Lecture 10

CODES OF ETHICAL CONDUCT

 Guidelines for Ethical Conduct

o National Practice Standards for the Mental Health Workforce
o APS Code of Ethical Conduct
o CAPA Code of Ethical Conduct
 National Practice Standards
o Code of Ethics
o Ethical and Practice Guidelines
o Procedures
 Standards:
o Standard 1: rights and responsibilities, safety and privacy
o Standard 2: consumer and carer participation
o Standard 3: awareness of diversity
o Standard 4: mental health problems & mental disorders
o Standard 5: promotion & prevention
o Standard 6: early detection & intervention
o Standard 7: assessment, treatment, relapse prevention, and support
o Standard 8: integration and partnership
o Standard 9: service planning, development and management
o Standard 10: documentation and information systems – good for protecting you
(litigation) and client
o Standard 11: evaluation and research
o Standard 12: ethical practice and professional responsibilities – abide by Code of
Ethics
 APS Code of Ethics
o Adopted September 2007
o Now adopted by PsyBA
o Used in conjunction with APS Ethical Guidelines document (which is separate)

o General Principle A: RESPECT for the rights and dignity of people

 A1 – justice
 A2 – respect
 A3 – informed consent
 A4 – privacy
 A5 – confidentiality
 A5.2 – disclosure
 A6 – release of information to clients
 A7 – collection of client information from associated parties
o General Principle B: PROPRIETY – professional behaviour and competence
 B1 – competence
 B2 - record keeping
 B3 – professional responsibility
 B4 – provision of psychological services at the request of a third party
 B5 – provision of psychological service to multiple clients
 B6 – delegation of professional tasks
 B7 – use of interpreters
 B8 – collaborating with others for the benefit of clients
 B9 – accepting clients of other professionals
 B10 – suspension of psychological services
 B11 – termination of psychological services
 B12 – conflicting demands between organisation and code
 B13 – psychological assessment
 B14 – research
 o General Principle C: INTEGRITY – honest and objective in psychology dealings with
clients and colleagues
 C1 – reputable behaviour
 C2 – communication
 C3 – conflict of interest
 C4 – non exploitation -> no sex until 2 years after client/psychologist
termination
 C5 – authorship
 C6 – financial arrangements
 Although there are a lot of rules, these ethics are grey. Two secrets to following the Code of
Ethics:
1. Understand the underlying principle
2. Talk to your peers and supervisors to understand the best way to approach
the ethical situation

Lecture 11
INTEGRATING THE SUBDISCIPLINES

 DSM-V says that addiction involves the compulsive or uncontrolled use of a substance that
leads to clinically significant impairment or distress over a 12 month period
 Being in a remote area is one of (if not the most) significant barrier to seeking treatment for
drug use
 Cannabis is the most popular (10.2%) followed by Cocaine (2.5%) and Methamphetamine
(1.4%)
o Previously more people used speed vs. ice, but now it’s the other way around
meaning that they are using a harder form of the drug and more frequently, causing
increased meth problems.
 Alcohol and tobacco use has decreased
 People in their 40s are most likely to smoke daily
 Addiction spiral -> spiraling distress
o Binge intoxication -> withdrawal negative affect -> preoccupation anticipation ->
binge intoxication (continuing cycle)
 Drugs activate reward pathway in the brain -> releases dopamine from the nucleus
accumbens
 Cocaine & heroin are highly addictive for this reason
 Nicotine is not a potent reinforcer highlighting the clear role of social factors in shaping
tobacco addition
 Not all users become addicted
o Genetic vulnerability (stronger for some drugs, particularly alcohol)
o Epigenetic heritability
 Hedonic Homeostatic Dysregulation Theory
o Problematic drug use starts with an Impulse Control Disorder where the drug use is
POSITIVELY reinforced (it makes me feel good so I keep using it)
o Then it moves onto a Compulsive Disorder where it becomes NEGATIVELY
reinforced (I feel anxious, I take it, I feel better)
 Drug specific cultural factors
o Attitudes
o Media, trends, laws
o Culture, setting
 Non-drug specific cultural factors
o Individualism
o Consumerism
o Secularism
o Policy
 Socio economic status contributes to health outcomes, including drug use
o Low SES groups are more likely to drink, smoke, and use illicit drugs
 Socio demographic factors
o LGBTQIA -> up to 7x higher drug use
 Family systems
o Family history of drug use or criminality
o Ineffective supervision/discipline
o Poor parent-child bond
o Excess family conflict/abuse
o Family isolation
 Developmental trajectory
o In utero
 Maternal drug use
o Early childhood
 Child temperament
 Neglect/abuse
 Externalizing/internalizing disorders
o Primary school/pre-teen
 Emotion & behavioural regulation difficulties
o Adolescence
 Exposure to drugs
 Emotional change
 Sleep deprivation
 Risk taking behaviours
 Cognitive immaturity
 Importance of peers
o Adulthood
 Leaving home
 Employment
 Symbolism
 Cultural norms
 Attachment
o Insecure attachment or severely deprived
o Difficulties forming secure attachment later
o Attachment-autonomy balance is important in balancing safe identity exploration
and reducing risk taking behaviours
 Stress
o Prolonged stress is very bad for mental and physical health
 Heightened fight/flight system
 Neural priming
o Low SES groups have increased stressors
 Increased hopelessness
 Drug reward
 Resilience
o Effective parenting
o Social connectedness
o Appeal to adults
o Self-efficacy
o SES advantages
o Religious faith (belonging)
o Good schools/education

