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Registered Australian Psychologists' Responses to Ethical Dilemmas Regarding Medicare Funding of Their Services
Abstract
Psychological services have been funded by the Australian government through Medicare since 2006. Medicare guidelines specify the conditions that psychologists can treat and the types of treatment that will be funded. The current study aimed to carry out an exploratory investigation of possible ethical issues raised by these guidelines. Psychologists' responses to hypothetical ethical dilemmas related to Medicare funding were examined. Two hundred and thirty-seven registered psychologists responded to an online questionnaire. Results suggest that psychologists base ethical decisions regarding Medicare-funded services on a number of factors, including the Australian Psychological Society Code of Ethics, best practice/treatment considerations, client interests, and Medicare guidelines. The characteristics of the dilemma and whether the situation can be referred to in the Code of Ethics appeared to influence psychologists' decisions. Participants were more ethically willing (they would do what they believed they should do) when the situation could be clearly related to the Code of Ethics. It was concluded that as psychologists must consider various professional values and standards, Medicare guidelines add a further level of complexity to practice decisions, and further education regarding Medicare rules is recommended.
... and so on. Previous studies have been successful in recruiting participants using both of these techniques simultaneously (Duncan et al., 2013;Politis and Knowles, 2013). Unfortunately, a response rate could not be calculated, as it is unknown how many individuals were notified of the survey. ...
... It is important to interpret the results of this study while considering its limitations. Firstly, although the present methods of data collection have been successful in recruiting psychologist samples in previous research (Duncan et al., 2013;Politis and Knowles, 2013), it is likely that the majority of individuals who were contacted to take part in the study declined to participate. Therefore, the extent to which results can be generalized to all therapists is unclear. ...
Exposure therapy is consistently indicated as the first-line treatment for anxiety-related disorders. Unfortunately, therapists often deliver exposure therapy in an overly cautious, less effective manner, characterized by using their own ‘therapist safety behaviours’. Cognitive behavioural models postulate that beliefs about therapist safety behaviours are related to their use; however, little is known about the beliefs therapists hold regarding therapist safety behaviour use. The present study aimed to identify the beliefs exposure therapists have regarding the necessity of therapist safety behaviours and to examine the relationship between this construct and therapist safety behaviour use. Australian psychologists ( n = 98) completed an online survey that included existing measures of therapist safety behaviour use, therapist negative beliefs about exposure therapy, likelihood to exclude anxious clients from exposure therapy, and use of intensifying exposure techniques. Participants also completed the Exposure Implementation Beliefs Scale (EIBS), a measure created for the present study which assesses beliefs regarding the necessity of therapist safety behaviours. Beliefs about the necessity of therapist safety behaviours – particularly in protecting the client – significantly predicted therapist safety behaviour use. Findings suggest that exposure therapy training media should aim to decrease therapist safety behaviour use by addressing beliefs about the necessity of therapist safety behaviours, especially in protecting the client.
Key learning aims
(1) To understand what therapist safety behaviours are in the context of exposure therapy.
(2) To identify common beliefs about therapist safety behaviours.
(3) To understand how beliefs about therapist safety behaviours relate to therapist safety behaviour use.
(4) To consider how exposure therapy delivery may be improved by modifying beliefs about therapist safety behaviours.
(5) To explore how beliefs about therapist safety behaviours may be modified to reduce therapist safety behaviour use.
... The original questionnaire describing three exemplary clinical and ethical dilemmas (short case presentations) combined with a multiple-choice questionnaire containing recommended solutions to the presented dilemmas was used. Other authors have also used the short case study method in studies investigating ethical issues (Bhola et al., 2015;Coverdale et al., 1997;Politis and Knowles, 2013). The original version of the questionnaire survey was drawn up by Anna Bogatyńska-Kucharska. ...
