Book Needed Biomedical Ethics by, David DeGrazia,Thomas Mappes
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Sep 21, 2022
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About This Presentation
Book Needed: Biomedical Ethics by, David DeGrazia,Thomas Mappes
& Jeffrey Brand-Ballard (2010) Biomedical Ethics 7th ed. McGraw-Hill.
Case Studies:
- Complete case studies 31, 33 and 34 in the appendix area of the text. Make sure you provide information with page numbers from Chapter 8-Genet...
Slide Content
Book Needed: Biomedical Ethics by, David DeGrazia,Thomas
Mappes
& Jeffrey Brand-Ballard (2010) Biomedical Ethics 7th ed.
McGraw-Hill.
Case Studies:
- Complete case studies 31, 33 and 34 in the appendix area of
the text. Make sure you provide information with page numbers
from Chapter 8-Genetic and Human Reproduction Pages (523-
94) to support your answers to earn full points
Read ethical case and provide a paragraph with information and
comments regarding topic. Remember to use references. Review
each video on depression as a reference for the discussion
board.
YouTube URL: http://www.youtube.com/watch?v=z-
IR48Mb3W0
The Case of the Depressed Patient
When seriously ill patients ask to discontinue life-sustaining
treatment, depression may be impairing their ability to make
decisions. In this case study, a geriatrician discusses how a
physician might work through the ethics of this situation.
At 80, R.L. lives with his wife in a retirement community. He
has always valued his independence, but recently he has been
having trouble caring for himself. He is having difficulty
walking and managing his medications for diabetes, heart
disease, and kidney problems.
His doctor diagnoses depression after noting that R.L. has lost
interest in the things he used to enjoy. Lethargic and sleepless,
R.L. has difficulty maintaining his weight and talks about
killing himself with a loaded handgun. He agrees to try
medication for the mood disorder.
Two weeks later, before the effect of the medicine can be seen,
R.L. is hospitalized for a heart attack. The heart is damaged so
severely it can't pump enough blood to keep the kidneys
Mappes
& Jeffrey Brand-Ballard (2010) Biomedical Ethics 7th ed.
McGraw-Hill.
Case Studies:
- Complete case studies 31, 33 and 34 in the appendix area of
the text. Make sure you provide information with page numbers
from Chapter 8-Genetic and Human Reproduction Pages (523-
94) to support your answers to earn full points
Read ethical case and provide a paragraph with information and
comments regarding topic. Remember to use references. Review
each video on depression as a reference for the discussion
board.
YouTube URL: http://www.youtube.com/watch?v=z-
IR48Mb3W0
The Case of the Depressed Patient
When seriously ill patients ask to discontinue life-sustaining
treatment, depression may be impairing their ability to make
decisions. In this case study, a geriatrician discusses how a
physician might work through the ethics of this situation.
At 80, R.L. lives with his wife in a retirement community. He
has always valued his independence, but recently he has been
having trouble caring for himself. He is having difficulty
walking and managing his medications for diabetes, heart
disease, and kidney problems.
His doctor diagnoses depression after noting that R.L. has lost
interest in the things he used to enjoy. Lethargic and sleepless,
R.L. has difficulty maintaining his weight and talks about
killing himself with a loaded handgun. He agrees to try
medication for the mood disorder.
Two weeks later, before the effect of the medicine can be seen,
R.L. is hospitalized for a heart attack. The heart is damaged so
severely it can't pump enough blood to keep the kidneys
working.
Renal dialysis is necessary to keep R.L. alive, at least until it's
clear whether the heart and kidneys will recover. This involves
moving him three times a week to the dialysis unit, where
needles are inserted into a large artery and a vein to connect
him to a machine for three to four hours.
After the second treatment, R.L. demands that dialysis be
stopped and asks to be allowed to die.
You are R.L.'s physician. What should you do?
R.L.'s was an actual case that presented his physicians with a
common dilemma in treating patients with serious illnesses: Had
depression rendered him incapable of making a legitimate life-
and-death decision?
When patients agree to undergo or refuse medical treatment,
they are supposed to reach the decision by a process called
informed consent. The doctor discloses information about the
medical condition, treatment options, possible complications,
and expected outcomes with or without treatment.
To give informed consent or refusal, the patient must be acting
voluntarily and must have the capacity to make the decision.
That means the patient must be able to understand the
information, appreciate its personal implications, weigh the
options based on personal values and life goals, and
communicate a decision. From an ethical point of view,
informed consent is based on the philosophical principles of
autonomy and beneficence. In R.L.'s case, these two principles
are in conflict. First, R.L.'s prognosis is unclear, and the
physician does not know if the benefits of dialysis will
outweigh the burdens. Under normal circumstances, this
decision would be made by R.L., but the physician suspects the
patient's capacity for autonomous decision making is impaired
by depression.
Depression is a mood disorder that can profoundly affect a
person's ability to think positively, experience pleasure, or
imagine a brighter future. Depressed people frequently have
little energy, poor appetites, and disturbed sleep. They may
Renal dialysis is necessary to keep R.L. alive, at least until it's
clear whether the heart and kidneys will recover. This involves
moving him three times a week to the dialysis unit, where
needles are inserted into a large artery and a vein to connect
him to a machine for three to four hours.
After the second treatment, R.L. demands that dialysis be
stopped and asks to be allowed to die.
You are R.L.'s physician. What should you do?
R.L.'s was an actual case that presented his physicians with a
common dilemma in treating patients with serious illnesses: Had
depression rendered him incapable of making a legitimate life-
and-death decision?
When patients agree to undergo or refuse medical treatment,
they are supposed to reach the decision by a process called
informed consent. The doctor discloses information about the
medical condition, treatment options, possible complications,
and expected outcomes with or without treatment.
To give informed consent or refusal, the patient must be acting
voluntarily and must have the capacity to make the decision.
That means the patient must be able to understand the
information, appreciate its personal implications, weigh the
options based on personal values and life goals, and
communicate a decision. From an ethical point of view,
informed consent is based on the philosophical principles of
autonomy and beneficence. In R.L.'s case, these two principles
are in conflict. First, R.L.'s prognosis is unclear, and the
physician does not know if the benefits of dialysis will
outweigh the burdens. Under normal circumstances, this
decision would be made by R.L., but the physician suspects the
patient's capacity for autonomous decision making is impaired
by depression.
Depression is a mood disorder that can profoundly affect a
person's ability to think positively, experience pleasure, or
imagine a brighter future. Depressed people frequently have
little energy, poor appetites, and disturbed sleep. They may
have difficulty concentrating, or they may be troubled by
feelings of guilt and hopelessness. Preoccupation with death is
common and, in some cases, may include contemplating suicide.
Because R.L. was suicidal before his heart attack, no one was
sure whether his refusal of dialysis represented an authentic
exercise of his right to stop life-saving treatment or a
convenient means to passively end his life. On the other hand, if
the doctor continued dialysis, he would be denying R.L. the
same right to refuse treatment that another patient who was not
depressed would have.