Lecture 12
LEGISLATIVE FRAMEWORKS

 NSW Mental Health Act 2007

o Law governing how we care and treat people with mental illness
 o People are entitled to the least restriction of their freedom and least interference
with their rights & dignity
o The Act makes provision for the care of patients who:
1. Are admitted to mental health facility voluntarily
2. Are admitted or detained in mental health facility involuntarily
3. Are required to receive treatment in the community
 Both the Mental Health Act of 2007 and 1990 provide care for patients who have committed
a criminal offence and are mentally ill -> either Forensic or Correctional patients
 Informal (voluntary) admission
o involves informed consent
 person provides permission for treatment and must be deemed well
enough & capable of giving informed consent
 Formal (involuntary) admission
o Person is admitted or detained against their wishes
 Can be on advice of medical/mental health practitioner
 Forensic patient – admitted having committed an offence
o Can only be carried out if person is mentally ill or mentally disordered
 Mentally ill
 Has mental illness
 Risk of harm to self or others (physically, emotionally, financially
etc.)
 Has continuing condition
 Condition that impairs mental functioning (delusions,
hallucinations, disturbance or mood, sustained or repeated
irrational behaviour)
 No other care of less restrictive kind is available
 Mentally disordered
 Displays irrational behaviour
 Significant physical risk to self or others
 No other care of less restrictive kind is available
 Community Treatment Order (CTO)
o Valid for 12 months
o Sets out terms under which a person must accept medication/therapy/rehab
o For Bipolar:
 Issue with treatment is maintaining medication, as it may have side effects
and is unpleasant, making you feel vulnerable and want to return to
“manic” phase, where you feel good and full of energy -> therefore people
tend to stop taking their meds.
o CTO is generally ordered if you are already mentally ill, or if judged by a qualified
practitioner to be likely to become mentally ill in 3 months, as well as if CTO is
judged to be the least restrictive alternative for treatment.
 Most common pathway to Formal Admission is scheduling -> practitioner fills out Schedule 2
of the Mental Health Act (1990).
 Other ways of Formal Admission
o Admission by police or ambulance officers
 Esp. for forensic patients or when person is at risk of self-harm or other-
harm
o Admission at request of primary carer, relative, or friend -> ONLY IN REMOTE AREAS
o Admission by Order of Course (magistrate)
 Process following detainment:
o Can be detained up to 3 days
o Must be examined every 24 hours by a doctor
o Must be discharged as no longer mentally disordered
o They must be seen by a magistrate:
 Must be legally represented
 Must be medicated at minimum level until seen by magistrate
  Must appear before magistrate in street clothes
 Two key changes in 1990 and 2007 Acts:
o Allowing ambulance drivers to formally admit patients
o Collapsing 2 types of Community Treatment Orders into a single category
 Section 39 of National Law Act 2009 provides direction for requirements for mandatory
notifications under the National Law
o Aim is to prevent the public from being placed at risk of harm
o Intention is that practitioners notify the Australian Health Practitioner Regulation
Agency (AHPRA) if they believe another practitioner has behaved in a way that
presents a serious risk to the public
o Obligation to make notification both in and outside one’s own health profession ->
notifications made to AHPRA
o Notifiable conduct:
 Practiced profession while intoxicated
 Engaged in sexual misconduct in practice of profession
 Placed public at risk of substantial harm in practice of profession
 Privacy Act 1988 -> 13 Australian Privacy Principles (APPs)
o APP 1 – open and transparent management of personal information
o APP 2 – anonymity and pseudonymity
o APP 3 – collection of solicited personal information
o APP 4 – dealing with unsolicited personal information
o APP 5 – notification of the collection of personal information
o APP 6 – use or disclosure of personal information
o APP 7 – direct marketing
o APP 8 – cross-border disclosure of personal information
o APP 9 – adoption, use, or disclosure of government related identifiers
o APP 10 – quantity of personal info
o APP 11 – security of personal info
o APP 12 – access to personal info
o APP 13 – correction of personal info

