Paper Summary:

This paper provides an analytical discussion of the history and current ethical issues in mental health care delivery in rural areas, focusing on challenges that the mental health provider faces personally and professionally, and describing the ethical dilemmas that they face when providing services to clients. The paper explains that these challenges include the practitioner as a generalist, dual relationships, and confidentiality issues. Service delivery and access to care are also discussed, as well as the use of technology to further the treatment options for clients in rural areas. The paper concludes that a social and professional support system, as well as knowledge of professional codes of conduct, can make the practitioner-client relationship more positive in the rural communities.

Table of Contents:
Introduction
History and Policy
Rural Issues
Generalist Practice
Current Ethical Concerns
Dual Relationships
Confidentiality
Current Practice
Suggestions for Future Practice
Conclusion
References

From the Paper:

"The history of mental health in the United States is deep rooted. In the 17th and 18th centuries, individuals with mental illnesses underwent great suffering at the hands of American society (MHA, 2010). Many individuals fell under the category of "insane" and were locked up in jail like housing or insane asylums. Even though the APA was well established by this time, the ethics and guidelines of care were not. The code of ethics looked nothing like it does today. It took several decades of patients being mistreated and several organizations to advocate for them before there was change. One of the most significant changes was when the U.S. Congress initiated funding for the infrastructure for community-based mental health centers with the passage of the Mental Retardation Facilities and Community Mental Health Act of 1963; two of the expressed goals of this act were to ensure (1) the provision of care and (2) a wide range of supportive/supervisory services for individuals who had been released from long-term state psychiatric institutions (Gerhart, 1990)."

Sample of Sources Used:

• American Psychological Association (2002). 2007 Annual report s for boards and committees: Committee on rural health. Retrieved May 7, 2010 from http://www.apa.org/about/governance/bdcmte/reports/2007/crh.aspx.
• Barry, M.M., Doherty, A., Hope, A., Sixsmith, J. & Kelleher, C.C. (2000). A community needs assessment for rural mental health promotion. Health Education Resources, 15 (3), 293-294.
• Brown, F.W. (1998). Rural telepsychiatry. Psychiatric Services, 49(7), 963.
• Brownlee, K. (1996). Ethics in community mental health care: The ethics of non-sexual dual relationships: A Dilemma for the rural mental health profession. Community Mental Health Journal, 32(5), 497-503. Retrieved April 21, 2010, from ABI/INFORM Global.(Document ID: 10321571).
• Campbell, C., & Gordon, M. (2003). Acknowledging the inevitable: Understanding multiple relationships in rural practice. Professional Psychology: Research and Practice, 34(4), 430-434. doi:10.1037/0735-7028.34.4.430.

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