Ethics and Governance in Psychological Practice Lecture PDF

Ethics and Governance in Psychological Practice CMPS11091 Prof Liz Gilchrist Based on material prepared by Dr. Clara Calia Topics • Code of Ethics and Conduct Group exercises • Legal and Professional obligations • Safeguarding • Informed Consent Group exercises BPS- Code of Conduct Prin...

Ethics and Governance in Psychological Practice CMPS11091 Prof Liz Gilchrist Based on material prepared by Dr. Clara Calia Topics • Code of Ethics and Conduct Group exercises • Legal and Professional obligations • Safeguarding • Informed Consent Group exercises BPS- Code of Conduct Principles and the Codes serve primarily as guidelines for thinking about the decisions individuals need to make. Salience - how readily something comes to mind Confirmation bias - the human tendency to look for evidence that confirms their belief and to ignore other evidence Loss aversion - behaviour to avoid loss Ethical reasoning is subject to various competing biases. Maintaining awareness of such biases is important when trying to think through ethical challenges. These include: Beliefs about disclosure - tendency to be more honest when they believe their actions will be known by others, Dissonance reduction - acting to maintain consistent beliefs Acting ethically can be affected by a number of individual and group influences as well as context, so even though an individual may be aware of ethical issues and has worked through the decision-making process, their motivation or ability to act ethically may be compromised. BPS- Code of Conduct Key considerations include conformity and resistance, context, power, emotion, and the role of social norms, organisational pressures and group/self-identity. Psychologists are well placed to consider and reflect on these factors in their own decision-making. Acting ethically depends on many skills including: a capacity for leadership, effective prioritisation and risk management. Fear, difficulty, fatigue and perverse reward systems are some of the many environmental issues that could influence implementation of a decision. BPS- Structure of the Code This Code is based on four ethical Principles, which constitute the main domains of responsibility, within which ethical issues are considered Respect Competence Responsibility Integrity Respect Privacy and confidentiality Respect Respect for the dignity of persons and peoples is one of the most fundamental and universal ethical principles across geographical and cultural boundaries, and across professional disciplines. This inherent worth means that all human beings are worthy of equal moral consideration. Statement of values: Psychologists value the dignity and worth of all persons, with sensitivity to the dynamics of perceived authority or influence over persons and peoples and with particular regard to people’s rights. In applying these values, you should consider: Communities and shared values within them Impacts on the broader environment Issues of power Consent Self-determination Compassionate care, including empathy, sympathy, generosity, openness, distress tolerance, commitment and courage Competence Psychologists, whether academic, practitioner or in training, may offer a range of services that usually require specialist knowledge, training, skill and experience. Competence refers to their ability to provide those specific services to a requisite professional standard. Statement of values: Psychologists value the continuing development and maintenance of high standards of competence in their professional work and the importance of working within the recognised limits of their knowledge, skill, training, education and experience. Possession of appropriate skills and care The limits of their competence and the potential need to refer on to another professional Advances in the evidence base The need to maintain technical and practical skills Matters of professional ethics and decision-making Any limitations to their competence to practise taking mitigating actions as necessary In applying these values, you should consider: Caution in making knowledge claims Responsibility Professional accountability Psychologists must accept appropriate responsibility for what is within their power, control or management. Statement of values: Psychologists value their responsibilities to persons and peoples, to the general public, and to the profession and science of Psychology, including the avoidance of harm and the prevention of misuse or abuse of their contribution to society. In applying these values, psychologists should consider: Responsible use of their knowledge and skills Respect for the welfare of human, non-humans and the living world Potentially competing duties Integrity Honesty, openness and candour Acting with integrity includes being honest, truthful, accurate and consistent in one’s actions, words, decisions, methods and outcomes. Statement of values: Psychologists value honesty, probity, accuracy, clarity and fairness in their interactions with all persons and peoples, and seek to promote integrity in all facets of their scientific and professional endeavours. In applying these values, Psychologists should consider: Accurate unbiased representation Fairness Avoidance of exploitation and conflicts of interest Maintaining personal and professional boundaries; Addressing misconduct. Excercise 15 minutes group discuss: BPS values- Respect, Competence, Responsibility