When patients ask to have life-sustaining treatment withheld,
doctors have been taught to consider whether depression is
driving the request, because the condition lifts in two-thirds of
those who are treated with anti-depressant medications. The
presumption is that once the problem has cleared, the patient
will look at treatment decisions differently.
Recent research has challenged that presumption by showing
depressed patients don't necessarily choose to hasten death in
the first place and they often make the same decisions after they
recover from depression.
Thus, depressed patients may be able to give informed consent,
but doctors and loved ones must consider whether the decision
to refuse medical treatment is logical, internally consistent, and
conforms with past life choices and values.
In R.L.'s case, the doctor, in consultation with a psychiatrist,
decided to continue the course of anti depressant medication to
see if, when it began to take effect, R.L. would change his mind
about treatment. In the meantime, his dialysis was continued.
After five weeks, R.L. showed no improvement, and he began to
refuse medications and food. His wife was asked to give consent
for a feeding tube.
On conferring with the rest of the family, R.L.'s wife denied the
doctor's request. Her husband's repeated refusal of dialysis had
convinced the family R.L. really did want to die. In addition,
R.L.'s unchanged physical condition indicated that, if he
survived to discharge, he would probably need nursing home
feelings of guilt and hopelessness. Preoccupation with death is
common and, in some cases, may include contemplating suicide.
Because R.L. was suicidal before his heart attack, no one was
sure whether his refusal of dialysis represented an authentic
exercise of his right to stop life-saving treatment or a
convenient means to passively end his life. On the other hand, if
the doctor continued dialysis, he would be denying R.L. the
same right to refuse treatment that another patient who was not
depressed would have.
When patients ask to have life-sustaining treatment withheld,
doctors have been taught to consider whether depression is
driving the request, because the condition lifts in two-thirds of
those who are treated with anti-depressant medications. The
presumption is that once the problem has cleared, the patient
will look at treatment decisions differently.
Recent research has challenged that presumption by showing
depressed patients don't necessarily choose to hasten death in
the first place and they often make the same decisions after they
recover from depression.
Thus, depressed patients may be able to give informed consent,
but doctors and loved ones must consider whether the decision
to refuse medical treatment is logical, internally consistent, and
conforms with past life choices and values.
In R.L.'s case, the doctor, in consultation with a psychiatrist,
decided to continue the course of anti depressant medication to
see if, when it began to take effect, R.L. would change his mind
about treatment. In the meantime, his dialysis was continued.
After five weeks, R.L. showed no improvement, and he began to
refuse medications and food. His wife was asked to give consent
for a feeding tube.
On conferring with the rest of the family, R.L.'s wife denied the
doctor's request. Her husband's repeated refusal of dialysis had
convinced the family R.L. really did want to die. In addition,
R.L.'s unchanged physical condition indicated that, if he
survived to discharge, he would probably need nursing home
care, a fate he had resisted even before his depression.
Ultimately, the physician shared the family's assessment that
R.L.'s consistent refusals indicated an authentic wish to halt
treatment. He was taken off dialysis and put on comfort
measures. Six days later, he died.
How would you sort through the ethics of this situation?
Melinda Lee, M.D. (Santa Clara University '69), is associate
professor of medicine at Oregon Health Sciences University and
a geriatrician with Providence ElderPlace in Portland.
Winter 1997
Project #2: Community Literacy Profile
Project #2 = 40% ENGL101 Course Grade and consists of the
following components:
· Observation Report (10% P#2 Grade)
· Interview Report (10% P#2 Grade)
· Rough Draft #1 (10% P#2 Grade)
· Peer Review Sessions (15% P#2 Grade)
· Community Profile (50% P#2 Grade)
· Author's Memo (5% P#2 Grade)Assignment PromptTask
Description
You will write a literacy profile of a community to which you
belong or are interested in. By literacy we mean any learning or
shared knowledge as a form of know-how. A literacy profile
informs your audience of the shared knowledge and discourse of
specific community functions. You will focus on specific
language, written artifacts, and genres. You will conduct
primary research by:
· observing the community in action,
· interviewing a community leader, or active member, of your
chosen community.
You will also conduct some secondary research to help interpret
and synthesize your primary research. In your profile you will
quote evidence from both your primary and secondary research
to provide multiple perspectives of the community’s discourse
strategies and group literacies.
Ultimately, the physician shared the family's assessment that
R.L.'s consistent refusals indicated an authentic wish to halt
treatment. He was taken off dialysis and put on comfort
measures. Six days later, he died.
How would you sort through the ethics of this situation?
Melinda Lee, M.D. (Santa Clara University '69), is associate
professor of medicine at Oregon Health Sciences University and
a geriatrician with Providence ElderPlace in Portland.
Winter 1997
Project #2: Community Literacy Profile
Project #2 = 40% ENGL101 Course Grade and consists of the
following components:
· Observation Report (10% P#2 Grade)
· Interview Report (10% P#2 Grade)
· Rough Draft #1 (10% P#2 Grade)
· Peer Review Sessions (15% P#2 Grade)
· Community Profile (50% P#2 Grade)
· Author's Memo (5% P#2 Grade)Assignment PromptTask
Description
You will write a literacy profile of a community to which you
belong or are interested in. By literacy we mean any learning or
shared knowledge as a form of know-how. A literacy profile
informs your audience of the shared knowledge and discourse of
specific community functions. You will focus on specific
language, written artifacts, and genres. You will conduct
primary research by:
· observing the community in action,
· interviewing a community leader, or active member, of your
chosen community.
You will also conduct some secondary research to help interpret
and synthesize your primary research. In your profile you will
quote evidence from both your primary and secondary research
to provide multiple perspectives of the community’s discourse
strategies and group literacies.
Part 1: Discovery & Research
In this part of the project you will conduct both primary and
secondary research to learn about your community. Each
research activity will require a mini-report that summarizes
what you learned.
· Understanding Profiles as a Genre Activities: Research
examples of profiles. Learn the obligatory moves in design,
organization, content, and style (D.O.C.S.) of profiles.
· Observation Report: Experience the community or place in
action; go where they are at and systematically document what
they do.
· Interview Report: Find a knowledgeable and experienced
community member, either a leader or active member, that you
can interview. You’ll ask questions to help fill in the blanks of
what you still need to know.
Part 2: Writing a Profile
Some questions to consider while planning and writing your
profile:
· What information about community activities gathered during
research should you highlight?
· What are the most interesting aspects of this community’s
language, especially for your intended readers?
· How much description of location, activities, and people
involved is needed for your readers?
· What are your own biases about the group you are profiling?
How much of this bias should be reflected in your profile?
· What is the lasting impression on your audience?
