Psychologists in public inpatient psychiatric settings: Ethical dilemmas.

Abstract

Psychologists face new ethical dilemmas as their roles expand in public hospital psychiatric units. Clinical and administrative practices indicate psychological values, models, and interventions are useful and effective when serving seriously mentally ill inpatients. Issues addressing the clinical, administrative, and training competence of psychologists in public hospital settings are discussed. It is recommended that national guidelines be developed to be used by state licensing and hospital credentialing boards in verifying preparation for public inpatient psychiatric practice.Psychologists in public psychiatric inpatient settings have begun adapting to the changing mental health service delivery system. The "medicalization" of diagnostic and intervention techniques and psychiatrists' renewed identification with the medical profession have resulted in some diminished clinical options for psychologists (Paul & Menditto, 1992). Changes in hospital management have resulted in ancillary activities, such as psychotherapy and psychoeducation, being provided by nurses, social workers, and occupational therapists. Pressures from consumer groups and insurers have led to shorter hospital stays and greater clinical accountability. Responding to these patterns, psychologists in public settings have started expanding their roles and identities into new clinical, administrative, and training areas and have raised new ethical dilemmas that warrant examination by the profession.

Psychologists working in state psychiatric hospitals: An exploration of factors related to work engagement

“…The psychologist has a difficult role, in that she/he is neither a prescribing physician nor a front line staff member. Instead, the psychologist fills a professional role that is often misunderstood within the hospital system (Sommer & Clancy, 1958;Wood et al, 1994). For these reasons, job ambiguity has been identified as a variable that could be related to work engagement in the current dissertation.…”

“…The role of psychologists and counselors has been ambiguous throughout the past century in psychiatric hospitals (Sommer & Clancy, 1958;Wood, Rogers, McCarthy & Lewine, 1994).…”

“…Psychiatric hospitals generally continue to operate under the medical model in which medications and psychiatry are the basis of most interventions, and the goal is more to prevent patients from acting out as opposed to recovering (Geczy, Sultenfuss & Donat, 1990). In general, psychologists offer patients individual and group therapy, work as a member of an interdisciplinary team to establish treatment goals, conduct psychological assessments of patients and offer support to other team members (Wood et al, 1994). Psychologists also assess intellectual capacity, determine personal strengths of the patient and assist in diagnosis (Wechsler, 1944).…”

“…Little research has examined the work engagement patterns of psychologists in state hospital settings, and what has been completed is outdated (Ishiyama et al, 1962;Sommer & Clancy, 1958;Wood, Rogers, McCarthy, & Lewine, 1994). Updated research will not only enable training programs to better prepare psychologists for work in state mental hospitals, but also will allow hospitals to make the best use of the psychological resources at their disposal.…”

“…Job ambiguity was assessed specifically in order to determine the extent to which psychologists in state hospitals believe that their job roles are clear, and how job ambiguity predicts work engagement. Previous research has indicated the likelihood of job ambiguity for psychologists in such settings (Ishiyama et al, 1962;Sommer & Clancy, 1958;Wood et al, 1994), however, this research is long outdated. An aim of this research was to provide information to educators and hospital administrators to better train and retain engaged psychologists in state hospitals, and to improve and maintain good quality treatment for patients.…”