Lecture 13
SELF-CARE IN A HIGH BURNOUT PROFESSION

 Continuous Professional Development (CPD)

o Every year, 30 hours of CPD is required
 Must include 10 hours of peer consultation each year
o Peer consultation counts as CPD hours, but CANNOT be counted towards one’s own
10 hours of peer consultation
o Supervising interns does not count towards CPD
o You need to document everything in a log book
 Types of CPD
o Conducting or attending psychology workshops, seminars, lectures, or courses of
study
o Writing, assessing, or reading & analysing
 Peer review journal articles
 Scholarly books
 Research proposals & grants
o Producing, reviewing, or viewing & analysing
 Professional videos
 Audios
 Internet resources
 Scientific posters
o Providing peer consultation to another psychologist
 Active CPD
 o Active training through written and oral activities that enhance or test learning
 Seminars with tests
 Role playing
 Providing peer consultation
 Oral presentations
 Masters (for example) provides an approved area of practice. To maintain endorsement in an
approved area of practice, half of your CPD hours must be within endorsed area. If you have
2 areas of practice (which is rare), then you’d allocate 25% for each area
o i.e. 15 hours for 1 approved area, 7.5 hours each if you have 2 areas
 You must have an up to date CPD portfolio that contains:
o A learning plan
o How the CPD related to your professional development
o All CPD activities undertaken incl. proof: receipts, invoices, certificates etc.
 Random audits are taken annually
 Punishments for non-compliance:
o Refusal of registration
o Registration contingent on completion of specified CPD activities
o Undergo performance assessment
o Undergo an examination
o Disciplinary proceedings instigated
 Failure to maintain ongoing professional development is linked with burn out, lower
professional standards, and unhappiness with one’s profession
 Symptoms of burn out:
o Increases in
 Dissatisfaction
 Disappointment
 Irritability
 Boredom
 Withdrawal
 Callousness
 Fatigue
 Aggressive feelings towards clients
 Sexual impulses towards clients
 Feelings of failure
 Misuse of alcohol/drugs
 Emotional displays
o Decreases in
 Job engagement & satisfaction
 Energy
 Self-esteem
 Pleasure
 Persistence
 Pride in work
 Most people have some of these symptoms without having burnout. It’s more important to
look at the PATTERN of symptoms.
 Prevalence of burn out is highest among caring professions (psychologists & counsellors),
along with teachers and police.
 3 dimensions of burn out:
o Exhaustion
 Lowers cognitive capacity
 Problem solving, memory, attention
o Cynicism
 Increases callousness
 Depersonalization of client
 Self-protecting mechanism
 Emotional & cognitive distancing
 o Ineffectiveness
 The most important factors that influence burn out are SITUATIONAL FACTORS
o Type of occupation
o Working conditions
o MISMATCH THEORY
 Burnout is far more likely when there is mismatch between employee
needs and working conditions:
1. Workload
2. Control
3. Rewards
4. Community
5. Fairness
6. Values
 Factors within the person:
o Demographics -> younger (<30), unmarried, divorce (worse than single), higher
education are all more at risk
o Personality -> high trait anxiety, depression, self-consciousness, emotional
instability, external locus of control, poor coping styles, stress prone, Type A
personality
o Attitudes -> higher expectations are more at risk of burn out
 Combating burn out:
o Change organisation -> promote job engagement
o Change individual -> self care strategies
 We should aim for burn out prevention rather than treatment/cure.