· Start the profile with a lead paragraph or “hook”—what do
you find in the community that will be most compelling to your
audience? How will you support that lead?
· The profile should be about 1500-1700 words and should
follow MLA format as described in Writer’s Help 2.0, Lunsford.
Context surrounding the project:
· Information can be drawn from published studies and reports,
news media, and personal experience (secondary research);
In this part of the project you will conduct both primary and
secondary research to learn about your community. Each
research activity will require a mini-report that summarizes
what you learned.
· Understanding Profiles as a Genre Activities: Research
examples of profiles. Learn the obligatory moves in design,
organization, content, and style (D.O.C.S.) of profiles.
· Observation Report: Experience the community or place in
action; go where they are at and systematically document what
they do.
· Interview Report: Find a knowledgeable and experienced
community member, either a leader or active member, that you
can interview. You’ll ask questions to help fill in the blanks of
what you still need to know.
Part 2: Writing a Profile
Some questions to consider while planning and writing your
profile:
· What information about community activities gathered during
research should you highlight?
· What are the most interesting aspects of this community’s
language, especially for your intended readers?
· How much description of location, activities, and people
involved is needed for your readers?
· What are your own biases about the group you are profiling?
How much of this bias should be reflected in your profile?
· What is the lasting impression on your audience?
· Start the profile with a lead paragraph or “hook”—what do
you find in the community that will be most compelling to your
audience? How will you support that lead?
· The profile should be about 1500-1700 words and should
follow MLA format as described in Writer’s Help 2.0, Lunsford.
Context surrounding the project:
· Information can be drawn from published studies and reports,
news media, and personal experience (secondary research);
· Information will be obtained firsthand, through interviews,
observation, surveys, correspondence, or attendance at public
events (primary research);
· Reporters of information check that their sources are credible
and accurate;
· The level of detail is adjusted to anticipate what readers are
likely to know already and to make new information easier to
follow;
· Informative documents often use illustrations - such as charts,
tables, graphics, and images - to help readers understand
concepts and ideas;
· Your project will be developed through a writing process that
requires planning and forethought;
· Each stage of that writing process is important to the overall
project;
· Drafts of your project will be due on specific days/times:
· The first rough draft will be due by 11/8
· Final draft will be due by 11/22
· Your work will be peer-reviewed during its development.
Interview Script
Interviewing Wil Rilero, Freshman. 12 credits.
How would you describe the psychology course workload?
· Describes workload as overwhelming and stressful.
how much time do you spend on psychology every day?
· About 2 hours everyday
Do you ever do homework in psychology class before it starts?
· Yes, often works on other classes assignments when he arrives
early to class
Does this psychology class affect your sleep schedule?
· Sometimes must stay up to complete work
Does this psychology class stress you out?
· Sometimes experiences stress when given a big assignment,
however, not a crazy amount of stress, expected stress levels for
a college class
Why have you chosen a psychology course?
observation, surveys, correspondence, or attendance at public
events (primary research);
· Reporters of information check that their sources are credible
and accurate;
· The level of detail is adjusted to anticipate what readers are
likely to know already and to make new information easier to
follow;
· Informative documents often use illustrations - such as charts,
tables, graphics, and images - to help readers understand
concepts and ideas;
· Your project will be developed through a writing process that
requires planning and forethought;
· Each stage of that writing process is important to the overall
project;
· Drafts of your project will be due on specific days/times:
· The first rough draft will be due by 11/8
· Final draft will be due by 11/22
· Your work will be peer-reviewed during its development.
Interview Script
Interviewing Wil Rilero, Freshman. 12 credits.
How would you describe the psychology course workload?
· Describes workload as overwhelming and stressful.
how much time do you spend on psychology every day?
· About 2 hours everyday
Do you ever do homework in psychology class before it starts?
· Yes, often works on other classes assignments when he arrives
early to class
Does this psychology class affect your sleep schedule?
· Sometimes must stay up to complete work
Does this psychology class stress you out?
· Sometimes experiences stress when given a big assignment,
however, not a crazy amount of stress, expected stress levels for
a college class
Why have you chosen a psychology course?
· Interested in the topics and need the credits.
Reflection:
The interviewee said that at times this class has been
overwhelming and stressful, but he explains that it’s a normal
amount of stress for a college class. I think he is just saying that
most classes experience this amount of stress, and at times it
overwhelms him, especially with other class’s work. I might
incorporate this in the paper to show and normalize stress in
classes from freshman.
I think the interview went fine, if I could have interviewed the
professor, I might have gotten more more interesting interview
questions.
Standards in the Profession: Skill Standards,
Credentialing, Program Accreditation,
and Ethical Standards
Chapter Three
©2017 Cengage Learning22
Skill Standards
12 competency areas (see Activity 3.1)
1. Participant empowerment
2. Communication
3. Assessment
4. Community and service networking
5. Facilitation of services
6. Community and living skills and supports
Reflection:
The interviewee said that at times this class has been
overwhelming and stressful, but he explains that it’s a normal
amount of stress for a college class. I think he is just saying that
most classes experience this amount of stress, and at times it
overwhelms him, especially with other class’s work. I might
incorporate this in the paper to show and normalize stress in
classes from freshman.
I think the interview went fine, if I could have interviewed the
professor, I might have gotten more more interesting interview
questions.
