasion of privacy, or even criminal prosecution if that information is disclosed to third parties. In an effort to mitigate these issues, federal confidentiality laws protect patients’ rights while they are receiving treatment (e.g., Americans with Disabilities Act). However, there are certain situations (e.g., disclosure to law enforcement where a crime was committed) when information must be released.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 446–447 for additional information.*

9.2.7 Potential Problems with the Current Legal Framework   *There are many problems with our current legal framework regarding protection of health care information. There is a lack of uniformity (e.g., state vs. federal differences), lack of reform provisions, preemption, separation of legal standards for mental health confidentiality, and substance/alcohol use confidentiality issues.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues,” pages 447–449 for additional information.*

The Saylor Foundation’s “Unit 9 Assessment”   - Assessment: The Saylor Foundation’s “Unit 9 Assessment” Link: The Saylor Foundation’s “Unit 9 Assessment”

 Instructions: Complete this unit assessment. For each question,
pick the best possible answer. The correct answers will be displayed
when you click the "Submit" button.  

 You must be logged into your Saylor Foundation School account in
order to access this quiz.  If you do not yet have an account, you
will be able to create one, free of charge, after clicking the
link.  

 Completing this assessment should take approximately 15 minutes.

Final Exam   - Final Exam: The Saylor Foundation’s “PSYCH205 Final Exam” Link: The Saylor Foundation’s “PSYCH205 Final Exam”

 Instructions: You must be logged into your Saylor Foundation
account in order to access this exam. If you do not yet have an
account, you will be able to create one, free of charge, after
clicking the link.