Survey targets ethics in mental health field

The moral struggles and ethical controversies encountered in physician practices all over America can be considered insurmountable at times. A recent study published in Psychiatric Times focused on a range of ethical dilemmas encountered in daily practice. More than 700 psychiatrists and other mental health professionals including nurses, psychologists, and students took part in the survey.1

The multiple-choice moral struggles survey asked participants to respond to a range of ethical dilemmas encountered in daily practice.

"Medscape had done an ethics survey in 2010 with their readership. I thought a similar survey geared to psychiatry would be of interest," says Cynthia M.A. Geppert, MD, PhD, MPH, chief of consultation psychiatry and ethics, New Mexico Veterans Affairs Health Care System, Albuquerque, associate professor in the Department of Psychiatry and director of ethics education, University of New Mexico School of Medicine, Albuquerque.

The survey uncovered a high level of ethical obstacles and other issues that physicians face, says Geppert. The respondents were all subscribers and readers of Psychiatric Times which has a readership of about 40,000, according to Geppert. When she asked how often the respondents had encountered ethical dilemmas in their practice, of the 640 participants who answered the question, 34% reported facing ethics issues once or twice a week, 43% once or twice a month, and 23% hardly ever.

Participants were also asked about their level of comfort and preparedness when faced with ethical dilemmas in daily practice. Clearly from the responses, psychiatrists recognize and reflect on ethical problems in the profession. Of the 633 participants who responded to that question, 29.4% felt they had adequate skills and knowledge to analyze and resolve ethical dilemmas; 47.2% said they occasionally needed ethical consultation but knew where to find such assistance; and 23.4% said they occasionally needed help, but did not know who to turn to for an ethics consult.

When asked to what extent participants would benefit from expert ethics consultation, of the 644 respondents, a mere 4.1% replied they would never benefit from consultation, and 9.8% said they would often benefit. Some (35.7%) said they seldom needed an ethics consult, and more than half (50.4%) said they could occasionally use a consultation.

"The most surprisingly result [of the study] was that so many psychiatrists and other mental health professionals took the time out of their busy schedules to respond. Not so much surprising, but inspiring, was the moral seriousness of the responses, which showed the daily efforts of psychiatrists to do the right thing despite considerable pressure to compromise ethical values," says Geppert. Pressures usually come from managed care and insurance companies, the pharmaceutical industries, legislative and regulatory demands, and institutional policies, Geppert says. "In sum, there are now many third-party forces that are involved in the practice of psychiatry that present conflicts of interest that may compromise the patient-centered therapeutic alliance."

For example, according to Geppert, a number of respondents commented that there are pressures from insurance and managed care companies to discharge patients before they are ready to leave the hospital. "Psychiatrists often feel pressure to over document the acuteness of a patient's psychiatric condition, say continuing to be suicidal, in order to obtain the extra hospital days the patient clinically needs to be appropriately treated," says Geppert.


  1. Geppert C. The 2011 Psychiatric Times ethics survey: moral struggles. Psychiatric Times 2011; 28:30-34. Web:


  • Cynthia M.A. Geppert, MD, PhD, MPH, Chief of Consultation Psychiatry and Ethics, New Mexico Veterans Affairs Health Care System, Albuquerque, Associate Professor, Department of Psychiatry, Director of Ethics Education, University of New Mexico School of Medicine, Albuquerque. E-mail: