In two previous articles (see Caring for others: Why do we do it? and Caring for others: Avoiding common traps) we discussed the process of providing emotional and psychological (or social) support to others – including the reasons why we help; the traps we can fall into as we attempt to help others; and the typical needs and motivations behind supporting others.

In this article, we delve into key ethical considerations when providing social support, including the adoption of a code of ethics, the ethical decision-making process, and confidentiality issues. If you wish to gain further insight into the fundamentals of social support, we recommend that you review the articles in our “Social Support” article category.

Introduction

In offering social support to others, not only might we fail to help – or worse, inadvertently harm – our care recipient, but also, a lack of awareness could land us in legal or ethical trouble. As a social supporter, it is not enough to say, “Oh, I didn’t know.” Those involved with social support have a duty to find out about appropriate and ethical conduct, relevant legal codes, and boundary issues that will ensure that their offering is truly helpful.

We must follow the dictum of the Hippocratic Oath taken by all practitioners of the healing arts: first, do no harm. Put more positively, our two general ethical responsibilities are to:

1. Provide the best help possible to our helpee, and
2. Maintain our own wellbeing in the service of optimal care for the helpee.

This article discusses the over-arching responsibilities we have to our helpee. Then we propose some essential areas of responsibility towards ourselves as carers if we would be ethical helpers.

Responsibilities towards your helpee

What are the responsibilities imposed by a mandate for ethical practice, and how are these different from duties imposed by the legal system? Also, what purpose does a code of ethics serve? We must be able to recognise the subtly unethical behaviours that can crop up in ourselves or others. We discuss issues of confidentiality, which are paramount for the ethical helper.

Empowerment also has a place in this discussion; we see a responsibility to foster it in helpees. In a different vein, we see how crucial our unconditional acceptance of a helpee is for high quality social support. We discuss the question of personal limits, and why you need to know what yours are. And finally, if you are to be effective, you must know when and how to refer someone to a professional helper (if you are not one). There are some suggestions to clarify that. Many of these issues are the “deep end” of the helping business: the serious side which, if we fall afoul of it, trips us up in major ways, despite our most golden intentions for helping. Thus it is essential to gain awareness of what we must do if in order to do right by our helpee.

Ethics and the law

Practicing as an ethical helper involves much more than following a code of ethics. The nature of ethical dilemmas is that the problems are often complex, the answers not clearcut. Ethical codes are guidelines, not dogma, and the standards and codes vary between agencies. One thing that most organisations agree on, however, is that the social supporter who would practice safely should find out what their State (and Federal) legal boundaries and responsibilities are for the type of assistance that they are undertaking.

While both laws and ethics provide guidelines for acceptable helping practice and often overlap with each other, they are coming from different paradigms. A set of ethical codes is aspirational, setting out the goal behaviour that all helpers following it should try to attain. A legal code, on the other hand, offers the minimum standards that one must meet in order to avoid liability. Legal standards are enforced by government agencies, and ultimately, the court system. The upholding of ethical codes is generally overseen by professional bodies (e.g., peak associations such as the Australian Counselling Association for counsellors), national certification boards, and government boards which regulate professions.

Most of the time ethical codes will state that helpers must act in accordance with relevant legal statutes and regulations, yet there are times when ethical and legal duties conflict, creating a challenging situation for the helper. For instance, social supporters who work with minors and certain confined populations, such as prisoners or institutionalised persons, especially need to know how the law restricts what they can do. Some areas of social support that may be governed by law include issues of confidentiality, informed consent, parental consent, rights of institutionalised persons, and protection of care recipient welfare.

Being aware of legal rights and responsibilities that are relevant to your helping work will protect your helpee from unintentional harm. Equally importantly, they will protect you from unnecessary lawsuits that could arise merely because you are unaware of either the law or relevant ethical codes (Corey and Corey, 2007).

Codes of ethics: why have them?

Ethical codes are generally reactive: that is, when an incident happens or trend occurs which impacts on the welfare of helpees, the documents are changed to reflect the new concerns. This means that such codes tend to be dynamic, changing with societal attitudes and values. Generally, however, codes of ethics are steadfast in serving three main purposes:

1. They inform helpers about solid ethical practice;
2. They provide a way of making helpers accountable. The ultimate end goal here is protecting the “consumer” of the helping service;
3. They function as catalysts for us as helpers to improve our practice, as we can reflect on our helping in the context of the ethical principles contained in the code (Corey and Corey, 2007).

