Sunday, October 28, 2012

To Breach, or Not to Breach....That is the Question


 

 In 2000, the American Psychiatric Association formed a Task Force to revise the guidelines on Psychiatric Services in Jails and Prisons. Paul Applebaum, in his writings on ethics and forensic psychiatry, suggested that ethics in the correctional system differ from those in the community.  There are situations that arise in prison that have no clear cut standards on a proper decision to breach or not to breach confidentiality regarding something a prisoner has shared confidentially; Standard 4.01, Maintaining Confidentiality. It is suggested by some experts that psychologists inform inmates that in certain situations, there is no guarantee that confidentiality will be kept, Standard 4.02, Discussing the Limits of Confidentiality.  This approach serves two purposes: 1) to cut down on information being shared that would lead to a breach; and 2) promote trust that if a breach is necessary, the inmate is not surprised. 

In his article, "Decisions to Breach Confidentiality When Prisoners Report Violations of Institutional Rules", Dr. Pinta states, "It is useful to categorize decisions to breach confidentiality as either treatment driven or security driven." Pinta explains that although this seems to oversimplify these issues, it assists in cutting through the moral dillemas with regard to the dual roles (correctional officer and security, and psychologist and treatment).  For example, a security driven decision would be if an inmate shares that he is going to start a prison riot, already has hatched the plan, and has engaged numerous inmates to participate, the decision to breach confidentiality is clear as it will endanger the entire prison population.  Additionally, if an inmate shares that he is planning to kill his cellmate due to on-going differences, and is in possession of a weapon, the psychologist has no choice but to go to prison officials with this information; Standard 4.05b (3), Disclosures, as well as the possibility of
Tarasoff laws being applicable in this case (vary by state).  A treatment based decision might be if an inmate shares personal sexual encounters that are on-going in exchange for cigarettes. There is no threat to security of the facility or any specific person, therefore, the psychologist must adhere to Standard 4.01, Maintaining Confidentiality.

Pinta goes on to say in his article that there are numerous gray areas for which there is no right or wrong decision to breach confidentiality.  Some examples he uses are possessing a makeshift weapon, possessing/using marijuana, selling drugs, and having sex with a staff member.  With the latter situation, I question whether or not this area is truly gray and if it would possibly fall under Standard 1.03, Conflicts Between Ethics and Organizational Demands; or possibly 3.05, Multiple Relationships, although correctional staff members are not held to the APA Code of Ethics.


Although correctional psychologist are on a slippery slope with regard to ethical situations, making sound decisions and thinking things through in steps, while adhering to the APA Principles and Code of Ethics, is the key to delivering services in the correctional setting. With experience, the psychologist can do important work for a population greatly in need of these important services. 




Pinta, E.R. (2009). Decisions to breach confidentiality when prisoners report violations of institutional rules. The Journal of the American Academy of Psychiatry and the Law, (37), 150-154.
Retrieved from http://cjb.sagepub.com.felix.albright.edu/content/33/4/542.



4 comments:

  1. Sheila,
    Very interesting, thoughtful, and enlightening article. It seems as though this task force has some decency and respect for therapist/patient relationships and confidentiality, while recognizing security concerns. Although I truly believe that it does become a "slippery slope" when faced with security matters, it was uplifting to see that there has been positive action being taken to clearly define roles and responsibilities in the prison systems.

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    1. Thanks, Pam. I appreciate your comments and taking the time to visit my blog!

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  2. What a great topic and love your writing style. There is so much to Ethics, who would have thought! I love that everyone who is blogging is doing such totally different topics, I am learning so much. I am sure that 4.05, Disclosures, is a very nebulous area for professionals within a prison setting. Their over all job is to keep things safe and secure, and with that population I am sure this is NOT an easy task. Great job.

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    1. Thanks, Cynthia. I appreciate the feedback and glad you are enjoying the subject matter.

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