A mental health therapist, Cathy, working in a rural clinic, receives a phone call from a 42-year-old client, Emma. Cathy has met with Emma on only two occasions – once for the initial mental health assessment and one treatment session. The mental health assessment found that Emma has suffered from depression for many years. Emma has made two serious suicide attempts in the past with intent to die. In the last attempt, 1 year ago, Emma jumped off of an overpass and broke both her legs. Hospitalization was needed as she required multiple surgeries. Five weeks ago, her mom was growing increasingly worried about her daughter and brought Emma to the hospital. Emma was admitted to a nearby urban hospital in a psychiatric unit due to depression and suicidal ideation. She was just released from hospital three days ago.
On the phone with her therapist, Cathy, Emma states that even though she was just released from hospital she still has suicidal ideation. However, Emma is guarded and doesn’t want to share details of her ideation because she doesn’t want to return to hospital nor have the police involved.
While on the phone, Cathy wonders about the ethical dilemma she finds herself in – should she respect Emma’s autonomy or does she have a duty to breach the client’s confidentially (as per the regulations of Alberta’s Health information Act) by calling the police to pick up Emma and escort her to hospital to ensure that Emma is safe? (Each province has similar legislation governing the release of client information).
Cathy is concerned that calling the police on her client will damage the therapeutic rapport she has built with Emma; thus, resulting in Emma no longer willing to attend her therapy sessions. Cathy ponders the underlying values of respecting for autonomy (respecting Emma’s choice to not go to hospital), respecting Emma’s dignity (by not overruling her choice to go to the hospital), the value of Integrity in the therapeutic relationship (being open with Emma about the possibility of sending the police to Emma’s home), and the value of safety (calling police to ensure that Emma stays safe). As a psychologist, she is aware of her ethical responsibilities that reflect these values as both part of her role in a health organization with Organizational Values and her profession (see the Canadian Code of Ethics for Psychologists, 2017 Ed.)