JCPSLP November 2017

Ethical conversations

Mental health and illness What are our ethical duties toward clients and colleagues? Belinda Kenny, Patricia Bradd, and Noel Muller

M ental health issues have significant impact on the lives of many Australians. Here, we will explore some of the ethical issues that speech pathologists may need to consider when they manage clients or interact with colleagues who have mental health concerns. We aim to facilitate conversations regarding mental health to help speech pathologists identify and respond appropriately to signs that clients or colleagues may benefit from support. Ethical considerations with clients From a speech pathologist who is endeavouring to work with an adult who has depression and declining therapy following a stroke, to those who are employed by specialist forensic and mental health service agencies, to the therapist who is working with young people who have experienced trauma, many of us have been touched by mental illness in the therapeutic sense. The World Health Organization (2017) has defined mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community”. Mental health illness and mental health issues can affect any person across their lifespan, either continuously or episodically. Speech pathologists have an important role in both the prevention and remediation of clients with mental ill health (Murray, 2009). Speech pathologists also have ethical responsibilities when managing clients with mental health concerns. The Speech Pathology Code of Ethics (Speech Pathology Australia, 2010) calls us to conduct our practice by upholding the principles of beneficence and non- maleficence. Keeping this in mind, consider the following scenario: A general practitioner has referred an 18-month-old child to your clinic for review of his communication as the child has not yet begun to talk. You send a pre- clinic questionnaire to the family to complete, to bring along to the first appointment, which seeks details about both the child and the family situation. The mother discloses through this questionnaire that she has experienced significant and sustained postnatal depression following the birth of her little boy. You meet mum and the toddler at the initial assessment. Mum’s affect is flat and she is barely engaging with the child. During a play task, he seeks her attention by touching her face and showing her a

toy, but she fails to make eye contact or respond to his efforts. What ethical considerations do we need to consider in the above situation? In relation to the Speech Pathology Australia Code of Ethics (2010), we have “duties to our clients and to the community” (section 3.1). What are our duties to the child in this context? What are our duties to the mother? Are there safety or welfare considerations (clause 3.1.7) that we may need to consider? The Speech Pathology Code of Ethics (Speech Pathology Australia, 2010) provides some guidance in relation to our responsibilities to our clients and the community (section 3.1) as part of our Standards of Practice. This along with our values of respect and care require us to consider the ethical principles of autonomy (section 2.4) for the mother while ensuring the safety and welfare of the child (clause 3.1.7). This scenario also raises the issue of the safety and welfare of the mother, which may require the speech-language pathologist to pro-actively address her underlying mental illness support needs along with the child’s communication needs by assisting the family to engage with appropriate support services. Ethical considerations with colleagues Many practising health professionals successfully manage mental health issues and provide competent, quality services to the community. However, speech pathologists are employed in demanding clinical environments. They manage complex clients within resource constraints. An inverse relationship exists between stress and self-care, and there are links between stress-induced job dissatisfaction and perceptions of professional competence (Ayala, Ellis, Grudev, & Cole, 2017). Hence, recognising and responding appropriately to staff members experiencing mental health issues is important for individuals, colleagues and managers. Yet knowledge and confidence in deciding when and how to respond may be a barrier to speech pathologists accessing support. The following scenario highlights potential ethical issues that may arise when mental health issues are not addressed in the workplace. Jess 1 enjoys speech pathology practice but this has been a challenging year. Staffing changes have required her to cover a new caseload and manage increased administrative responsibilities. It has been a difficult year, personally, with distressing family issues

Belinda Kenny (top), Patricia Bradd (centre) and Noel Muller

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JCPSLP Volume 19, Number 3 2017

www.speechpathologyaustralia.org.au