and Integrity: please provide examples of these principle in practice from your own experience Legal and professional obligations Psychologists’ professional practice is impacted upon and governed by a range of legislation and regulation. It is the therapist’s responsibility to ensure they are aware of the legislation and guidelines that govern their particular area of practice as well as the terms of their employment or terms contracted with a commissioner of their services. Psychologists are also advised to consider membership of a union or similar body to ensure they have access to appropriate representation, support and legal advice should they be subject to a complaint or disciplinary action. Important examples to note are: Equality Act 2010 This Act protects people against unfair treatment, promotes equality and prevents discrimination against any of nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, and sexual orientation. Psychologists, where they operate in an organisational context, must also seek to encourage and influence others in ensuring that equality of opportunity is embedded in all thinking and all practice relating to access to services for client groups and recruitment and employment practices. Data Protection Act 1998 The Data Protection Act defines personal and sensitive personal data. It gives individuals the right to know what information is held about them and provides a framework to ensure that personal information is handled properly. Good information governance is at the heart of safe practice. It encompasses physical data security, access controls and acceptable use, data quality, and records management. Freedom of Information Act 2000 Health and Safety at Work Act 1974 The Freedom of Information Act 2000 provides public access to information held by public authorities. Public authorities include government departments, local authorities, the NHS, State schools and police forces. Information held by Scottish public authorities is covered by Scotland’s own Freedom of Information (Scotland) Act 2002. This legislation permits information to be withheld from disclosure in certain prescribed circumstances, for example information provided in confidence, related to law enforcement or where it relates to personal matters. This Act places a duty on all employers ‘to ensure, so far as is reasonably practicable, the health, safety and welfare at work’ of all their employees. Employees themselves also have obligations under the legislation. Mental Capacity Act 2005 Framework with regard to capacity and consent for all individuals aged 16 years and above in England and Wales. Scotland -Adults with Incapacity Act 2000 & Northern Ireland - Mental Capacity Act 2016. 5 principles: 1. A person must be assumed to have capacity unless it is established that he lacks capacity. 2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. 3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 4. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. 5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action. Mental Health Act 1983 amended 2007 The main purpose is to allow compulsory action to be taken to ensure that people with mental disorders receive the care and treatment they require for their own health or safety, or for the protection of other people. The Act sets out the criteria that must be met before compulsory measures can be taken, along with protections and safeguards for patients. 5 principles: vleast restrictive option and maximising independence vempowerment and involvement vrespect and dignity vpurpose and effectiveness vefficiency and equity Excercise 15 minutes group discuss: Ethical autobiography - state how you have implemented ethical guidelines in your clinical practice. Safeguarding Safeguarding means protecting people’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. Abuse takes many forms and cuts through various domains of life: Ø Physical abuse Ø Sexual violence and abuse Ø Psychological/emotional abuse Ø Financial & Institutional abuse Ø Neglect Safeguarding children Working Together to Safeguard Children – A guide to inter-agency working to safeguard and promote the welfare of children. key principles: (a) safeguarding is everyone’s responsibility and for services to be effective each professional and organisation should play their full part; (b) safeguarding requires a child-centred approach based on a clear understanding of the needs and views of children. Safeguarding children Therapists should: • be alert for early intervention support for a child who: has a disability, has additional needs, is a young carer, is showing signs of engaging in anti-social or criminal behaviour, has returned home from care and/or is showing early signs of abuse and/or neglect. • be alert to heightened vulnerability where a child is in a family circumstance presenting challenges for the child, such as substance abuse, adult mental health problems and domestic violence. • consider the potential impacts of parental/carer ill-health on the family; • be aware that children within the same family can be treated differently; • be aware/seek to understand how children can come to abuse other children; • recognise that some professionals use their position to abuse children and vulnerable people. Therapists should be aware of situations of risk which require additional consideration: • sexual exploitation & domestic