Dilemmas for psychologists in mental health centers.

Abstract

Psychologists working in community mental health centers are sometimes faced with problems not encountered by their academic colleagues or those in private practice. As employees of centers, psychologists licensed for independent practice may not be professionally autonomous since centers do not readily make the distinction between administrative and clinical supervision. Doctoral level psychologists may be supervised by social workers, physicians, o r Master's level psychologists when such individuals are center supervisors. A particular threat to autonomy is medical supervision in such centers. Third parry payers will often reimburse only those services supervised by physicians. Financially troubled centers then will, of course, insist on medical supervision to receive payment. Unless psychologists hold administrative positions, there may be little control of psychological services in centers. Such centers may enter into contracts for testing with schools and courts, often without psychological consultation. Non-psychologists often administer tests, particularly those which are computer-scored. Also, non-psychologists may serve as liaison to various agencies receiving psychological services and be in the position of interpreting test scores. Thus a social worker may provide court testimony regarding an evaluation performed by a psychologist. Research opportunities may be limited in centers since resources are typically not available for anything but direct services. Continuing education and staff development may be limited, even though several states require continuing education for renewal of license for practice of psychology. The 1977 Ethical standards and Standards for prowiderr o f psychological services indicate that psychologists should: receive continuing education. direct psychological services, moderate institutional pressure, and prorect the rights of clients. Employment in mental health centers may impede the above mandate. There is probably much diversity between centers throughout the country and survey data would suggest the extent of the problem.