Paternalism and autonomy: psychotherapists' choices in dilemmas and their justifications as ethical aspects of the therapeutic relationship Paternalizm i autonomia: wybierane przez psychoterapeutów rozwiązania dylematów oraz ich uzasadnienia jako etyczne aspekty relacji terapeutycznej 1 Usługi psychologiczne. Anna ORCID iDs 1. Anna Bogatyńska-Kucharska https://orcid.org/0000-0001-7762-9518 2. Jarosław Kucharski https://orcid.org/0000-0001-6129-4477 3. Marcin J. Jabłoński https://orcid.org/0000-0002-3430-5932 Aim: The aim of the study was to analyse solutions to ethical dilemmas based on the criterion of "paternalism-autonomism" in the context of psychotherapists' professional experience and therapeutic modality. Another aim was to review the sources of choices of ethical decisions from the perspective of the "intuitiveness-ethical reflection" dichotomy, and to assess the percentage of ethical, ambiguous, and non-ethical justifications of solutions preferred in those ethical dilemmas. Method: It was a cross-sectional qualitative study. An original questionnaire describing three exemplary clinical and ethical dilemmas combined with a multiple-choice questionnaire containing recommended solutions to the presented dilemmas was employed in the study. The responses were correlated with the modality of psychotherapy (cognitive-behavioural, psychoanalytic-psychodynamic, psychodynamic-systemic, systemic, integrated) and the professional experience of therapists. The statistical analysis included questionnaires obtained from 191 respondents. Results: Statistical data indicate the general advantage of autonomous decisions in the entire group of therapists, regardless of their professional experience. A significant advantage of autonomic solutions over paternalistic solutions was demonstrated in all analysed therapeutic approaches with the exception of the cognitive-behavioural approach. Moreover, a statistically significant majority of psychotherapists reported the use of ethical reflection when choosing the solutions to the discussed dilemmas. A comparison of the total number of selected justifications revealed a significant advantage of ethical justifications over ambiguous and non-ethical ones, regardless of the professional experience of therapists and in all modalities except the psychoanalytic-psychodynamic and psychodynamic-systemic types. Conclusions: The principle of respect for autonomy plays an important role in the professional ethics of psychotherapists, and the preference for ethical considerations and justifications when choosing solutions to practical ethical dilemmas indicates a potential benefit of incorporating ethics into the professional training of therapists. Keywords: psychotherapy, ethical dilemmas, paternalism, autonomy, good of the patient Celem badania jest analiza rozwiązań dylematów etycznych ze względu na kryterium paternalizm-autonomia wybieranych przez psychoterapeutów z uwzględnieniem doświadczenia zawodowego oraz modalności respondentów. Ponadto artykuł przedstawia analizę deklarowanego przez psychoterapeutów sposobu rozstrzygania dylematów (rozwiązania intuicyjne lub namysł etyczny) oraz uzasadnień wskazanych rozwiązań (uzasadnienia etyczne, niejednoznaczne, pozaetyczne). Na potrzeby badania przekrojowego stworzono autorski kwestionariusz. Podstawę kwestionariusza stanowią opisy przykładowych dylematów etycznych oraz ich rozwiązania i uzasadnienia (pytania wielokrotnego wyboru z kafeterią odpowiedzi). Odpowiedzi respondentów zostały skorelowane z modalnością psychoterapeutyczną (w badaniu wyróżniono podejścia: poznawczo-behawioralne, psychoanalityczno-psychodynamiczne, psychodynamiczno-systemowe, systemowe, integrujące) oraz doświadczeniem zawodowym. Do analizy statystycznej wykorzystano dane zebrane od 191 respondentów. Wyniki wskazują na przewagę rozwiązań autonomicznych niezależnie od doświadczenia zawodowego psychoterapeutów. Poza tym wyniki badania wskazują na wyraźną przewagę rozwiązań autonomicznych nad paternalistycznymi we wszystkich badanych podejściach teoretycznych poza poznawczo-behawioralnym. Ponadto statystycznie istotnie więcej psychoterapeutów wskazywało, że wybór rozwiązania dylematu etycznego wymagał namysłu etycznego. Porównanie wskazywanych przez badanych uzasadnień dla rozwiązań dylematów etycznych wykazuje przewagę uzasadnień etycznych niezależnie od doświadczenia zawodowego oraz wśród przedstawicieli wszystkich podejść z wyjątkiem psychoanalityczno-psychodynamicznego oraz psychodynamiczno-systemowego. Zasada szacunku dla autonomii odgrywa istotną Abstract Streszczenie
... The original questionnaire describing three exemplary clinical and ethical dilemmas (short case presentations) combined with a multiple-choice questionnaire containing recommended solutions to the presented dilemmas was used. Other authors have also used the short case study method in studies investigating ethical issues (Bhola et al., 2015;Coverdale et al., 1997;Politis and Knowles, 2013). The original version of the questionnaire survey was drawn up by Anna Bogatyńska-Kucharska. ...
