Ethics in Community Mental Health Care: Commonplace Concerns

This edited book takes on the task of clarifying ethical concerns that arise in community mental health care. Bioethicist Patricia Backlar and psychiatrist David Cutler start from the premise that ethics “is not a hifalutin subject” but, rather, an endeavor in which we reflect on the question of how best to live and what best to do in our professional work. The editors’ aim is to present thoughtful analyses and to stimulate reflection on what they characterize as commonplace concerns. They have succeeded in developing a very useful and substantive text that promises to be of considerable interest to mental health practitioners, trainees, and clinical ethicists.

The book is organized around themes that are salient in community mental health care, ranging from traditional psychiatric ethics topics such as professional boundaries and involuntary treatment to newly emerging areas such as anticipatory planning in psychiatric treatment and conflicts of interest. The authors draw from extensive clinical experience, and they share their hard-earned practical wisdom and understanding of relevant conceptual literature in a manner that is very attuned to the realities of community mental health care.

Although the text has some biases and is not grounded in the evidence-based clinical ethics scholarship that has been developed over the past two decades, it is nevertheless a valuable resource that will help many caregivers to think more systematically about complex ethical issues confronted on a daily basis. These ethical issues pertain to therapeutic relationships with mentally ill patients; despair and fear experienced by families and informal caregivers; challenges in developing supportive housing and rehabilitation services; the personal safety of clinicians; how, when, and why to approach involuntary interventions; factors contributing to imprisonment of mentally ill people; use of psychiatric advance directives and health care proxies; and consumer advocacy in the conduct of scientific research.

While they emphasize the ordinary, Backlar and Cutler have developed a not-so-ordinary collection of papers that fills a vacancy in the psychiatric ethics literature, offers sound clinical insights, and conveys an unusual sense of authenticity and compassion.