Rights and Responsibilities of Psychologists and Clients – Involuntary Hospitalization

Dr. Donna L. Roberts

Temporary means of protection and stabilization

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A fundamental aspect of the ethical practice of psychology involves clearly defining the rights and responsibilities of both the client and the psychologist as they engage in the collaborative task of therapy. These guidelines permeate all phases of the treatment relationship and represent issues paramount for protecting all parties and serving the best interest of the client. The topic encompasses both moral and legal issues, including informed consent, record keeping, involuntary hospitalization, malpractice, confidentiality, and the duty to warn and protect.

Involuntary Hospitalization

Hospitalization for psychiatric illness has undergone revolutionary changes over the last five decades. The increasing trend toward de-institutionalization has significantly decreased the number of patients and the duration of their stay in long-term psychiatric treatment facilities. Today the average length of stay for adults in a psychiatric facility is twelve days. The mental health care team and patient begin planning for discharge on the first day of admission. The National Association of Psychiatric Health Systems reports that about 88 percent of adults treated in its members' hospitals are admitted voluntarily (APA Joint Commission on Public Affairs, 1994). However, in most states, individuals so disabled by their illnesses that they cannot recognize their need for inpatient care and/or who refuse recommendations of hospital treatment may be involuntarily admitted by psychiatrists and/or family members, but often only with the intervention of the court system and a thorough evaluation by a psychiatrist (Bersoff, 2008).

While involuntary treatment is sometimes necessary, it is used only in extreme circumstances and is always subject to an ethical review which protects the rights of patients. The purpose of hospitalization is to provide protection from stresses of living and from self-inflicted harm while the patient is stabilized, and a long-term treatment plan is established. The guiding ethical principle mandates providing adequate psychological treatment in the least restrictive setting. Specifically, this policy “requires that treatment be no more harsh, hazardous, or intrusive than necessary to achieve therapeutic aims and to protect clients and others from physical harm (Corey, Corey & Callahan, 2002, p. 179). Thus, a psychiatrist's decision to admit a patient depends primarily on the severity of the patient's illness. The presence or absence of social support, such as family members or other caretakers, can also influence the psychiatrist's decision to hospitalize a patient. With sufficient social support, a person who might otherwise require hospitalization can often be cared for at home (APA Joint Commission on Public Affairs, 1994).

Commitment procedures and regulations vary from state to state, but all encompass a strict set of procedures to insure protection of the patient's legal rights. Most states allow a psychiatrist to involuntarily admit a patient to a hospital for a brief evaluation period, usually spanning approximately three-days. During the evaluation period, a team of psychiatrists and mental health professionals can assess whether the patient requires longer hospital care or can be managed effectively with less intensive treatment, such as partial hospitalization (APA Joint Commission on Public Affairs, 1994). Further complicating the issue, many health insurance companies require detailed assessment and specific certification procedures before agreeing to pay for a hospitalization and subsequently periodically review the patient's progress to determine the length of stay that will be covered.

Many psychiatric hospitals and mental health units of general hospitals provide a full range of care, including, individual and group psychotherapy, medication, vocational rehabilitation, occupational training and social services. The period of hospitalization can temporarily reduce the stress and obligations of daily life, allowing patients to concentrate fully on recovery. As the crisis lessens and patients are better able to assume responsibilities, the treatment team can help them plan for discharge and refer them to the community-based services that will assist their continued recovery.

Ethical issues involving aspects of the rights and responsibilities inherent in each role of the therapeutic relationship can be complex and controversial. While the basic mandate of acting in the best interests of the client seems straightforward, in practice, it can require challenging professional assessments and judgment calls, and is thus subject to debate and conflicting interpretation. The issues are further complicated by the various legal standards and requirements related to patient issues. Practitioners must be firmly grounded in their professional standards and clearly demonstrate their continued commitment to serving the psychological well being of their clients, even when, or more precisely, especially when, difficult ethical dilemmas arise.

REFERENCES

APA Joint Commission on Public Affairs. (1994). Psychiatric hospitalization. http://www.psych.org/public_info/hospital.cfm.

Bersoff, D. N. (2008). Ethical conflicts in psychology, 4e. Washington, DC: American Psychological Association.

Corey, G., Corey, M. and Callahan, P. (2002). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.

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