Standards in the Profession: Skill Standards,
Credentialing, Program Accreditation,
and Ethical Standards
Chapter Three
©2017 Cengage Learning22
Skill Standards
12 competency areas (see Activity 3.1)
1. Participant empowerment
2. Communication
3. Assessment
4. Community and service networking
5. Facilitation of services
6. Community and living skills and supports
7. Education, training, and self-development
8. Advocacy
9. Vocational education and career support
10. Crisis intervention
11. Organizational participation
12. Documentation
©2017 Cengage Learning33
Credentialing (slide 1 of 7)
Credentialing has many benefits for both the consumer and
helper
The two most common types of credentials are certification and
licensure
©2017 Cengage Learning44
Credentialing (slide 2 of 7)
Certification
8. Advocacy
9. Vocational education and career support
10. Crisis intervention
11. Organizational participation
12. Documentation
©2017 Cengage Learning33
Credentialing (slide 1 of 7)
Credentialing has many benefits for both the consumer and
helper
The two most common types of credentials are certification and
licensure
©2017 Cengage Learning44
Credentialing (slide 2 of 7)
Certification
predetermined standards of professionalism
practice of a professional
©2017 Cengage Learning55
Credentialing (slide 3 of 7)
Licensure
LCSW, a
doctorate in psychology (licensed psychologist) or a medical
degree (licensed physician and/or board-certified
psychiatrist)
-party (insurance)
reimbursement
©2017 Cengage Learning66
Credentialing (slide 4 of 7)
Credentialing in the Human Services
practice of a professional
©2017 Cengage Learning55
Credentialing (slide 3 of 7)
Licensure
LCSW, a
doctorate in psychology (licensed psychologist) or a medical
degree (licensed physician and/or board-certified
psychiatrist)
-party (insurance)
reimbursement
©2017 Cengage Learning66
Credentialing (slide 4 of 7)
Credentialing in the Human Services
– Center for Credentialing and Education (CCE), with
NOHS and CSHSE, developed the Human Service – Board
Certified Practitioner (HS-BCP) credential
bachelor’s, or master’s degree
-educational requirements differ based on the
degree (See Table 3.1)
exam, those with the HS-BCP must earn
60 hours of continuing education every 5 years
©2017 Cengage Learning77
Credentialing (slide 5 of 7)
Selected Credentials in Related Helping Professions
Counselors (NBCC)
ofessional Counselor (LPC)
NOHS and CSHSE, developed the Human Service – Board
Certified Practitioner (HS-BCP) credential
bachelor’s, or master’s degree
-educational requirements differ based on the
degree (See Table 3.1)
exam, those with the HS-BCP must earn
60 hours of continuing education every 5 years
©2017 Cengage Learning77
Credentialing (slide 5 of 7)
Selected Credentials in Related Helping Professions
Counselors (NBCC)
ofessional Counselor (LPC)
©2017 Cengage Learning88
Credentialing (slide 6 of 7)
Selected Credentials in Related Helping Professions
psychologist and as a counseling
or clinical psychologist
psychologist
with this license
©2017 Cengage Learning99
Credentialing (slide 7 of 7)
Selected Credentials in Related Helping Professions
-mental health nurse
Credentialing (slide 6 of 7)
Selected Credentials in Related Helping Professions
psychologist and as a counseling
or clinical psychologist
psychologist
with this license
©2017 Cengage Learning99
Credentialing (slide 7 of 7)
Selected Credentials in Related Helping Professions
-mental health nurse
hiatric mental health nurse
©2017 Cengage Learning1010
Program Accreditation
-study,
a visit
from an accreditation team, and recommendations to the board
of
directors of the accrediting body
-57)
about 45
programs with full accreditation
more accredited programs
through CSHSE
©2017 Cengage Learning1111
Ethical Standards (slide 1 of 2)
The Development of Ethical Codes
©2017 Cengage Learning1010
Program Accreditation
-study,
a visit
from an accreditation team, and recommendations to the board
of
directors of the accrediting body
-57)
about 45
programs with full accreditation
more accredited programs
through CSHSE
©2017 Cengage Learning1111
Ethical Standards (slide 1 of 2)
The Development of Ethical Codes
ethics (1953)
1. Protect consumers and further professional standing of the
organization
2. Making a statement about maturity and identity of the
profession
3. Guiding professionals toward behaviors and actions that
reflect
underlying professional values
4. Offering a framework for the sometimes difficult ethical
decision-making process
5. Serving as a measure of defense if the professional is sued
for
malpractice
©2017 Cengage Learning1212
Ethical Standards (slide 2 of 2)
The Development of Ethical Codes
ks of the ethical code:
1. Does not address some issues and offers no clear way of
responding to other issues
2. Periodically has conflicts within the same code, between two
related codes, between the code and the law, or between the
code and a helper’s value system
1. Protect consumers and further professional standing of the
organization
2. Making a statement about maturity and identity of the
profession
3. Guiding professionals toward behaviors and actions that
reflect
underlying professional values
4. Offering a framework for the sometimes difficult ethical
decision-making process
5. Serving as a measure of defense if the professional is sued
for
malpractice
©2017 Cengage Learning1212
Ethical Standards (slide 2 of 2)
The Development of Ethical Codes
ks of the ethical code:
1. Does not address some issues and offers no clear way of
responding to other issues
2. Periodically has conflicts within the same code, between two
related codes, between the code and the law, or between the
code and a helper’s value system
3. Sometimes difficult to enforce code violations
4. Does not include the public in code construction and does not
always take public’s interest into account
5. Has a difficult time keeping up with and addressing “cutting
edge” issues
©2017 Cengage Learning1313
Ethical Decision Making (slide 1 of 3)
Problem-Solving Model (Corey, et al. (2015)
1. Identify problem or dilemma
2. Identify potential issues involved
3. Review relevant ethical guidelines
4. Know applicable laws and regulations
5. Obtain consultation
6. Consider possible and probably courses of action
7. Enumerate consequences of various decisions
8. Decide on the best course of action
©2017 Cengage Learning1414
Ethical Decision Making (slide 2 of 3)
Principle and Virtue Ethics Model (Kitchener)
1. Autonomy protects independence, self-determination,
and freedom of choice for clients
2. Nonmaleficence is the concept of “do no harm”
4. Does not include the public in code construction and does not
always take public’s interest into account
5. Has a difficult time keeping up with and addressing “cutting
edge” issues
©2017 Cengage Learning1313
Ethical Decision Making (slide 1 of 3)
Problem-Solving Model (Corey, et al. (2015)
1. Identify problem or dilemma
2. Identify potential issues involved
3. Review relevant ethical guidelines
4. Know applicable laws and regulations
5. Obtain consultation
6. Consider possible and probably courses of action
7. Enumerate consequences of various decisions
8. Decide on the best course of action
©2017 Cengage Learning1414
Ethical Decision Making (slide 2 of 3)
Principle and Virtue Ethics Model (Kitchener)
1. Autonomy protects independence, self-determination,
and freedom of choice for clients
2. Nonmaleficence is the concept of “do no harm”
3. Beneficence relates to the promoting the good of
society
4. Justice involves equal and fair treatment to all clients
5. Fidelity is related to maintaining trust and being
committed to clients
6. Veracity being truthful and genuine with the client
within the counseling relationship
©2017 Cengage Learning1515
Ethical Decision Making (slide 3 of 3)
Developmental Models (Kohlberg; Perry; Kagen)
-level helpers
– black and white thinking; concreteness;
rigidity; oversimplification; stereotyping; self-
protectiveness; authoritarianism
-level helpers
ism (commitment in relativism) – more
complex thinking; open to differing opinions;
flexible; empathetic; sensitive to the context of an
ethical dilemma; nondogmatic
©2017 Cengage Learning1616
Ethical, Professional, and Legal Issues:
society
4. Justice involves equal and fair treatment to all clients
5. Fidelity is related to maintaining trust and being
committed to clients
6. Veracity being truthful and genuine with the client
within the counseling relationship
©2017 Cengage Learning1515
Ethical Decision Making (slide 3 of 3)
Developmental Models (Kohlberg; Perry; Kagen)
-level helpers
– black and white thinking; concreteness;
rigidity; oversimplification; stereotyping; self-
protectiveness; authoritarianism
-level helpers
ism (commitment in relativism) – more
complex thinking; open to differing opinions;
flexible; empathetic; sensitive to the context of an
ethical dilemma; nondogmatic
©2017 Cengage Learning1616
Ethical, Professional, and Legal Issues:
Competence and Qualifications as a Professional
and have a thirst for ongoing knowledge
ls
education
©2017 Cengage Learning1717
The Effective Human Service Professional:
Professionally Committed, Ethically Assured
must be real,
not just lip service
behaviors
Skill Standards
and have a thirst for ongoing knowledge
ls
education
©2017 Cengage Learning1717
The Effective Human Service Professional:
Professionally Committed, Ethically Assured
must be real,
not just lip service
behaviors
Skill Standards
Slide 1Skill StandardsCredentialing (slide 1 of 7)Credentialing
(slide 2 of 7)Credentialing (slide 3 of 7)Credentialing (slide 4
of 7)Credentialing (slide 5 of 7)Credentialing (slide 6 of
7)Credentialing (slide 7 of 7)Program AccreditationSlide
11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17
A separate and unequal system
People with mental illness face legal discrimination
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Comment
<!--iframe-->
Stigma against the mentally ill is so powerful that it's been
codified for 50 years into federal law, and few outside the
mental health system even realize it.
