Book Review: Ethical decision-making in school mental health (2nd ed.)

Archives > Volume 19 (2022) > Issue 1 > Item 12

DOI: 10.55521/10-019-112

Raines, J. C. & Dibble, N. T. (2021). Ethical decision-making in school mental health (2nd ed.). Oxford University Press.

Reviewed by MaryAnn Thrush, PhD, MSW
Lincoln Memorial University

International Journal of Social Work Values and Ethics • Volume 19(1), Copyright 2022 by IFSW

This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of IFSW.

Ethical Decision-Making in School Mental Health is a great book for anyone teaching an ethics course or for those making decisions for individuals with less standing/status. The authors begin this informative and well-written book by defining the term ethics. They suggest there are two pillars of ethics: the Golden Rule and fiduciary responsibilities. While all the major religions give credence to the Golden Rule, the authors suggest that it is necessary, but also, insufficient for a complete code of ethics. They posit that the Golden Rule serves as a moral basis, and fiduciary considerations serve as a legal basis. Together they provide a solid foundation for making ethical decisions.

The authors outline seven aspects of ethical decision-making that serve as a guide for ethical predicaments:

  1. Know yourself and your responsibilities.
  2. Analyze the situation.
  3. Consider consultation.
  4. Identify possible courses of action.
  5. Consider clinical concerns.
  6. Implement the decision.
  7. Review and document the situation.

The first consideration, know yourself and your responsibilities, includes one’s primary ethical orientation:  deontological or consequentialist. Deontological ethics is based on duty and on moral principles.  Consequentialist ethics posits that the right action is one that produces the best result.  In Chapter 1, the authors deconstruct these ethical orientations, illustrating how they apply to the individual decision maker. The authors explore the pros and cons of each ethical approach and introduce two, more current, ethical theories:  ethics of virtue and ethics of care. While ethics of virtue is based on duty, ethics of care takes into account emotions felt by the people involved. This latter theory seems to be particularly appropriate for social work professionals. Ethics of care has the potential to deepen the emotional bond between practitioners and clients and allows the practitioner to model and express unconditional positive regard.

Another aspect of the ‘know yourself’ element includes one’s professional responsibilities. There is an expectation that the practitioner is able to use knowledge and skills consistently, in the service of the student. The authors also suggest that a commitment to self-care needs to be included in ethical obligations.

Chapter 2 describes the way to begin analyzing the situation in order to have a clear vision of the issue and of the people involved. Stakeholders, besides the student, might include parents, teachers, colleagues, other students, and administrators. Using the ethics of care theory, one might consider issues of loyalty and trust, but also, who benefits, who was harmed, and long-term consequences of a specific course of action. Analysis should also include the potential influence of stakeholders with different levels of power. When analyzing the situation, one needs to consider assent, given that students are minors, and that mandatory reporting is required for certain types of cases.

Chapter 3 considers the advantages of seeking consultation with other professionals, both legal and clinical. The authors list ten reasons to seek consultation, most of which entail helping the practitioner look at the situation from different perspectives and consider possible unintended consequences. A good consultant is one with whom the practitioner has an ongoing relationship. A mature, experienced colleague offers a structured environment within which sensitive elements can be discussed. In addition to clinical consultations, legal consultations may be helpful and sometimes necessary.

After analyzing the situation and consulting with appropriate professionals, the practitioner is ready to begin identifying various courses of action. Five factors need to be considered at this stage: primary goals, including costs and benefits; going beyond either/or options; consideration of tension among various stakeholders; projection of outcomes and consequences (both negative and positive); and consideration of the moral principles of the profession.

Chapter 5 goes into detail about managing clinical concerns, both for the practitioner and others involved. The risk of suicide underscores the importance of having a competent team in place in case a crisis occurs. Consideration of warning signals, level of danger, location, whether the student needs to be hospitalized, responding to the family’s culture and ethical values, consideration of the student’s level of development and competency, all need to be well-thought-out ahead of time.

As action plans are implemented, Chapter 6 stresses remaining empathic and maintaining positive regard for the student and stakeholders while focusing on managing, rather than solving the dilemma. Additionally, the practitioner needs to continue to anticipate unintended consequences from both the therapeutic and the legal perspectives.

The final chapter considers the ethics of recordkeeping, discussing the three goals: improving client treatment, social conditions, and the practitioner’s critical thinking skills. By keeping records that maintain confidentiality and the client’s privacy, the practitioner details ethical and fiduciary accountability. Additional considerations are record accuracy; who has access; and how the information is communicated, documented, and ultimately destroyed.

Ethical Decision-Making in School Mental Health has multiple strong elements; however, perhaps the most important is the way the authors deconstruct ethical decision-making. The book is a thorough discussion of the factors that go into ethical decision-making and the fiduciary responsibility of school mental health practitioners. This book is not limited to school practitioners but can serve as a good foundation for anyone who makes decisions regarding individuals with less standing, such as persons served by our criminal justice system, persons hospitalized, and elders, to name a few. Finally, in addition to making ethical decisions for others, Ethical Decision-Making in School Mental Health serves as a guide for making personal decisions concerning ethical dilemmas.