2012 Student Ethics Essay Award – 2nd Place
Compassion and the Impaired Practitioner: Considerations for Prevention, Judgment, and Action in Ethics Violation Cases
By Alison Brady
University of Minnesota–Twin Cities, Minneapolis, Minnesota
Chapter Advisor: Sarah Angerman, PhD, CCC-A
The subject of the "impaired clinician" is a personal one for me because a close member of my family lost his job of many years due to mental health and addiction problems. Although he did not work in the field of communication sciences and disorders, the forces that contributed to his impairment—work-related stress, financial problems, and depression—are at least familiar to, if not a daily part of life, for many professionals in our field. His struggle has demonstrated to me that "impairment" can happen to anyone. It has also deeply influenced the way I view the causes and consequences of impairment in professionals across all settings. I am sharing my story now to bring attention to the issues facing impaired clinicians in our professional community and to offer some insight into the best approach for dealing with the problems they create.
Over the years, I have learned that my family member's experience with the devastating effects of mental illness and addiction is by no means uncommon. I have also come to understand that knowledge and empathy are among the most valuable tools for helping those who suffer from mental illness, addiction, or substance abuse problems. As I face my future career as a speech-language pathologist, I hope to use the lessons I have learned from my personal experience to become a self-aware practitioner, supportive colleague, and proactive member of the ASHA community.
When a professional in our field is suffering from mental illness or addiction, whose responsibility is it to intervene? While the "model addict" in our minds shows up for treatment ready to repent and reform, the reality is that getting help is never easy for someone facing serious mental health, addiction, or substance abuse problems. However, many may feel that the impaired clinician got him- or herself into the mess and is, therefore, solely responsible for getting out of it. Unfortunately, a professional in our field who falsifies charges for services, misrepresents information in reports or research, abandons patients, fails to document treatment, or violates the Code of Ethics in other ways has the potential to damage the reputation of all ASHA members. For this reason, it is important for us to consider what ways we, as a group of professionals determined to protect the reputation of our field, should collaborate to help prevent these types of problems in the first place, as well as to repair damage once it has been done.
The most important tool to achieve these aims is education. New members of the ASHA community should have sound knowledge of both the ethical issues that can put a person's career in jeopardy, as well as the risks to mental health posed by working in an often stressful and emotionally taxing field. The clinician armed with thorough knowledge of the professional guidelines and ethical responsibilities outlined by ASHA can hold him- or herself accountable for any actions that could lead to violation of the Code of Ethics. Additionally, if given helpful information about preventative mental health care early on, new clinicians will be empowered with self-awareness and the ability to take control of their mental health should problems arise down the road.
ASHA should also consider providing ongoing mental health support services to practitioners. There are many factors that make our line of work stressful; large caseloads, emotionally challenging clients and families, demands of supervisors, wrestling with insurance companies over services, and navigating cross-cultural differences can all contribute to workplace stress and anxiety. It is not uncommon for other high-stress professions to provide such services to members of their field. For example, law students are given information on mental health resources for attorneys the day they complete their bar examination. In this way, their professional organization has anticipated that some, if not all, of their young practitioners will need mental health support in the future, for which they provide clear and open access. By offering a similar resource, ASHA can help prevent unnecessary damage to the lives of clinicians faced with mental health, substance abuse, and addiction problems.
It is also important for professionals in our field to be given resources that will help them support impaired colleagues. When it is estimated that one in eight Americans suffers from drug or alcohol addiction and more than a quarter of adults in the U.S. suffer from some form of mental illness, it is likely that many of us will work with an impaired clinician at some point in our careers. ASHA members should be educated about how to take appropriate steps to intervene when a colleague is suffering. Whether that education comes in the form of a small magnet posted in a public area or a free regional meeting to discuss mental health and addiction issues, ASHA can develop accountability by teaching colleagues to read the signs of problem behavior before careers and lives are ruined.
Impaired clinicians have the potential to put clients at financial, physical, and emotional risk. For this reason, it is also worthwhile to explore ways to educate clients about what they can expect when receiving services from a professional in our field. If clients and caregivers could be given a brief handout about their rights when they start receiving services, they will be better able to identify and, subsequently, report on behaviors not in keeping with the ASHA Code of Ethics. By expanding transparency of practices to include providing clients with clear information on the appropriate patient-practitioner relationship, we create another safety net for protecting the reputation of our field.
Finally, I'd like to examine how we should treat impaired clinicians once they violate the ASHA Code of Ethics. I feel that a person's impairment must be taken into consideration when the Board of Ethics is deciding punishment. This view is informed by my firm belief in second chances as well as by my observation that losing one's career results not only in loss of livelihood, but also loss of self-worth and identity. Additionally, an impaired practitioner may be less likely to seek help if it results in permanent termination of his or her clinical, administrative, supervisory, teaching, or research role. Of course, any behavior that would be considered criminal or which puts clients in danger warrants very serious discipline. For instances of first-time or minor violations of the Code of Ethics, however, I propose that the following reprisal measures be considered: probationary periods, an ASHA-designated mentor or committee to monitor the progress of the offending practitioner, and/or required documentation of counseling services in order to regain certification and licensing.
Through better education and outreach about the causes and consequences of impairment in the field of communication sciences and disorders, ASHA can build a professional environment that seeks to prevent issues before they arise and allows for some compassion when the Code of Ethics is broken due to mental illness, addiction, or substance abuse. In this way, ASHA can help reduce the stigma that criminalizes mental health issues and commit itself to ensuring that every member gets the mental health support they need in order to protect the reputation and integrity of our entire professional community.