Ethical Justice

1. Ethical Justice Chapter Thirteen: Ethical Issues for Treatment Staff in Forensic Settings

2. Ethical Issues for Treatment Staff in Forensic Settings Correctional settings are visited by mental health practitioners under a variety of different employment circumstances, providing inmate evaluations and treatment. Some work as employees of the correctional agency, some are employed by a company contracted to the correctional agency, and others can be private practitioners that are contracted to a specific county or corrections system.

3. Practitioner Competence Mental health practitioners have an obligation to be competent when providing their services in general. This means they must not accept casework or seek employment placing them beyond their professional abilities. They also have an obligation to seek educational and credentialing from legitimate institutions and avoid unaccredited programs and diploma mills.

4. Role of Forensic Units Behavioral health care is provided either in a local county jail, a state or federal prison, or a detention facility. Federal and state correctional systems have access to forensic units where inmates requiring an inpatient level of behavioral health care will be sent. In these units, there are two types of evaluations that occur; evaluation for the legal system and evaluation for the purpose of providing treatment.

5. Role of Forensic Units Dual Agency Forensic mental health (FMH) practitioners who are assessing an inmate for a strictly legal issue should advise the inmate that they are not there to treat them and that the information obtained in the course of the evaluation is not confidential. In some units, the same provider is expected to treat both an inmate and perform a forensic evaluation for the court. This is referred to as dual agency.

6. Role of Forensic Units Access to an Attorneys FMH examiners have an ethical obligation to inquire as to whether an arrested inmate has accessed an attorney and, if not, the arrestee must decide whether they wish to proceed without one or to consult with one first.

7. Correctional Culture FMH examiners must understand that the correctional setting belongs to law enforcement personnel mandated with maintaining the security of both inmates and non-inmate. Security will not be compromised to meet the needs of others. Because of the competing goals, there is often a tension between health care providers and jail security staff.

8. Evaluations The following are examples of different types of inmate evaluations: Treatment evaluations Treatment evaluations are conducted in the same manner as in the community, with a heightened sensitivity to issues related to contraband, risk of suicide, predation, etc. Some correctional settings are well designed for these treatments but most are not – providers often speak with inmates through cell doors, etc. Malingering mental illness is problematic, referring to feigning illness, often for medication, attention, or as the result of personal crises

9. Evaluations Competency to stand trial Competency to stand trial evaluations address the inmate’s current mental state and whether they are able to understand their charges and assist their attorney in their defense. These evaluations are conducted in the community and in a correctional setting. Criminal responsibility Criminal responsibility evaluations deal with the mental state of an offender at the time of a crime. This evaluation should not be done by a treating behavioral health provider.

10. Evaluations Dangerousness Once found not responsible due to mental disease or defect, the aquitee will undergo an evaluation to determine if they need to be transferred to a forensic unit, a civil psychiatric unit in the community, or outpatient treatment. These evaluations are characteristically done by psychiatrists employed by a state or the federal government and who work in a forensic unit.

11. Informed Consent//Confidentiality Inmate clients, as well as clients outside of correctional facilities, should be informed of the benefits and risks of any treatment and of any limits on confidentiality. There is a treatment-security dichotomy when it comes to breaching confidentiality. One approach to dealing with the dichotomy is four-pronged: One must be aware of the ethical issues or concerns One must have an ethics-based priority paradigm There is hopefully a period of deliberation, even if brief, possibly including input from another professional One must make a decision and take responsibility for it.

12. Disciplinary Hearings The consensus among the forensic mental health community appears to be that behavioral health professionals should not participate in assessing the responsibility of inmates for violations of correctional regulations. Solitary confinement, usually called segregation, isolated inmates from others. The sensory deprivation can be problematic, especially when an inmate suffers from a major mental disorder. Inmates in segregation should have the same access to mental health care as those in the general population. Inmates are placed in restraints by correctional staff due to self-injurious or other directed violence. Behavioral health staff should assess the mental health needs of such individuals at and during the time of restrains.

13. Sex Offenders Treatment of sex offenders in a prison is ethical, although there are issues that arise, such as voluntariness and confidentiality in the treatment. It is important to note that it is a misuse of the behavioral health field professions to house sex offenders past the expiration of their sentence through civil commitment for dangerous sexual predators.

14. Physical and Sexual Assault Victims Behavioral health staff should cooperate in assessing the mental health needs of physical and sexual assault victims and help ascertain the need for protective custody, special cell arrangements, and even transfer to another facility.

15. Sexual Relationships Sexual contact with patients in the community is considered unethical because of the context and power differential. This is the same in correctional facilities or even more so because the power differential is much greater. Behavioral health providers in these settings need to be vigilant for attempts to entice them to engage in minor boundary violations by inmates.

16. Sexual Relationships The mental health community appears to be divided on the specific of the ethical issues pertaining to the death penalty. Some view the death penalty as separate from their role and others believe that it is unethical to treat an inmate in order to get them well enough to be tried for capital murder or have their death sentence carried out.

17. Release to the Community Behavioral health care workers should ensure that mentally ill inmates are not released without appropriate follow up arranged in the community.

18. Administrative Education Behavioral health staff in correctional settings have an ethical obligation to education and/or alert correctional staff and administration to issues interfering with the delivery of appropriate behavioral health care to inmates. Examples include: housing conditions, food, or treatment by prison staff.