violence; • social/economic and/or emotional vulnerability; • internet abuse (cyber bullying, exposure to pornography or violence); • shame-based abuse where children or young people may be physically assaulted or murdered because of bringing perceived ‘shame’ to their families or breaking cultural expectations of ‘honour’; • Trafficking, any child transported for exploitative reasons is considered to be a trafficking victim, whether or not they have been forced or deceived. Safeguarding adults at risk of harm The Care Act 2014 brought in new legislation regarding the safeguarding of all vulnerable adults. An adult at risk of harm is a person aged 18 or over with need for care or support, who is experiencing, or is at risk of, abuse or neglect, and as a result of their needs is unable to protect himself or herself against the abuse or neglect or the risk of it. Safeguarding adults means: • Protecting the rights of adults to live in safety, free from abuse and neglect. • People and organisations working together to prevent and stop both the risks and experience of abuse or neglect & promote adult’s wellbeing is promoted • Recognising that adults sometimes have complex interpersonal relationships and may be unclear or unrealistic about their personal circumstances and therefore potential risks to their safety and wellbeing Informed consent The concept of informed consent relates to the client’s right to choose whether to receive psychological services, and to make this choice on the basis of the best information available presented in the most appropriate way. The principles apply, whether the therapist works in the public, private or voluntary sector or in independent practice. Ø Express consent must be sought in advance for the use of video, audio recording or one-way screens, with a clear explanation of the purpose of these Informed consent Therapists should: Ø ensure that they have sought and received the consent of the client in an appropriate manner prior to undertaking any assessment, intervention or research activities. Ø be aware that a client’s desire for help, and the immediate impact of the psychologist’s supportive listening, may affect the client’s ability to make informed choices about the help they wish to receive. Ø be aware that their own desires to help a client may bias their presentation of information, such as the probability of successful outcomes. Ø be aware of the complexities of obtaining informed consent to treatment due to the perceived power, status and authority of the professional psychologist. Informed consent In order to ensure that the client has all the information necessary to make an informed decision about whether to take part or not in a psychological activity, they must be provided with relevant information in a format that is designed to meet their specific needs. The therapist should consider providing information about the following: • what the psychological activity involves, • the benefits of the activity, either directly to the client in the case of assessment or intervention; • any alternative assessment or treatment options and their known availability; • foreseeable risks and how minor or serious they may be, • what might be the benefits and potential costs and risks to them of engaging or not engaging in the proposed psychological activity; • the client’s right to withdraw their consent from assessment, treatment or intervention at any stage Informed consent with children and young people All children and young people have a right to express their views freely and be involved in any decision-making that affects their lives. Therefore, therapists must gain their informed consent. Any direction or guidance provided by parents or other caregivers must be ‘in accordance with the child’s evolving capabilities’ and support the ‘exercise by the child of his or her rights’. Every therapist should consider how they can: • provide an accessible explanation to the child or young person about their work; • offer a clear reason for their possible involvement; • provide an opportunity for the child to talk about what working with the therapist might involve. • discuss and agree how information is recorded and possibly shared with others with - young people are ‘Gillick competent’ can consent to information not being shared with parents; • discuss how the child or young person will be kept safe; • ensure that the child or young person has understood the therapist’s role; • ensure the child or young person understands they can withdraw their consent at any point; • ensure their practice acknowledges and respects the culture, community and context of the child or young person. Informed consent with people who may lack capacity Make a judgment about a client’s ability to give informed consent. This should include whether the person is able to: • understand the information relevant to the decision (e.g. psychological treatment); • retain that information; • use or weigh that information as part of the process of making the decision; • communicate their decision (whether by talking, using sign language or any other means) The Mental Capacity Act Code of Practice highlighting the need to assist a client in making a decision for themselves (with the use, for example, of memory aids, simplified resources, etc.). Excercise 15 minutes group discuss: Think about how much information is required for participants to provide valid and informed consent