Aim: The aim of the study was to analyse solutions to ethical dilemmas based on the criterion of “paternalism-autonomism” in the context of psychotherapists’ professional experience and therapeutic modality. Another aim was to review the sources of choices of ethical decisions from the perspective of the “intuitiveness – ethical reflection” dichotomy, and to assess the percentage of ethical, ambiguous, and non-ethical justifications of solutions preferred in those ethical dilemmas. Method: It was a cross-sectional qualitative study. An original questionnaire describing three exemplary clinical and ethical dilemmas combined with a multiplechoice questionnaire containing recommended solutions to the presented dilemmas was employed in the study. The responses were correlated with the modality of psychotherapy (cognitive-behavioural, psychoanalytic-psychodynamic, psychodynamic-systemic, systemic, integrated) and the professional experience of therapists. The statistical analysis included questionnaires obtained from 191 respondents. Results: Statistical data indicate the general advantage of autonomous decisions in the entire group of therapists, regardless of their professional experience. A significant advantage of autonomic solutions over paternalistic solutions was demonstrated in all analysed therapeutic approaches with the exception of the cognitive-behavioural approach. Moreover, a statistically significant majority of psychotherapists reported the use of ethical reflection when choosing the solutions to the discussed dilemmas. A comparison of the total number of selected justifications revealed a significant advantage of ethical justifications over ambiguous and non-ethical ones, regardless of the professional experience of therapists and in all modalities except the psychoanalytic-psychodynamic and psychodynamic-systemic types. Conclusions: The principle of respect for autonomy plays an important role in the professional ethics of psychotherapists, and the preference for ethical considerations and justifications when choosing solutions to practical ethical dilemmas indicates a potential benefit of incorporating ethics into the professional training of therapists.
... Esta investigación, que pretendía la determinación del nivel de conocimientos de ética de los profesionales de la psicología, contó, en su versión inicial, con una muestra de 456 psicólogos de la división 29 de la APA. Desde la fecha de su publicación, han sido numerosas las réplicas realizadas (por citar sólo a algunos: Rae y Worchel, 1991;Pope y Vetter, 1992;Rubin y Dror, 1996;Pomerantz, Ross, Gfeller y Hughes, 1998;Gius y Coin, 2000;Pomerantz y Grice, 2001;Tubbs y Pomerantz, 2001;Sullivan, 2002;Hadjistavropoulos, Malloy y Sharpe, 2003;Del Río, Borda y Torres, 2007;Pomerantz y Pettibone, 2005;Urra, 2007;Politis, y Knowles, 2013). ...
... Clinician ethical dilemmas regarding patients with suicidal thoughts are less discussed -most publications being practitioner opinion surveys (15,16). Prominent clinician dilemmas are confidentiality concerns, limited direct care of patients with suicidal thoughts, and clouding of personal and professional domains (17)(18)(19). ...
This study aimed to explore ethical dilemmas and challenges faced by young mental healthcare researchers and professionals working with survivors of suicide (hereinafter suicide survivors). Two focus group discussions (FGDs) Researcher FGD (with those engaged in suicide research) and Clinician FGD (with those providing treatment to suicide survivors) – consisting of open-ended questions and lasting for 70-90 minutes were conducted and analysed using Thematic Analysis. Five themes were identified: i) struggling with the incongruity of harm within benefit, ii) difficulty in delineating boundaries, iii) self-doubt in one’s professional competence, iv) nature of suicide straining the limits of confidentiality, and v) working with structural limitations. The study helps to understand the obstacles and dilemmas encountered in adhering to ethical principles while working with vulnerable individuals.
... Therapists' experiences and responses to ethical dilemmas have received some attention in research, usually in the form of practitioner surveys (13,14,15) and through qualitative interviews (16). These surveys highlighted that the responses of practitioners vary in terms of the degree and type of ethical dilemmas experienced as well as with regard to perspectives on appropriate resolution. ...
Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. The trainees' responses to four open-ended questions on any one ethical dilemma encountered during therapy were analysed, using thematic content analysis. The results highlighted that the salient ethical dilemmas related to confidentiality and boundary issues. The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. The trainees felt that the professional codes had certain limitations as far as the effective resolution of ethical dilemmas was concerned. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India.
One way to improve ethical standards and competency of psychologists is by understanding how they respond to ethical dilemmas. This study asked psychologists to choose what they would do and what would be the worst thing to do in response to each of 20 vignettes describing an ethically difficult scenario. Participants were 95 registered psychologists practicing in an Australian state (New South Wales). Normative responses for “would” and “worst” responses were defined by a reference group of five psychologists experienced in professional ethics. The results showed that, unlike some previous studies, years of experience, gender and qualification were not significant predictors of normative choices. Overall, psychologists were better at identifying normative would than worst responses to ethical dilemmas. This finding highlights the need to raise awareness of what constitutes “bad” practice in order to help psychologists avoid engaging in behaviors that lead to misconduct. In addition, those who engaged in peer supervision were more likely to perform better on choosing the normative responses, suggesting the importance of receiving feedback and reflecting on clinical work to maintain ethical and professional standards.
The disclosure of bad news is one of the most difficult tasks of a physician. This study explores how physicians prefer to disclose bad news to patients with acute coronary disease in emergency centres in Iran, and to their families.
We explored the choices made by practicing psychologists in the face of specific ethical dilemmas, and the reasons for those choices. In addition, we explored the relationship between particular choices and particular reasons, as well as the relationship of various professional characteristics to those responses. We presented 294 psychologists, randomly selected members of the Division of Psychotherapy, with ten vignettes, each representing a potential problem of professional ethics. They were asked to indicate their preferred resolution to each dilemma and their primary reason for choosing this alternative. Although practitioners were more alike than different, results showed that respondents with certain characteristics—for example, professed theoretical orientation, sex, and years of experience—did differ in their choice of response to certain ethical dilemmas. Adherence to codified ethical guidelines was also shown to be related to willingness to take direct actions to resolve ethical dilemmas.
This paper outlines the legal and ethical duties of psychologists in relation to preserving as well as breaching confidentiality in therapeutic relationships. It analyses the results of a questionnaire examining psychologists' perceptions of the legal and ethical constraints on confidentiality and their likelihood of breaching confidentiality in different situations. The vast majority of participants indicated that the law permits them to disclose confidential information and that there is an ethical duty to disclose information to a third party when the patient is perceived to be dangerous. The results suggest that there is some uncertainty as to when confidentiality should be breached in practice and it is argued that the law is overly complex in this area and that guidelines are needed to assist psychologists in their clinical practice.
Sixteen licensed psychologists who lived and practiced in rural areas and small communities participated in interviews about ethical dilemmas they faced in daily practice. Dilemmas involving professional boundaries were identified as significant concerns for all of the psychologists. Major themes were the reality of overlapping business relationships, the effects of overlapping relationships on members of the psychologist's own family, and the dilemmas of working with more than 1 family member as clients or with others who have friendships with individual clients. The psychologists knew the content of ethical codes but often struggled in choosing how to apply those codes in the best interest of clients. Ongoing discussions regarding these choices can contribute to the evolution of practice codes applicable to rural areas and other small communities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors adopt a position that the Standards in the American Psychological Association (APA; 2002) Ethics Code should be based on or be logically related to some underlying ethical theory. The authors then review the 2002 APA Ethics Code from the standpoint of principle-based (prima facie) ethics. Their analysis shows that almost all of the enforceable standards in the 2002 APA Ethics Code are based on or can be linked logically to the criteria of principle-based ethics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
About half of the 647 psychologists who responded to a survey reported assessing or treating at least 1 patient who had been sexually intimate with a prior therapist. 958 sexual intimacy cases were reported. Most cases involved female patients, intimacies prior to termination, and harm to the patient. Harm was judged to occur to at least 80% of patients who engaged in sex with a therapist only after termination. Respondents reported that in about 4% of the 1,000 cases in which the issue of sexual intimacies arose, the allegations were false. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