This systemic discrimination, embedded in Medicaid and
Medicare laws, has accelerated the emptying of state psychiatric
hospitals, leaving many of the sickest and most vulnerable
patients with nowhere to turn.
Advocates and experts who spoke with USA TODAY describe a
system in shambles, starved of funding while neglecting
millions of people across the country each year.
(slide 2 of 7)Credentialing (slide 3 of 7)Credentialing (slide 4
of 7)Credentialing (slide 5 of 7)Credentialing (slide 6 of
7)Credentialing (slide 7 of 7)Program AccreditationSlide
11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17
A separate and unequal system
People with mental illness face legal discrimination
Share This Story
Tweet
Share
Share
Pin
Comment
<!--iframe-->
Stigma against the mentally ill is so powerful that it's been
codified for 50 years into federal law, and few outside the
mental health system even realize it.
This systemic discrimination, embedded in Medicaid and
Medicare laws, has accelerated the emptying of state psychiatric
hospitals, leaving many of the sickest and most vulnerable
patients with nowhere to turn.
Advocates and experts who spoke with USA TODAY describe a
system in shambles, starved of funding while neglecting
millions of people across the country each year.
The failure to provide treatment and supportive services to
people with mental illness – both in the community and in
hospitals – has overburdened emergency rooms, crowded state
and local jails and left untreated patients to fend for themselves
on city streets, says Patrick Kennedy, a former congressman
from Rhode Island who has fought to provide better care for the
mentally ill.
The USA routinely fails to provide the most basic services for
people with mental illness -- something the country would never
tolerate for patients with cancer or other physical disorders,
Kennedy says.
Former congressman Patrick Kennedy: "We have a wasteland of
people who have died and been disabled because of inadequate
care."
(Photo: H. Darr Beiser, USA TODAY)
"Mental health is a separate but unequal system," Kennedy says.
"We have a wasteland of people who have died and been
disabled because of inadequate care."
Although most people with mental illness are not violent, the
USA's dysfunctional, long-neglected mental health system is
under a microscope because of mass shootings in which the
perpetrators had serious psychiatric problems. In a series of
stories in the coming months, USA TODAY will explore the
human and financial costs that the country pays for not caring
more about the nearly 10 million Americans with serious mental
illness.
Stigma, a common thread in this series, forces many to live in
shame rather than seek support, even as their lives unravel. Yet
patients who want help often can't find it, says Kennedy, who
has acknowledged his own struggles with bipolar disorder and
drug addiction.
“'There is no other area of medicine where the government is
the source of the stigma.' ”
Rep. Tim Murphy, R-Pa.
Stigma even shaped the crafting of the Medicaid law a half-
people with mental illness – both in the community and in
hospitals – has overburdened emergency rooms, crowded state
and local jails and left untreated patients to fend for themselves
on city streets, says Patrick Kennedy, a former congressman
from Rhode Island who has fought to provide better care for the
mentally ill.
The USA routinely fails to provide the most basic services for
people with mental illness -- something the country would never
tolerate for patients with cancer or other physical disorders,
Kennedy says.
Former congressman Patrick Kennedy: "We have a wasteland of
people who have died and been disabled because of inadequate
care."
(Photo: H. Darr Beiser, USA TODAY)
"Mental health is a separate but unequal system," Kennedy says.
"We have a wasteland of people who have died and been
disabled because of inadequate care."
Although most people with mental illness are not violent, the
USA's dysfunctional, long-neglected mental health system is
under a microscope because of mass shootings in which the
perpetrators had serious psychiatric problems. In a series of
stories in the coming months, USA TODAY will explore the
human and financial costs that the country pays for not caring
more about the nearly 10 million Americans with serious mental
illness.
Stigma, a common thread in this series, forces many to live in
shame rather than seek support, even as their lives unravel. Yet
patients who want help often can't find it, says Kennedy, who
has acknowledged his own struggles with bipolar disorder and
drug addiction.
“'There is no other area of medicine where the government is
the source of the stigma.' ”
Rep. Tim Murphy, R-Pa.
Stigma even shaped the crafting of the Medicaid law a half-
century ago, because Congress didn't want to "waste" federal
money on mental illness, says Ron Manderscheid, executive
director of the National Association of County Behavioral
Health & Disability Development Directors. "People were
operating under the belief that mental health was a black hole
for money," Manderscheid says.
An obscure provision of the Medicaid law specifies that funds
may be used for hospitals treating physical conditions but
generally not for mental health, says Tim Murphy, R-Pa., a
child psychologist who has introduced legislation to ease these
restrictions.
The Medicare law discriminates against those with mental
illness, as well, by limiting the number of days that patients can
receive inpatient psychiatric care. Medicare imposes no such
limits for physical health, says Mark Covall, president and CEO
of the National Association of Psychiatric Health Systems.
By denying hospital care to the mentally ill, Murphy says
Congress set two standards for health, effectively telling the
country that the mentally ill are less deserving of a decent life
than others. By forcing the mentally ill to live with sickness,
confusion and disability, federal law reinforces the assumption
that the mentally ill are incapable of leading functioning, safe,
successful lives.
"The federal government has set so many barriers to getting
care, which they have done with no other type of illness, and it
is wrong," Murphy says. "There is no other area of medicine
where the government is the source of the stigma."
Without federal support, states haven't been able to afford to
keep their psychiatric hospitals open. States closed 10% of their
hospital beds from 2009 to 2012, says Robert Glover, executive
director of the National Association of State Mental Health
Program Directors.
Private hospitals have reduced their psychiatric beds, as well,
because Medicare and Medicaid typically pay less for inpatient
mental healthcare than for medical care, says Ron Honberg,
national director of policy and legal affairs at NAMI, the
money on mental illness, says Ron Manderscheid, executive
director of the National Association of County Behavioral
Health & Disability Development Directors. "People were
operating under the belief that mental health was a black hole
for money," Manderscheid says.