Some available ethical codes

Whilst there are no specific codes of practice or statutory requirements for those offering social support, it would be considered good practice to be aware of codes that apply to the helping professions. You can find some samples of Codes of Ethics at these sites:

• The Australian Counselling Association – click here to access.
• The Australian Association of Social Workers – click here to access.
• The New Zealand Association of Counsellors – click here to access.
• Psychotherapy and Counselling Federation of Australia – click here to access.
• Australian Psychological Society – click here to access
• The (U.S.) National Association of Social Workers’ code – click here to access
• The American Psychological Association – click here to access

Ethical decision-making: getting a procedure in place

From time to time it’s possible that when you’re offering your support you are faced with an ethical issue. Ethical problems are often not straightforward, so it makes sense to be prepared in advance. Here are some guiding principles to consider:

As far as possible, base any actions you take on sound judgment (part of growing as a social supporter is developing that). Sound judgment includes establishing whether you have an ethical, legal, or other (say, practice-based) problem.

NEVER overstep your boundaries. Remember, you are a Mental Health Social Supporter, not a professional therapist.

Stay up-to-date with local laws and current versions of the code of conduct you have adopted.

Explore various courses of action to resolve the dilemma.

Engage in an ongoing process of examination, working out the consequences of various actions for the parties involved, and for yourself. Second, what do you think about including your helpee in the process? Think about this: you are trying to help someone who has been beleaguered by life and events. You are keen to encourage them to become more independent and have more empowerment. Where appropriate, you may be able to foster more of such actions by making ethical decisions with them, rather than for them. You can think of the helpee as a collaborator (again: this may not always be possible). Remember, your role as a social supporter is not to direct, it is to support and where necessary refer to an appropriately trained professional.

Spotting unethical behaviour

Are you certain that you can recognise unethical behaviour when it is happening: in yourself? In colleagues and others? Chances are that, even if you haven’t been helping others for a long time, you would be able to identify grossly unethical actions: for example, the professional who claims that developing a sexual liaison with her client is somehow therapeutic for him. Or what about the volunteer helper who may not be getting paid in dollars, but is quietly accepting gifts of value from one of his helpees, a care recipient who can ill afford to give the gifts, but does not, in her state of mental illness, realise that?

These ethical transgressions seem blindingly obvious, but what about the more subtle situations that happen in everyday helping? Consider these examples:

1. Robert has, with the permission of his helpee Veronica, posted Veronica’s story on his website, ostensibly so that people will see what she has overcome, be impressed, and affirm her. Robert says that he hopes this will raise Veronica’s profile and her self-esteem. It is also true that, as people read the story, they hear about Robert’s role in her “miraculous” recovery, and some have emailed Robert to try to get appointments with him.

2. Jan sees her fellow social supporters weekly. They meet at a coffee bar in the small community where they all live, and where locals congregate. Sometimes the talk gets round to support work, and Jan, an entertaining story teller, is able to delight the group with humorous vignettes of things that have happened with her helpees. Of course, she never mentions names, but the vibrancy of her stories is greatly amplified by including other (true) details that are relevant to the story. She has a commanding presence, and a significant voice.

3. Maria is caring for her elderly mum in her own home. The situation works fairly well, although Maria, a writer, finds the constant demands that her mother makes a bit irritating in terms of the disruption to her thought while she is trying to write. The public nurses come by each week to see if her mum needs anything, and recently, Mum has mentioned that she isn’t really sleeping that well. The nurse says that she could give her medication for that, but it would mean that Mum was sleeping more during the day. Maria jumps on this solution, telling the nurse that they should definitely go ahead with it, “so that Mum can be more comfortable”.

Do you see yourself in any of these situations, or similar ones? Do you have a sense of what has gone wrong in the examples above? Can you name which, if any, ethical constraints are being violated? If Robert, Jan, or Maria were your colleagues, how willing would you be to address the ethical issue that may be occurring with each of them? We ask because personal confrontation of the erring colleague is indeed the normally recommended course of action.

If you think that it takes emotional honesty, courage, and the willingness to say something difficult – especially to someone that you work with – you are right. And if the person who is committing the ethical oversight is in a position of power over you, there is more bad news: you are vulnerable. But consider this. If your primary motivation is genuinely to provide social support to vulnerable people, and yet you stand by and do nothing while part of that population is being undermined – however subtly – how truly supportive are you? Confrontation of this sort is an art, a skill that develops over time. However, if we do not engage it when there is clearly a need, we may need to be reminded – and forgive us the paraphrase – that for unethical ways to prevail, all that is necessary is for good men (and women) to do nothing.