As part of a larger study of behaviors and standards of psychologists and resources for guiding their actions, survey data were collected from 456 (231 male and 225 female) American Psychological Association members selected from Division 29 (Psychotherapy). Participants were asked to rate the degree to which they considered each of 83 behaviors to constitute good or poor practice. About one fourth (22) of the behaviors were considered to be uniformly "poor" by at least 60% of the participants. Only 2 behaviors were judged uniformly "good" by at least 50% of the participants. About one fourth (18) of the behaviors were difficult to judge (i.e., at least 20% of the participants indicated "don't know/not sure"). Participants tended to report that their behavior conformed to their standards of good practice and had a tendency to maintain stricter standards for judging whether a behavior was good or poor practice than for judging whether it was ethical or unethical. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The International Union of Psychological Science is searching for ethical principles that are universal for the discipline of psychology. Codes of ethics adopted by other international organizations are reviewed, as well as recent comparisons of psychology codes across national boundaries. Distinctions are made between declarations of human rights and professional codes of ethics, between ethical principles as overarching values and as rules of conduct, and between Euro-North American and non-Western cultural values. Organizations such as the United Nations and Amnesty International work for the elimination of abuses of human rights. Professional associations establish guidelines to promote the ethical behavior of their members. The hope for articulating universal ethical principles for psychologists is based on respect for our common humanity while still respecting the diversity of beliefs in different cultures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although we currently possess considerable information about the incidence and consequences of sexually intimate relationships between psychotherapists and clients, there is virtually no documentation of the extent to which psychotherapists are sexually attracted to clients, how they react to and handle such feelings, and the degree to which their training is adequate in this regard. "Feelings" toward clients are generally relegated to vague and conflicting discussions of countertransference, without benefit of systematic research. Survey data from 575 psychotherapists reveal that 87% (95% of men, 76% of women) have been sexually attracted to their clients, at least on occasion, and that, although only a minority (9.4% of men and 2.5% of women) have acted out such feelings, many (63%) feel guilty, anxious, or confused about the attraction. About half of the respondents did not receive any guidance or training concerning this issue, and only 9% reported that their training or supervision was adequate. Implications for the development of educational resources to address this subject are discussed.
A sample (N = 102) of mental health practitioners (75% nondoctoral; 25% doctoral) participated in a survey study that assessed reasons used by clinicians to resolve professional ethical conflicts. Results were consistent with expectations and suggested that although practitioners do evaluate what should be done in ethical conflict situations in line with existing ethical guidelines, they may not always be willing to implement this ideal. This study suggested that when faced with an ethical conflict, professionals tend to think in terms of formal codes of ethics and relevant legal guidelines in determining what they should do, but are more likely to respond to personal values and practical considerations in determining what they actually would do if faced with the situation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described.
To examine whether there was a reduction in demand for psychological services provided through the Access to Allied Psychological Services (ATAPS) projects after the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) program, and whether any such reduction was greater in urban than rural areas.
A Division-level correlation analysis examining the relationship between the monthly number of sessions provided by allied health professionals through the ATAPS projects run by Divisions of General Practice, and allied health professional services reimbursed by Medicare Australia under the Better Access program, between 1 November 2006 and 31 March 2007.
Uptake of each program, assessed by the number of sessions provided.
Overall, despite dramatic uptake of the Better Access program in the first 5 months after its introduction, the demand for ATAPS services was not reduced. The correlations between the numbers of sessions provided by both programs overall (r = - 0.078; P = 0.074) and in rural Divisions (r = 0.024; P = 0.703) were not significant. However, there was a significant negative correlation between the numbers of sessions provided by both programs in urban Divisions (r = - 0.142; P = 0.019).
For the first 5 months of the Better Access program, the two programs seemed to operate relatively independently of each other in terms of service provision, but in urban Divisions there was a move towards services provided through the Better Access program. Early indications are that the two programs are providing complementary services and are working together to address a previously unmet need for mental health care.
Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of 258 students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
As part of a larger study of behaviors and standards of psychologists and resources for guiding their actions, survey data were collected from 456 (231 male and 225 female) American Psychological Association members selected from Division 29 (Psychotherapy). Participants were asked to rate the degree to which they considered each of 83 behaviors to constitute good or poor practice. About one fourth (22) of the behaviors were considered to be uniformly "poor" by at least 60% of the participants. Only 2 behaviors were judged uniformly "good" by at least 50% of the participants. About one fourth (18) of the behaviors were difficult to judge (i.e., at least 20% of the participants indicated "don't know/not sure"). Participants tended to report that their behavior conformed to their standards of good practice and had a tendency to maintain stricter standards for judging whether a behavior was good or poor practice than for judging whether it was ethical or unethical.