An obscure provision of the Medicaid law specifies that funds
may be used for hospitals treating physical conditions but
generally not for mental health, says Tim Murphy, R-Pa., a
child psychologist who has introduced legislation to ease these
restrictions.
The Medicare law discriminates against those with mental
illness, as well, by limiting the number of days that patients can
receive inpatient psychiatric care. Medicare imposes no such
limits for physical health, says Mark Covall, president and CEO
of the National Association of Psychiatric Health Systems.
By denying hospital care to the mentally ill, Murphy says
Congress set two standards for health, effectively telling the
country that the mentally ill are less deserving of a decent life
than others. By forcing the mentally ill to live with sickness,
confusion and disability, federal law reinforces the assumption
that the mentally ill are incapable of leading functioning, safe,
successful lives.
"The federal government has set so many barriers to getting
care, which they have done with no other type of illness, and it
is wrong," Murphy says. "There is no other area of medicine
where the government is the source of the stigma."
Without federal support, states haven't been able to afford to
keep their psychiatric hospitals open. States closed 10% of their
hospital beds from 2009 to 2012, says Robert Glover, executive
director of the National Association of State Mental Health
Program Directors.
Private hospitals have reduced their psychiatric beds, as well,
because Medicare and Medicaid typically pay less for inpatient
mental healthcare than for medical care, says Ron Honberg,
national director of policy and legal affairs at NAMI, the
National Alliance on Mental Illness.
"It's just pure discrimination," Covall says. "It's penalizing the
poor and disabled."
Mental health advocates have had more success reforming the
private insurance system.
The Affordable Care Act, for example, requires that health
exchanges provide equal mental and physical health coverage.
While in Congress, Kennedy led the fight to require private
insurers to provide equal coverage for physical and mental
health, resulting in a 2008 "parity" law that applies to policies
issued after July 1. Kennedy has joined in lawsuits against
insurance companies to force them to comply.
“'If I have diabetes, there is no stigma to that. But if my brain
doesn't work, why am I supposed to be ashamed of that?'”
Pastor Rick Warren
Pastor Rick Warren, a best-selling author, couldn't get long-
term care for his son, Matthew, who suffered from depression
for many years.
(Photo: Robert Hanashiro, USA TODAY)
Although Medicare has corrected some of its unequal payments
in recent years, it isn't affected by the parity law, Kennedy says.
The federal government hasn't yet issued rules governing how
the parity law affects Medicaid, the largest provider of mental
health services in the country.
Pastor Rick Warren, a best-selling author, struggled to find
long-term care for his son, Matthew, who suffered from
depression for many years. "At one point, we were counseled
that Matthew needed extended, long-term help in a long-term
care facility," Warren told USA TODAY. "When we began to
look for one, we couldn't find one."
Warren, founder of Saddleback Community Church in Orange
County, Calif., began speaking out about mental illness after
Matthew killed himself last year, at age 27. Warren compares
the stigma of mental illness to that of AIDS and HIV. In both
cases, people are blamed for bringing suffering upon
"It's just pure discrimination," Covall says. "It's penalizing the
poor and disabled."
Mental health advocates have had more success reforming the
private insurance system.
The Affordable Care Act, for example, requires that health
exchanges provide equal mental and physical health coverage.
While in Congress, Kennedy led the fight to require private
insurers to provide equal coverage for physical and mental
health, resulting in a 2008 "parity" law that applies to policies
issued after July 1. Kennedy has joined in lawsuits against
insurance companies to force them to comply.
“'If I have diabetes, there is no stigma to that. But if my brain
doesn't work, why am I supposed to be ashamed of that?'”
Pastor Rick Warren
Pastor Rick Warren, a best-selling author, couldn't get long-
term care for his son, Matthew, who suffered from depression
for many years.
(Photo: Robert Hanashiro, USA TODAY)
Although Medicare has corrected some of its unequal payments
in recent years, it isn't affected by the parity law, Kennedy says.
The federal government hasn't yet issued rules governing how
the parity law affects Medicaid, the largest provider of mental
health services in the country.
Pastor Rick Warren, a best-selling author, struggled to find
long-term care for his son, Matthew, who suffered from
depression for many years. "At one point, we were counseled
that Matthew needed extended, long-term help in a long-term
care facility," Warren told USA TODAY. "When we began to
look for one, we couldn't find one."
Warren, founder of Saddleback Community Church in Orange
County, Calif., began speaking out about mental illness after
Matthew killed himself last year, at age 27. Warren compares
the stigma of mental illness to that of AIDS and HIV. In both
cases, people are blamed for bringing suffering upon
themselves, he says.
<!--iframe-->
"If I have diabetes, there is no stigma to that," says Warren,
who is making mental health one of his key ministries. "But if
my brain doesn't work, why am I supposed to be ashamed of
that? It's just another organ. People will readily admit to taking
medicine for high blood pressure, but if I am taking medication
for some kind of mental problem I'm having, I'm supposed to
hide that."
Treating Mental Illness in New York, From All Angles
By The Editorial Board
· Nov. 25, 2015
Image
CreditCreditShannon Freshwater
As too many people know only too well, mental health is a
world of unmet needs and untold suffering. Society’s ability to
identify and treat emotional ailments and addiction is painfully
inadequate. Families, left to themselves, struggle and fail. They
often lack the resources to confront problems or don’t try: two
things in plentiful supply are ignorance and denial.
Into this void, bearing a multiagency “road map” with a
kitchen-sink approach, has stepped Mayor Bill de Blasio. In an
emotional news conference on Monday, he unveiled a citywide
initiative, called “ThriveNYC,” to tackle mental illness and
addiction.
The plan’s six “guiding principles” and 54 programs encompass
widely varying things like training for 250,000 New Yorkers in
mental health “first aid,” a public-service ad campaign, early-
childhood programs teaching social and emotional skills, more
screening and treatment for maternal depression, and new
initiatives in online education and data collection.
The human element includes 100 consultants in the schools to
connect students with care, as well as a “Mental Health Corps”
<!--iframe-->
"If I have diabetes, there is no stigma to that," says Warren,
who is making mental health one of his key ministries. "But if
my brain doesn't work, why am I supposed to be ashamed of
that? It's just another organ. People will readily admit to taking
medicine for high blood pressure, but if I am taking medication
for some kind of mental problem I'm having, I'm supposed to
hide that."
Treating Mental Illness in New York, From All Angles
By The Editorial Board
· Nov. 25, 2015
Image
CreditCreditShannon Freshwater
As too many people know only too well, mental health is a
world of unmet needs and untold suffering. Society’s ability to
identify and treat emotional ailments and addiction is painfully
inadequate. Families, left to themselves, struggle and fail. They
often lack the resources to confront problems or don’t try: two
things in plentiful supply are ignorance and denial.
