There May Be Instances When Someone Will Seek Mental Health

There May Be Instances When Someone Will Seek Mental Health Assistance

There may be instances when someone will seek mental health assistance and may not meet the full diagnostic criteria for a mental disorder, or they may not want a diagnosis on their record. It is the clinician’s responsibility to ensure they are using diagnosis in an ethical manner, according to the ACA Code of Ethics, along with the APA Ethical Principles of Psychologists and Code of Conduct. There may be times when a client questions their diagnosis and wants their case reviewed, possibly because of issues with insurance coverage, or they may believe their diagnosis will cause harm to them in other aspects of their life. Imagine you’re a consultant who reviews cases of potential ethical violations.

A nonprofit mental health agency has hired you to review a recent case that came into question and determine if there was an ethical violation regarding the use of a diagnosis. The case was filed because the client disagrees with the diagnosis given and would like a different diagnosis. She is worried that the diagnosis given will be detrimental to her career and family life. The clinician has written a report justifying their use of the diagnosis for your review. You have been asked to present your findings to the agency board.

Kassi is a 38-year-old White woman who came to the agency seeking substance abuse treatment. She mentioned that she needed to show her employer that she was taking appropriate measures to treat the issue, since it has impacted her productivity at work. Kassi stated that she works 40+ hours per week as an executive assistant and is also a single parent to a 14-year-old daughter. She reported that her job is quite stressful and requires her to be flexible with her schedule so that she can be available in the evenings, if needed. She mentioned that this causes her to be away from her daughter often, and she misses sporting events, band concerts, and other extracurricular activities and that has strained her relationship with her daughter.

She reported that she often comes home and will have a whiskey on the rocks, and that sometimes turns into 3 or more drinks. She mentioned that this amount has increased over time. This has caused her to be late to work on more than one occasion, and completely miss work once or twice over the last 6 months because she is nauseous, anxious, and has trouble sleeping. Her daughter has mentioned her concern about her drinking since it has also caused her to miss some of her extracurricular activities and her daughter’s friends do not want to come over when Kassi is drinking. Kassi reported that she is only seeking treatment because her work is requiring it, but she does not believe she has a problem with alcohol.

When reviewing the DSM-5 diagnostic criteria for alcohol use disorder, Kassi meets criteria A. 1, 3, 5, 6, 10a, and 11a. Since this is 6 criteria, she was given a diagnosis of severe alcohol use disorder (303.90). American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. (Note: The American Psychological Association is not affiliated with nor endorses the University of Phoenix or its course materials.) American Counseling Association. (2014).

Utilize the model for ethical decision-making presented in the Forester-Miller and Davis article to analyze the case and describe your ethical decision-making process.

Evaluate the clinician’s justification for the diagnosis given. Explain whether the use of the diagnosis in this case was ethical or unethical, according to the ACA and APA codes of ethics.

Paper For Above instruction

The safeguarding of ethical standards in clinical diagnosis is fundamental to the integrity of mental health practice. In the case of Kassi, a 38-year-old woman who was diagnosed with severe alcohol use disorder primarily to meet her employer’s requirements, ethical considerations surrounding diagnosis and disclosure come into focus. Using the ethical decision-making model proposed by Forester-Miller and Davis (1996), this analysis evaluates whether the clinician’s justification for diagnosing Kassi aligns with professional ethical standards articulated in the APA and ACA Code of Ethics.

Forester-Miller and Davis’s (1996) model involves six stages: identifying the problem, applying ethical codes, determining the nature and dimensions of the dilemma, generating potential actions, considering the consequences, and deciding on the best course. Applying this model, the primary ethical issue concerns whether diagnosing Kassi without her acknowledgment of problematic alcohol use, primarily for external reasons, complies with ethical standards that prioritize client wellbeing, autonomy, and honesty.

In step one—identifying the problem—it is evident that Kassi’s diagnosis was influenced significantly by external pressures, specifically her employer requiring treatment verification. This raises concern about whether the diagnosis accurately reflects her internal state or is primarily a strategic response to external demands. Such external influence risks compromising the ethical imperative for honesty in assessment, as emphasized by the APA's principle of fidelity and responsibility, which stipulates psychologists must act with integrity and avoid misrepresentation of client functioning (APA, 2017).

Applying the second step—using the ethical codes—indicates that the clinician’s decision to diagnose must uphold standards of beneficence and nonmaleficence, ensuring the diagnosis benefits the client and does not cause harm. If the diagnosis is primarily a compliance measure rather than an authentic reflection of Kassi’s mental health, it could be argued that the clinician's actions undermine these principles.

In the third step—determining the dilemma’s nature—the dilemma involves balancing the clinician’s obligation to provide accurate diagnoses and the client’s right to avoid a stigmatizing label that may adversely impact her career and family life. Kassi explicitly expresses concern that a diagnosis might harm her reputation and future opportunities, which underscores her autonomy and right to informed consent about her mental health record. Fulfilling this aspect of ethical practice requires transparency and client participation in diagnostic decisions (ACA, 2014).

Generating potential actions involves considering alternative approaches: for example, providing supportive counseling without formal diagnosis, or documenting behaviors and concerns without assigning a diagnostic label. These options could better respect Kassi's autonomy and reduce potential harm caused by stigma or misrepresentation.

Considering the consequences, diagnosing Kassi primarily to meet her employer’s requirement entails risks of ethical violations such as deception and misrepresentation, especially if the diagnosis does not entirely encapsulate her internal experience. It may also adversely impact her psychologically if she perceives the diagnosis as invalid or stigmatizing. Conversely, withholding a formal diagnosis when clinically indicated could impede access to appropriate services, which conflicts with beneficence.

The final decision should support ethical principles—ensuring full transparency, obtaining informed consent, and perhaps opting for less stigmatizing documentation of her substance use issues without formal DSM diagnosis unless clinically warranted and fully consensual.

In evaluating the clinician’s justification, if the diagnosis was solely to satisfy external requirements and not based on a comprehensive, collaborative assessment of her internal experiences and concerns, then this decision breaches ethical standards of honesty, integrity, and respect for client autonomy. According to the APA and ACA codes, diagnoses must be evidence-based and made with the client’s informed consent, not primarily for external compliance (APA, 2017; ACA, 2014). If the clinician’s report can be shown to be motivated by external pressures rather than Kassi’s actual clinical presentation, this constitutes an ethical violation.

In conclusion, applying the ethical decision-making model reveals that the use of the diagnosis in this case tends toward unethical practice if it prioritizes external compliance over honesty, client welfare, and informed consent. While accurate diagnosis is essential, it must be balanced with respect for client autonomy and the imperative to avoid harm. Clinicians must ensure that diagnoses are grounded in valid clinical assessment, and any external pressures should be navigated ethically by engaging the client fully and exploring alternatives that uphold professional standards.

References

• American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
• American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/knowledge-center/ethics
• Forester-Miller, H., & Davis, T. E. (1996). Practitioner’s guide to ethical decision making. (Rev. ed.).
• Gutheil, T. G. (2000). Ethical standards in psychiatric practice. Psychiatric Times, 17(3), 1-4.
• Knapp, S. J., & VandeCreek, L. (2012). Practical ethics for psychologists: A positive approach. American Psychological Association.
• McCarthy, J. P., & Rajagopal, S. (2018). Ethical dilemmas in mental health practice. Journal of Clinical Psychology, 74(4), 653-663.
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