Sixteen licensed psychologists who lived and practiced in rural areas and small communities participated in interviews about ethical dilemmas they faced in daily practice. Dilemmas involving professional boundaries were identified as significant concerns for all of the psychologists. Major themes were the reality of overlapping business relationships, the effects of overlapping relationships on members of the psychologist's own family, and the dilemmas of working with more than 1 family member as clients or with others who have friendships with individual clients. The psychologists knew the content of ethical codes but often struggled in choosing how to apply those codes in the best interest of clients. Ongoing discussions regarding these choices can contribute to the evolution of practice codes applicable to rural areas and other small communities.
Close-up insights on how experts in the field are re-interpreting ethical principles to create workable policies for today and tomorrow, from the creators of the 2007 APS Code of Ethics. First cooperative project between Wiley-Blackwell and the APS. Offers a close-up view of how enduring ethical principles are reinvented to ensure lasting relevance in times of modernisation and professional change. Will be an accredited option for APS Professional Development - the book will be built into PD workshops and also available for PD credits outside that context. Essential reading for those involved in healthcare ethics internationally.
Presents the American Psychological Association's Ethics Code. The document consists of an introduction, a preamble, 6 general principles, and specific standards and rules for conduct by psychologists. Topics covered by the standards include (1) General Standards, (2) Evaluation, Assessment or Intervention, (3) Advertising and Other Public Statements, (4) Therapy, (5) Privacy and Confidentiality, (6) Teaching, Training Supervision, Research, and Publishing, (7) Forensic Activities, and (8) Resolving Ethical Issues. (0 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this book is to update the previous editions and discusses revisions in the codes of ethics in the mental health field. The authors discuss the role of the Internet and how it has increased the amount of information for the layperson and to the professional, but also increases the responsibility to be sure that the information is accurate and is used appropriately. Also, the increased use of preferred practice guidelines, empirically validated treatments, and the like are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
ConsentPrivacyConfidentialityConclusion
References
Respect for the Dignity, Moral and Legal Rights of PeopleJusticeAutonomyNonmaleficenceBeneficenceVeracityFidelityResponsibilityConclusion
References
The aim of this paper was to consider the impact on psychologists of one component of the Australian Government's Better Outcomes in Mental Health Care (BOiMHC) program, namely the Access to Allied Psychological Services (ATAPS) component. This supports psychologists and general practitioners (GPs) to work together to provide optimal mental health care, via 102 projects being conducted by Divisions of General Practice. The paper was informed by data from five sources: a project-based minimum dataset; local project evaluation reports; a forum; a survey of projects: and a survey of Australian Psychological Society (APS) members. Taken together, the data from these sources showed that a significant number of psychologists are providing services through the projects, and the majority are finding it a positive and professionally rewarding experience. There is considerable variability regarding models of retaining, locating and referring to psychologists, and there are pros and cons associated with each. The major problem identified by psychologists is the level of remuneration. BOiMHC is currently moving into a new phase of continuation and expansion, and consideration was given to whether the data point to any changes that could be made to the ATAPS projects during this period of transition. In the main, the data suggest that the status quo should be retained, but the issue of remuneration must be addressed.
Recent research suggests a discrepancy between understanding vs. implementation of ethical principles. The present study investigated the relationship between decisions with regard to what "should" vs. what "would" be done in a variety of ethical conflict situations. Additionally, this research examined the influence of the degree of closeness of the respondent to the identified person-of-reference in each conflict scenario. The results strongly supported the conclusion that while professional clinicians are capable of recognizing conduct that falls below accepted ethical standards, they are less willing to follow through with required action. Restrictiveness of conflict resolution was related to both person-of-reference group and to specific ethical situation. The results are discussed in terms of attribution theory and actor-observer effects.
