Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry

Course overview

This course is based upon material published in Frontiers in Psychiatry and is available as an open access article. Background: Mental health care professionals deal with complex ethical dilemmas that involve the principles of autonomy, justice, beneficence, and non-maleficence. Such dilemmas are even more prominent in forensic mental health care, where the restriction of personal rights is legitimated not only by patient well-being but also by public safety interests. Little is known about either the use of formal ethics support services or specific ethical needs in forensic mental health care. Knowledge about the current structures and how they compare with those in general psychiatry would help to identify the most important ethical issues and to analyze whether there are unmet needs that might require specific ethics support. Results: Clinical ethics support was available in 74% of general psychiatric hospitals but in only 43% of all forensic psychiatric hospitals and 25% of those offering treatment for offenders with substance use disorders. Most ethics support services were interdisciplinary. The most frequently requested retrospective and prospective ethics consultations were on issues of omission and termination of treatment, coercive measures, and advance directives. Among the hospitals without access to ethics support, 71% indicated a need for training in ethics. Discussion: Our results show that ethics consultation is well established in general psychiatry, but less so in forensic psychiatry. Mental health care professionals in forensic psychiatry seem to have a need for ethics support and training in clinical ethics. We also found a difference in access to ethics structures between hospitals that treat mentally disordered offenders and those that treat offenders with substance use disorders. Further research should focus on how ethics support can be comprehensively implemented in forensic mental health care and how this might improve treatment quality and patient and staff well-being. This course on clinical ethics support availability in forensic psychiatry is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. This course is appropriate for beginning, intermediate and advanced level practitioners who wish to develop or increase their knowledge of clinical ethics support in the context of forensic psychiatric institutions. It may also be useful for licensed clinicians who require clinical continuing education courses for license renewal. The course is based on a journal article which includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A major benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Franke, Speiser, Dudeck, and Streb Learning Objectives: This course will provide the practitioner with detailed information regarding forensic psychiatry and clinical ethics support structures. Specifically, a professional will: Discriminate between the availability of CES in general psychiatric hospitals and in forensic psychiatric facilities Explain the organization of CES in psychiatric hospitals Describe the integration of CES in psychiatric hospitals Citation: Franke, Irina; Speiser, Oskar; Dudeck, Manuela; and Streg, Judith. Clinical Ethics Support Services Are Not as Well-Established in Forensic Psychiatry as in General Psychiatry. Frontiers in Psychiatry. 13 March 2020. Doi: 10.3389/psyt.2020.00186