Into this void, bearing a multiagency “road map” with a
kitchen-sink approach, has stepped Mayor Bill de Blasio. In an
emotional news conference on Monday, he unveiled a citywide
initiative, called “ThriveNYC,” to tackle mental illness and
addiction.
The plan’s six “guiding principles” and 54 programs encompass
widely varying things like training for 250,000 New Yorkers in
mental health “first aid,” a public-service ad campaign, early-
childhood programs teaching social and emotional skills, more
screening and treatment for maternal depression, and new
initiatives in online education and data collection.
The human element includes 100 consultants in the schools to
connect students with care, as well as a “Mental Health Corps”
of 400 doctors and clinicians to work in high-need
neighborhoods. Together with other programs, like the mayor’s
recently announced plan to build 15,000 units of supportive
housing for those who need social services as well as housing,
ThriveNYC is meant to strengthen the web of protection for the
city’s most vulnerable residents, on par with Mayor Michael
Bloomberg’s groundbreaking advances in fighting smoking,
obesity and other threats.
Advertisement
It will take months, maybe years, to see what ThriveNYC
amounts to. Not all of the money or programs are new, though
the label is. The mayor’s announcement could be a turning point
for a city making progress in containing a sprawling crisis, or it
could recede to become one among many well-trumpeted
initiatives that fade on the follow-through. The mayor’s office
has a strenuous job ahead, to focus on what is practical and
achievable, not politicized and rhetorical. But given the well-
established need — in the rates of depression and suicide, the
recent surge in heroin overdoses, the prevalence of mental
illness in city jails — it’s hard to argue against efforts to
achieve what the mayor says he will with ThriveNYC.
One only has to walk the streets of the city to see the untreated
suffering of many of the people sleeping and begging in the
street. They are the most visible evidence of the epidemic.
Other administrations have confronted parts of the problem,
alternating between tough and tender, though never in a
comprehensive way. Former Mayor Rudy Giuliani has recently
been lecturing the mayor about the need to harass homeless
people on the street until they are forced into treatment or go
away and become some other city’s problem.
Mr. de Blasio deserves credit for raising the issue of mental
health, and setting so high a bar. His news conference had a
personal edge: The mayor’s voice broke as he spoke of his
father’s alcoholism, and how his daughter, Chiara, has struggled
with drugs and depression. The de Blasio family’s willingness
to acknowledge its own troubles sets a good example for a city
neighborhoods. Together with other programs, like the mayor’s
recently announced plan to build 15,000 units of supportive
housing for those who need social services as well as housing,
ThriveNYC is meant to strengthen the web of protection for the
city’s most vulnerable residents, on par with Mayor Michael
Bloomberg’s groundbreaking advances in fighting smoking,
obesity and other threats.
Advertisement
It will take months, maybe years, to see what ThriveNYC
amounts to. Not all of the money or programs are new, though
the label is. The mayor’s announcement could be a turning point
for a city making progress in containing a sprawling crisis, or it
could recede to become one among many well-trumpeted
initiatives that fade on the follow-through. The mayor’s office
has a strenuous job ahead, to focus on what is practical and
achievable, not politicized and rhetorical. But given the well-
established need — in the rates of depression and suicide, the
recent surge in heroin overdoses, the prevalence of mental
illness in city jails — it’s hard to argue against efforts to
achieve what the mayor says he will with ThriveNYC.
One only has to walk the streets of the city to see the untreated
suffering of many of the people sleeping and begging in the
street. They are the most visible evidence of the epidemic.
Other administrations have confronted parts of the problem,
alternating between tough and tender, though never in a
comprehensive way. Former Mayor Rudy Giuliani has recently
been lecturing the mayor about the need to harass homeless
people on the street until they are forced into treatment or go
away and become some other city’s problem.
Mr. de Blasio deserves credit for raising the issue of mental
health, and setting so high a bar. His news conference had a
personal edge: The mayor’s voice broke as he spoke of his
father’s alcoholism, and how his daughter, Chiara, has struggled
with drugs and depression. The de Blasio family’s willingness
to acknowledge its own troubles sets a good example for a city
that needs to find — and stay on — a path to better mental
health.
A version of this article appears in print on Nov. 26, 2015, on
Page A34 of the New York edition with the headline: Treating
Mental Illness, From All Angles . Order Reprints | Today’s
Paper | Subscribe
Where Police Violence Encounters Mental Illness
By Matthew Epperson Jan 13, 2016
·
CreditCreditYarek Waszul
NEARLY 20 years ago, I was a social worker in a county jail
where I first began to understand just how frequently the police
deal with people with mental illnesses. Run-ins with the police
were a regular occurrence for many of my clients, with officers
often knowing them by name. They were overwhelmingly poor,
and poor people with mental illnesses are also likely to
experience homelessness and substance abuse — issues that
place them at increased risk of police contact and incarceration.
All too often, those interactions can end in violence and death,
as was the case with 19-year-old Quintonio LeGrier, who was
shot and killed by a Chicago police officer last month.
Responding to a 911 call made by Mr. LeGrier’s father, officers
found Mr. LeGrier wielding a baseball bat, and one officer
quickly opened fire.
This was not Mr. LeGrier’s first encounter with law
enforcement. He’d had several confrontations with the police at
the university he’d attended in recent months — at least one of
these incidents involved officers’ guns being drawn. His
experience bears a striking resemblance to that of one of my
former clients who was a college student in the late 1990s and
who had several tense exchanges with the police as his
symptoms worsened.
health.
A version of this article appears in print on Nov. 26, 2015, on
Page A34 of the New York edition with the headline: Treating
Mental Illness, From All Angles . Order Reprints | Today’s
Paper | Subscribe
Where Police Violence Encounters Mental Illness
By Matthew Epperson Jan 13, 2016
·
CreditCreditYarek Waszul
NEARLY 20 years ago, I was a social worker in a county jail
where I first began to understand just how frequently the police
deal with people with mental illnesses. Run-ins with the police
were a regular occurrence for many of my clients, with officers
often knowing them by name. They were overwhelmingly poor,
and poor people with mental illnesses are also likely to
experience homelessness and substance abuse — issues that
place them at increased risk of police contact and incarceration.
All too often, those interactions can end in violence and death,
as was the case with 19-year-old Quintonio LeGrier, who was
shot and killed by a Chicago police officer last month.
Responding to a 911 call made by Mr. LeGrier’s father, officers
found Mr. LeGrier wielding a baseball bat, and one officer
quickly opened fire.
This was not Mr. LeGrier’s first encounter with law
enforcement. He’d had several confrontations with the police at
the university he’d attended in recent months — at least one of
these incidents involved officers’ guns being drawn. His
experience bears a striking resemblance to that of one of my
former clients who was a college student in the late 1990s and
who had several tense exchanges with the police as his
symptoms worsened.