Checking for ethical awareness

How tuned in to potential ethical complications are you? For example, working with children may involve issues of parental consent. If you are a business person primarily and a social supporter in your spare time, are there any conflicts of interest with any clients given your dual roles? Challenge yourself to find at least one ethical dilemma. See if you can identify the ethical issues involved, and who would be hurt by the wrong action being taken. What should happen now? If this situation arose in the past and has already been dealt with, what did you do? How was it resolved, and how happy are you in retrospect with your action(s)? What did you learn from the situation?

Confidentiality issues in meeting helpee responsibilities

At least one of the situations above is an ethical problem because of violations of confidentiality. While at first glance, confidentiality may seem to be a simple precept – that is, you don’t talk about your helpees outside of the place where you are helping them – in truth, there are a number of problematic issues for ethical helpers, especially in the modern world of technology, multi-tiered health delivery systems, and complex legal requirements. Yet, as one of the most basic ethical obligations, we must observe confidentiality of helpee disclosures if we would preserve the trust on which our helping relationship is based.

Your helpees have a right to expect that their disclosures to you will remain confidential, but they also need to understand that that confidentiality is not absolute. Questions of safety for helpees or others, legal requirements for disclosure, and parental rights are only a few of the issues that may supersede their right to a confidential helping disclosure.

The duty to warn and protect

There are exceptions to confidentiality created by the courts of most modern nations. If as a social supporter, you have reason to believe that a helpee poses a danger to themselves or others, you are obligated by law to protect that helpee or relevant others by warning appropriate parties of the imminent danger. If you think that a helpee is, say, suicidal or about to self-harm, you must advise either the person’s family or relevant authorities, such as mental health crisis teams (the helpee’s circumstances will dictate who should be told). If the helpee is mentally unstable and has threatened to harm or kill others, you need to let them know that your duty to warn and protect overrides their right to confidentiality, and then you need to tell the right parties: possibly, the police, the crisis team, and the person or persons to whom the threat is directed.

Similarly, you have an obligation to warn and protect people who may be exposed, or may have been exposed, to a disease borne by a helpee: for example, someone who is HIV-positive and has disclosed this to you, but not told their sexual partner(s), of their HIV status.

A special note: confidentiality in a high-tech world

Confidentiality and privacy are complex issues in our technological world. With the advent of telephone messaging systems, fax machines, email, and phone texting, there are now multiple ways to accidentally violate your helpee’s privacy that were not nearly as widely used just a few years ago. As helpful as these methods of communication are, they pose special risks to confidentiality for helper and helpee alike. Take note of the following:

If you have an answering machine/messaging system, make sure that unauthorised people do not hear messages that are coming in, or that you’re retrieving.

If you must call to a helpee’s residence, make sure that you and the helpee are in agreement about what may be said, with whom you are allowed to speak, and when you may call. Not all helpees disclose to all family members that they are receiving social support.

When you must speak with a helpee on their mobile phone, assume that they are somewhere public, where anyone can hear them, and structure your conversation accordingly.

Never acknowledge who is on your helpee list, or that particular people are receiving your help. NEVER give out information on helpees to unknown callers. This one is linked with the boundary of not socialising with helpees. Imagine the situation where you might be seen socially with a helpee, and along comes a mutual acquaintance of both of you. The person, surprised to see you together, says, “So how do you two know each other, anyway?” An awkward moment, to say the least.

Never make any comments that you would not want your helpee to hear. What if these comments were to make their way to the courts system in any sort of dispute? Even if the dispute were not between you and the helpee, it could be harmful to the helpee if the remarks were about them, or about their relationship (for example: what if judgmental remarks you made about a helpee going through an acrimonious divorce were to be recorded or overheard by someone acting on the side of the ex-partner?).

If you must send a fax, a follow-up telephone call is in order to make sure that the facsimile is received by the correct person, and delivered to the intended recipient, if they are not standing by the fax machine at the moment it arrives.

And the very biggest confidentiality breaker of all: sending sensitive information via email, text message, or – unbelievable, but people have done it – via social networking sites. With all of these methods of communication, messages can and regularly are accessed by people other than the intended recipients. There is simply no guarantee of privacy or confidentiality, and you must be totally clear with your helpee about what information is permissible to send through these channels.

Summary

Guarding confidentiality and privacy may seem like common sense, but the “heads-up” is to stay alert for potential unintended breaches. At least, a thorough discussion with helpees at the outset of any helping work may be able to avoid the worst harm from this source.

This article was adapted from AIPC’s “Mental Health Social Support” e-course. For more information, visit www.mhss.net.au.