JCPSLP vol 19 no 3 2017 low res. pdf

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JCPSLP Volume 19, Number 3 2017 167
Ethical conversations
Belinda Kenny
(top), Patricia
Bradd (centre)
and Noel Muller
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.
Jess1 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
Mental 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
Mental health and
illness
What are our ethical duties toward clients and colleagues?
Belinda Kenny, Patricia Bradd, and Noel Muller