A broad ethics model for mental health practice

Abstract

Summary The article presents a broad ethical model in the context of psychiatric/psychological work that applies to mental health, in general. Also, it extends the five principles of the American Psychological Association (2002, 2010) ethics code by adding five new ones. The five extant ethics principles in the APA ethics code involve: beneficence/nonmaleficence; fidelity/responsibility; integrity; justice; and respect for rights/dignity. The five new ones that are suggested for addition involve: ethics as a system; ethics as science/science as ethics; ethics and law; ethics and assessment procedures (and their limits); and ethics in symptom/performance validity verification. The article undertakes discussion of the reasons why the five new ethical principles that are recommended are needed and the advantages that they would bring to any revision of extant ethical codes in the field of mental health. Together, the suite of 10 principles that has been constructed about ethics is applicable to any area of mental health. Further, the article presents a model of the growth in ethical thought according to Young (2011)’s Neo-Piagetian model, which involves Piaget's abstract formal stage, as well as an ensuing superordinate abstract stage (and it includes five substages – coordination, hierarchization, systematization, multiplication, and integration). The steps involved in the growth of ethical thought concern: contemplation of dilemmas; developing rules; leading to codes; and then principles and overarching theories. This takes place in the singular and then in the multiple (so we can speak of meta-theories, too). Aside from its applicability to individuals, the indicated sequence can be used to structure the process of institutional ethical code construction (which includes principles and perhaps a quasi – rather than a formal theory, generally). The sequence is consistent with the work of Cottone (2012) and Kitchener and Kitchener (2012), while integrating them. The present ethical model is used to help construct a revised version of the golden rule that reflects a universal moral, ethical concept, which could guide the construction both of personal ethical thought and that of institutions. This revised golden rule is quite intricate in that it considers multiple complexities, but still reflects the basic moral imperative in the original. The literature review supports the five new ethical principles for mental health that have been formulated. Specifically, it examines the literature on core values in various mental health fields, showing that there is no universal list. In addition, the article shows how the steps in the growth of ethical thought can be applied to the growth in understanding mental health therapy. Also, the article presents a broad ethical model and therapeutic model for mental health practice. This model includes the importance of overarching ethical thought throughout one's career, from student days onward, and also throughout each encounter with patients, including in assessment, diagnosis, and treatment. A section of the article examines the ethical decision-making process both from the point of view of models and the process of decision-making. Ethical decision-making is viewed as a pragmatic process in context that is informed by and structured by intuitive/emotional and deliberative/reflective reasoning processes. Overall, the article advocates for the personal responsibility that mental health professionals carry in constructing, meeting, and applying the highest ethical morals and values.