Clinical & Ethical Dilemmas Procedure

This procedure outlines the course of action for practitioners faced with clinical or ethical dilemmas. A dilemma might arise around such issues as client or practitioner safety, confidentiality, conflicts of interest, or child protection. Practitioners affiliated to Bronntanas are required to work to the codes of practice and ethics of their professional bodies e.g. the IACP, IAHIP  ECP. However it is recognised that such guidelines do not provide a clear answer to all dilemmas that a practitioner might meet, nor guidance as to the procedure to follow within a specific context.

The aim of this procedure is to safeguard practitioners, clients and those in relation to them. Some of the situations described are very unlikely to arise – nevertheless it is important that practitioners are prepared for every eventuality. The procedure below limits itself to the practical steps to be taken by all practitioners faced with dilemmas regarding their own practice, their own safety and well-being or that of their clients, or that of children, young people or adults in relation to a client. It should be read in conjunction with relevant Centre policies, such as the Policy and Procedure on Child Protection, Policy and Procedure on Confidentiality, Policy and Procedure on Health and Safety and the Policy and Procedure on Fire Safety.

Procedure

Practitioners who are concerned over an issue are directed to reflect on it in relation to the relevant Bronntanas policies and professional guidelines, as described above.

A decision is to be made as to the seriousness and urgency of the concern. With a serious concern, consult your supervisor immediately. If the matter is urgent and your supervisor is not available, contact the Clinical Director. All causes of concern are to be discussed with your supervisor as soon as practicable.

All concerns need to be reported to the Clinical Director or Operations Director. Any suspicion of child abuse should be reported immediately in accordance with mandatory reporting and Children First (https://www.tusla.ie/children-first). Where the supervisor is employed by Bronntanas, if a situation reported to the supervisor raises concerns over the professional conduct, the safety and well-being, or fitness to practice of the practitioner, the supervisor should report this to the Clinical Director (to be confirmed in writing where the concern is serious).

Bronntanas supervisors are to report urgent concerns for a client's safety and well-being to the Clinical Director (again, to be confirmed in writing as soon as practicable).
As outlined in the Policy and Procedure on Health and Safety, there may be occasions when a client arouses immediate concerns that have to be dealt with there and then. lf a client presents heavily under the influence of alcohol and drugs he or she should be advised that is not possible to work with them at that time and asked to leave.

Similar action should be taken if the client is speaking or behaving in an aggressive or threatening manner (other than when the client appears to be in a psychotic or delusional state when they may be at risk to themselves – see section 9 below). lf the client refuses to leave or the practitioner doesn't want to confront the client on their own, the practitioner should seek assistance. The practitioner is advised to make an excuse to leave the room and then alert any member of staff on duty in the office. If no member of staff is on duty, the practitioner should alert another practitioner, even when this means interrupting a session. If the client still refuses to leave, call the police for assistance:

 

— If the client appears to offer a strong risk to others or violence is threatened, call 999

— If the client is not violent and is just refusing to co-operate, call your clinical support peer. Having called for assistance, and when it feels safe to do so, call the Clinical Director to advise of the situation. If there is a potential risk to other clients or practitioners take steps to caution them accordingly. Sessions should be interrupted and clients advised to stay in the room until the situation is resolved. If a client appears to be in such a state of psychological distress that he or she is unable to engage with the practitioner and causes the practitioner unease, but may present a risk to him- or herself or others, it would not be appropriate to ask the client to leave. Steps to safeguard the client would necessitate breaking of confidentiality. The client must be informed that the practitioner is concerned for them and intends to inform a third party. Then Reception should be alerted, or another practitioner outside of reception hours. The Procedure outlined in Policy and Procedure on Confidentiality should then be followed.

In the situation outlined here, the practitioner should make immediate contact with their supervisor, failing that the Clinical Director to decide the course of action. If the above cannot be contacted and the practitioner is seriously concerned, then the decision may be taken to call the Garda, as outlined in section 7, or the Tusla Social Services Emergency Duty Service (see Appendix 2 for contact details). Any situation giving rise to concern that is brought to the attention of the Clinical Director is to be recorded, along with action taken and outcome. The record will be reviewed at Executive meetings in order to establish the effectiveness of current policies and procedures

Appendix 1

Policies and procedures to be read in conjunction with this procedure:


- Policy and Procedure on Child Protection - Children First
- Policy and Procedure on Confidentiality
- Policy and Procedure on Health and Safety
- Policy and Procedure on Fire Safety

Appendix 2

 

Contact Details for use in emergency:

Clinical Director :

Operations Director:

Tusla Emergency Duty Service



FURTHER RESOURCES  

Pieta House offers specialised treatment to clients who self-harm, suffer from suicidal ideation or have made multiple suicide attempts. Branches  across Ireland in Ballyfermot, Finglas, Lucan, Limerick, Tallaght, Kerry, Tipperary and Galway.

Visit Website: www.pieta.ie  Call: 1800 247 247

 

Samaritans provides confidential non-judgmental support, 24 hours a day for people experiencing feelings of distress or despair, including those which could lead to suicide.

Visit Website: www.samaritans.org   Call: 116 123

 

Your Mental Health is a place to learn about mental health and how to support yourself and others. Find resources and support services near you

Visit Website: www.yourmentalhealth.ie



The National LGBT Helpline . A volunteer-run service and operates Monday to Friday from 7 to 9pm.

Visit Website: www.lgbt.ie  Call: 1890 929 539



BeLonGto To Youth Services is the national organisation supporting lesbian, gay, bisexual, transgender, and intersex (LGBTI+) young people in Ireland. They also advocate and campaign on behalf of young LGBTI+ people, and offer a specialised LGBTI+ youth service with a focus on mental and sexual health, alongside drug and alcohol support.

www.belongto.org

 

Bronntanas offers access to a network of appropriately trained, experienced and supported psychotherapists/counsellors who will provide safe, confidential therapeutic spaces for those individuals, couples and families living in rural communities who identify as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Fetish (LGBTQIAF), or who are questioning their sexualities

www.bronntanas.org




 

Gay Switchboard Ireland provides a confidential telephone support service. Listening, support, and information are provided to all callers in a non- directive or judgmental way. The service is available to the LGBT community, their parents, families and friends, and to anyone who has concerns relating to sexuality, including HIV/AIDS related enquiries.

Visit Website: www.gayswitchboard.ie  Call: 01 872 1055

 

The National LGBT Helpline is a volunteer run service and operates Monday to Friday from 7 to 9pm.

Visit Website: www.lgbt.ie  Call: 1890 929 539





Gender Identity Family Support Line is a volunteer-led listening and support service for families of trans and gender non-conforming people in Ireland. The line is open from 6-9pm on the second and fourth Sunday of the month.

Call: 01 907 3707

 

 

Jigsaw offer a free service providing support and advice to young people (aged 12-25) experiencing mental health difficulties. Visit Website: www.jigsaw.ie/help

 

Transgender Equality Network Ireland (TENI) seeks to improve conditions and advance the rights and equality of trans people and their families. Their vision is an Ireland where trans people are understood, accepted and respected, and can participate fully in all aspects of Irish society.

Visit Website: www.teni.ie   Call: 01 873 35 75

 

RapeCrisisHelp  offers information about the professional support and the choices available to survivors of sexual violence.

Visit Website: www.rapecrisishelp.ie

You can call the 24 Hour Helpline on 1800 778888