What’s remarkable is that, even about 20 years later, the police
remain the primary responders to mental health crises like
these. According to data compiled by The Washington Post, of
nearly 1,000 people shot and killed by police officers in the
United States in 2015, 25 percent displayed signs of mental
illness. And about 14 percent of individuals in American jails
and prisons have a serious mental illness, which means that, for
most officers, interacting with individuals with mental illness is
an almost daily occurrence.
Advertisement
There are two simultaneous national crises — one of police
violence and the other of inadequate mental health treatment —
and we are making a mistake if we focus blame only on the
police. They have become, by default, the way in which our
society chooses to deal with people with mental illness in crisis,
particularly in poor and minority communities. We need also to
address the declining state of mental health services across the
country.
Right now, we are moving in the opposite direction. Between
2009 and 2011, Mr. LeGrier’s home state, Illinois, eliminated
more than $113 million in community mental health treatment
services. In Chicago, the number of public mental health clinics
was cut in half — to 6 from 12 — in 2012 as a cost-saving
measure. Illinois’s path follows the national trend of funding
cuts for mental health services. And of course these cutbacks
primarily affect people living in poverty, who are already at
heightened risk of suffering from mental illnesses.
You have 3 free articles remaining.
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So that leaves the police as our de facto front line. To date, the
dominant police model has been the Crisis Intervention Team
(C.I.T.), which provides training on responding to mental health
emergencies. Current research is as yet inconclusive on whether
this training actually reduces the use of force, and police
departments struggle with training and dispatching trained
officers to the right calls. About 15 percent of Chicago police
remain the primary responders to mental health crises like
these. According to data compiled by The Washington Post, of
nearly 1,000 people shot and killed by police officers in the
United States in 2015, 25 percent displayed signs of mental
illness. And about 14 percent of individuals in American jails
and prisons have a serious mental illness, which means that, for
most officers, interacting with individuals with mental illness is
an almost daily occurrence.
Advertisement
There are two simultaneous national crises — one of police
violence and the other of inadequate mental health treatment —
and we are making a mistake if we focus blame only on the
police. They have become, by default, the way in which our
society chooses to deal with people with mental illness in crisis,
particularly in poor and minority communities. We need also to
address the declining state of mental health services across the
country.
Right now, we are moving in the opposite direction. Between
2009 and 2011, Mr. LeGrier’s home state, Illinois, eliminated
more than $113 million in community mental health treatment
services. In Chicago, the number of public mental health clinics
was cut in half — to 6 from 12 — in 2012 as a cost-saving
measure. Illinois’s path follows the national trend of funding
cuts for mental health services. And of course these cutbacks
primarily affect people living in poverty, who are already at
heightened risk of suffering from mental illnesses.
You have 3 free articles remaining.
Subscribe to The Times
So that leaves the police as our de facto front line. To date, the
dominant police model has been the Crisis Intervention Team
(C.I.T.), which provides training on responding to mental health
emergencies. Current research is as yet inconclusive on whether
this training actually reduces the use of force, and police
departments struggle with training and dispatching trained
officers to the right calls. About 15 percent of Chicago police
officers are C.I.T. trained, while experts recommend training
for at least 25 percent.
But training alone will not solve the problem of police violence
against people with mental illnesses. A few cities, like San
Antonio, have made strides in building a better system by
integrating mental health services with law enforcement. We
need to invest more broadly in a mental health crisis system to
work in conjunction with the police.
For example, in domestic disturbance cases like Mr. LeGrier’s,
a triage mental health worker could quickly gather pertinent
information, assess risk of harm and engage family members as
part of a coordinated effort. A crisis team could respond to the
call, with police assistance if needed, to determine the safest
and most clinically appropriate disposition. A responsive
system would have suitable support available, such as a triage
center or respite beds to provide urgent services, which would
offer a clinically driven alternative to the more typical choices
of jail, the emergency room or the morgue.
This is tricky terrain — even promising new approaches won’t
completely eliminate fraught interactions between the police
and people with mental illnesses, or the chance of violence on
either side. But they provide a wider and more fitting array of
responses that could go a long way to averting future violence
or incarceration. They certainly would have helped many of the
clients I worked with in jail.
We also need to wrestle with our own complicated attitude
toward people with mental illness. Mr. LeGrier’s death is a rare
case of national attention being paid to a person with mental
illness being gunned down by the police, perhaps because a
bystander, Bettie Jones, was also killed. Just 10 days after the
shooting of Michael Brown in Ferguson, Mo., and only a few
miles away, a young man with mental illness named Kajieme
Powell was fatally shot by the police in St. Louis. Mr. Brown’s
death incited widespread protests, but despite the fact that Mr.
Powell’s shooting was actually captured on video, his senseless
death went largely unnoticed.
for at least 25 percent.
But training alone will not solve the problem of police violence
against people with mental illnesses. A few cities, like San
Antonio, have made strides in building a better system by
integrating mental health services with law enforcement. We
need to invest more broadly in a mental health crisis system to
work in conjunction with the police.
For example, in domestic disturbance cases like Mr. LeGrier’s,
a triage mental health worker could quickly gather pertinent
information, assess risk of harm and engage family members as
part of a coordinated effort. A crisis team could respond to the
call, with police assistance if needed, to determine the safest
and most clinically appropriate disposition. A responsive
system would have suitable support available, such as a triage
center or respite beds to provide urgent services, which would
offer a clinically driven alternative to the more typical choices
of jail, the emergency room or the morgue.
This is tricky terrain — even promising new approaches won’t
completely eliminate fraught interactions between the police
and people with mental illnesses, or the chance of violence on
either side. But they provide a wider and more fitting array of
responses that could go a long way to averting future violence
or incarceration. They certainly would have helped many of the
clients I worked with in jail.
We also need to wrestle with our own complicated attitude
toward people with mental illness. Mr. LeGrier’s death is a rare
case of national attention being paid to a person with mental
illness being gunned down by the police, perhaps because a
bystander, Bettie Jones, was also killed. Just 10 days after the
shooting of Michael Brown in Ferguson, Mo., and only a few
miles away, a young man with mental illness named Kajieme
Powell was fatally shot by the police in St. Louis. Mr. Brown’s
death incited widespread protests, but despite the fact that Mr.
Powell’s shooting was actually captured on video, his senseless
death went largely unnoticed.
If we are to prevent future tragedies, then we should be ready to
invest in a more responsive mental-health system and relieve
the police of the burden of being the primary, and often sole,
responders. For the sake of individuals like Quintonio LeGrier,
Kajieme Powell and many of the clients I’ve served, I hope we
are.
invest in a more responsive mental-health system and relieve
the police of the burden of being the primary, and often sole,
responders. For the sake of individuals like Quintonio LeGrier,
Kajieme Powell and many of the clients I’ve served, I hope we
are.
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