Saturday, July 6, 2013

Why Must Counselors be Advocates?


"Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net".

Many believe that counselors should be advocates for their clients. However, if this is done, it must be done so in a way that does not impart a counselor's own beliefs, political views, and religious practices onto one or more clients. This can be a challenge as there are many hot-button social issues that have political ramifications in today's America, and many individuals have very strong, yet polarizing beliefs. A counselor who publicly shows support on either side of a political issue at the behest of advocating for a client runs the risk of alienating other clients whose views differ. Though this is the case, counselors must not sit on the sidelines while legislation is proposed and passed that will have an impact on their clients. This was the topic of my first publication, an essay on counselor advocacy.

The following was published in the May 2013 issue of Counseling Today as the grand prize winner of the American Counseling Association's Foundation’s Graduate Student Essay Competition supported by Gerald and Marianne Corey and Allen and Mary Bradford Ivey. 

"Why must professional counselors accept an advocacy role in representing the interests of clients and becoming actively engaged in creating and supporting public policy initiatives that advance the role of counseling in addressing those interests?"

               In the wake of the highly publicized shootings in Connecticut and Colorado, it feels as though we have entered into an era where acts of violence are commonplace. Following such incidents, it is normal for people to search for answers and feel a sense of urgency to act. In response, there have been actions taken by the government in order to prevent future incidents; both firearms and mental health have been the focus of recent legislation. However, focusing policies on a specific group of people runs the risk of turning them into scapegoats.  Sensationalized news stories can create wildfires that paint the mentally ill as dangerous, ticking time bombs that must be closely monitored. Since the perpetrators of many recent shootings have been postulated to have suffered from mental health issues, this characterization of mental illness may seem realistic to the layperson. This in turn can lead to policies and laws being passed at the behest of the uninformed public that alienate those who are mentally ill and those seeking mental health services. In this respect, counselors must play an active role in advocating for this population, ensuring that legislation regarding mental health or illness does not infringe upon their right to privacy.

                Perhaps the biggest concern with recent policies is the ability of mental health providers to assure client confidentiality. The turnkey of the Tarasoff case ruling on duty to warn and protect was that of specific targets being threatened.  A bill recently passed in New York expanded on this mandatory reporting, requiring mental health professionals to report potentially dangerous clients. Additionally, following recent shootings, it was determined that HIPAA allows medical doctors who believe a patient is potentially dangerous are protected and encouraged in disclosing client information, including mental health records, to law enforcement officials. The goal in such legislation is to prevent violence from occurring by screening potential perpetrators. However, what exactly constitutes a potential threat is not clear, and the result of releasing a person’s medical and mental health history are not mentioned. In effect, medical professionals inexperienced in the area of mental health will be asked to make a discretionary decision to release sensitive information to individuals also untrained in the intricacies of mental illness. Furthermore, the potential backlash of not reporting an individual who goes on to commit a crime may encourage over-reporting and result in a prejudice against those with a history of mental illness. While this is being done as a means of prevention, it may discourage anyone with troubling thoughts to seek help. As counselors, we encourage clients to share thoughts and feelings that individuals may not feel safe sharing with anyone else.  While understanding that there are limits to confidentiality, it is not clear where professionals draw the line in regard to the potential for future harm. As professionals, we must advocate for the privacy and protection of our clients and assure that legislation passed will not jeopardize the ability for people with mental illness to receive services in confidence. 

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