We explored the choices made by practicing psychologists in the face of specific ethical dilemmas, and the reasons for those choices. In addition, we explored the relationship between particular choices and particular reasons, as well as the relationship of various professional characteristics to those responses. We presented 294 psychologists, randomly selected members of the Division of Psychotherapy, with ten vignettes, each representing a potential problem of professional ethics. They were asked to indicate their preferred resolution to each dilemma and their primary reason for choosing this alternative. Although practitioners were more alike than different, results showed that respondents with certain characteristics—for example, professed theoretical orientation, sex, and years of experience—did differ in their choice of response to certain ethical dilemmas. Adherence to codified ethical guidelines was also shown to be related to willingness to take direct actions to resolve ethical dilemmas. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In an earlier study, Bernard and Jara (1986) found that approximately 50% of clinical graduate students admitted that they would probably not do what the situation demanded when a peer was behaving unethically. In this study, we surveyed professional clinicians and found that significant numbers of them would also do less than they knew they should. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Rural Australians face particular difficulties in accessing mental health care. This paper explores whether 51 rural Access to Allied Psychological Services projects, funded under the Better Outcomes in Mental Health Care program, are improving such access, and, if so, whether this is translating to positive consumer outcomes.
The paper draws on three data sources (a survey of models of service delivery, a minimum dataset and three case studies) to examine the operation and achievements of these projects, and makes comparisons with their 57 urban equivalents as relevant.
Proportionally, uptake of the projects in rural areas has been higher than in urban areas: more GPs and allied health professionals are involved, and more consumers have received care. There is also evidence that the models of service delivery used in these projects have specifically been designed to resolve issues particular to rural areas, such as difficulties recruiting and retaining providers. The projects are being delivered at no or low cost to consumers, and are achieving positive outcomes as assessed by standardised measures.
The findings suggest that the rural projects have the potential to improve access to mental health care for rural residents with depression and anxiety, by enabling GPs to refer them to allied health professionals. The findings are discussed with reference to recent reforms to mental health care delivery in Australia.
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Executive director's report
- L Littlefield
Littlefield, L. (2011). Executive director's report—April 2011, Better access—Yes it is! InPsych: The Bulletin of the Australian Psychological Society Ltd, 33(2), 6–9.
InPsych: The Bulletin of the Australian Psychological Society Ltd A double-edged sword for psychology InPsych: The Bulletin of the Australian Psychological Society Ltd Improving access to and outcomes from mental health care in rural Australia Professional ethics across national boundaries
- R Mathews
- B Montgomery
- B Morley
- J Pirkis
- L Naccarella
- F Kohn
- G Blashki
- P Burgess
Mathews, R. (2010). Medicare audits result in concerning outcomes. InPsych: The Bulletin of the Australian Psychological Society Ltd, 32(1), 28. Montgomery, B. (2009). A double-edged sword for psychology. InPsych: The Bulletin of the Australian Psychological Society Ltd, 31(3), 5. Morley, B., Pirkis, J., Naccarella, L., Kohn, F., Blashki, G., & Burgess, P. (2007). Improving access to and outcomes from mental health care in rural Australia. Australian Journal of Rural Health, 15, 304–312, doi:10.1111/j.1440-1584.2007.00905.x Pettifor, J. L. (2004). Professional ethics across national boundaries. European Psychologist, 9, 264–272, doi:10.1027/1016-9040.
A double-edged sword for psychology
- B Montgomery
Survey of members providing Medicare-funded services under the Better Access and Better Outcomes initiative
- C Forsyth
- R Mathews
A changing landscape? Implications of the introduction of the Better Access initiative for the public mental health psychology workforce
- Gleeson
Mental health care under Medicare shown to be essential for community
- E Grant
Executive director's report-April 2011, Better access-Yes it is!
- Littlefield
An investigation into Australian psychologists' and undergraduate psychology students' beliefs about how psychologists “should” and “would” respond to ethical dilemmas (Unpublished master of psychology
- R Mackinnon
The Australian psychological society code of professional conduct
Medicare audits result in concerning outcomes
- Mathews
- Allan
Legal and ethical considerations when working across the public and private sectors
- Australian Psychological Society
Survey of members providing Medicare-funded services under the Better Access initiative
- Giese
A changing landscape? Implications of the introduction of the Better Access initiative for the public mental health psychology workforce. InPsych: The Bulletin of the Australian Psychological Society Ltd
- J Gleeson
- W Brewer
Survey of members providing Medicare-funded services under the Better Access initiative. InPsych: The Bulletin of the Australian Psychological Society Ltd
- J Giese
- L Littlefield
- R Mathews