Ethical and Policy Issues in Mental Healthcare

Introduction to Nursing Ethics

Nursing ethics can be described as the application of ethical values to nursing practice, which is essential for all healthcare workers. The four main ethical principles are autonomy, beneficence, justice, and non-maleficence (Haddad & Geiger, 2021). Autonomy is the position that patients retain the right to make decisions according to their own values and beliefs, which must be respected. Beneficence alludes to the notion that all patients must not be maltreated and nurses have to always seek to do good to them. Fairness and equality fall under the principle of justice, while non-maleficence requires nurses to avoid doing harm to patients. Even when observing all ethical principles, dilemmas are bound to appear and nurses can use the code of ethics to determine the best course of action.

Community Overview: Mental Health

Psychiatric disorders are a global phenomenon affecting a significant portion of the population. According to Jain et al. (2017), the World Health Organization (WHO) has established that at least 10% of the population worldwide suffers from some form of mental illness. Additionally, WHO finds that 25% of people have suffered some form of psychiatric illness at least once in their lifetime (Jain et al., 2017).

These statistics indicate that this community presents serious challenges to the world’s healthcare problems. Mental illness can cause stigma, especially due to myths and biases toward the patients. Other problems associated with mental illness include disability, which could be caused by alcohol abuse, depression, obsessive-compulsive disorder (OCD), bipolar mood disorder, and schizophrenia. Therefore, nursing practitioners face a major ethical challenge in handling patients in psychiatric wards.

Effects of Government Policies

Government policies have led to the development of psychiatric practice in the United States. The developments can be traced back to the colonial era when patients with mental illness were the responsibility of their families. The enlightenment of the 1700s led to the therapeutic optimism era characterized by scientific research. The first state hospital to treat mental illnesses was established in 1773, after which many institutions emerged (Bonnie & Zelle, 2019).

The policy also faced the era of deinstitutionalization necessitated by costs and criticism of institutional care as the conditions of treatment were deemed to be dehumanizing. Legislation, including the National Mental Health Act of 1946 and the Americans with Disabilities Act of 1990, has emerged as part of government policy. These government policies have defined and enforced ethics within the context of psychiatry.

National, State, and Local Policy Provisions

National government policies have been described previously, where two main pieces of legislation inform national policy: the Americans with Disabilities Act (1990) and the National Mental Health Act (1946). However, the federal government has also implemented many policy frameworks, including rehabilitation, affordable care, and addressing issues of compliance. Federal protections include the rights of persons, privacy rights, and community inclusions after Olmstead. At the state level, legislation differs across the states, where each is responsible for developing regulations for psychiatric care within its jurisdictions. Similar protections to those of the federal government are also offered. Lastly, the local authorities work within the frameworks provided by both the federal and state provisions.

Code of Ethics for Psychiatric Nursing

The code of ethics in nursing highlights the ethical standards, principles, and values in psychiatric care. Additionally, the code defines acceptable behaviors and enforced accountability and responsibility among nursing practitioners. There are four basic values contained in the code, and each has specific stipulations for nurses. Professional accountability requires registered psychiatric nurses to distinguish between professional and personal relationships.

Additionally, professional practice demands honesty, reliability, integrity, due diligence and impartiality. Unconditional respect requires nurses to observe patient respect, diversity, rights, and autonomy. Wholistic health is where the practitioners understand and acknowledge the interconnected and dynamic processes involved in mental health. Lastly, the quality practice milieu involves the quality of care, including such aspects as safe and competent practice. Therefore, psychiatric practitioners must display a commitment to the patient.

Implications of Code of Ethics for Psychiatric Nursing

Mental health patients are particularly vulnerable and should be handled with ultimate care. Registered psychiatric nurses are obligated by the code to optimize care outcomes. The main implication of the code is that it allows nurses to always maintain a safe environment for patients through competent, ethical practice. The quality of care is another implication and an objective achieved when all the principles and core values have been followed. According to D’Lima et al. (2017), quality of care is an academic discipline in itself that focuses on integrating scientific understanding with practice. The main implication for mental health nurses is that all actions guarantee clients’ safety and health and that the environment is conducive at all times. Lastly, the code ensures that psychiatric patients are offered protection of their human rights.

Ethical and Policy Issues

Many ethical and policy issues arise and have different implications for the coordination of care for the mentally ill. From a policy perspective, access to healthcare for mentally ill people is a challenge that needs to be addressed. There are access barriers, the majority of which are associated with compounded disparities across populations. Socio-cultural barriers include religion and related practices and beliefs, while systemic barriers comprise the organization of mental healthcare services.

Economic factors include health insurance and such individual aspects as denial, which also pose accessibility issues. Disruptions to continuity of care are a challenge emanating from policy problems that can be addressed through government legislation. From an ethics perspective, multiple issues undermine nursing practice, including the use of restraints, deprivation of liberty, seclusion, and non-adherent patients.

Policy Challenges

In the United States, mentally ill patients do not have any meaningful access to healthcare. According to Bonnie and Zelle (2019), 34.7% of adults with critical psychiatric disorders in 2015 failed to receive any treatment. Access raises an ethical discussion that touches on the principle of justice, which requires fairness among practitioners. Deinstitutionalization has been blamed for creating an environment where inequalities in access to mental healthcare persist. Additionally, access also encompasses such issues as health insurance or free healthcare services. Medicaid is a government-funded health insurance program that covers some services offered to poor people. However, it remains inadequate and many patients tend to foot large parts of the medication bills. When access is available, such issues as bias and stigma undermine its utilization.

Ethical Challenges

The first ethical issue is related to harm prevention, either for the patient or other people. Handling mentally ill patients becomes challenging because protecting some patients may necessitate restraining others, which poses an ethical dilemma. Bonnie and Zelle (2019) argue that the main question for practitioners should be whether an intervention prevents harm or whether a failure to intervene causes harm and injury. Privacy and relational autonomy present another challenge because they can easily be violated. However, the involvement of the family members may help ease this challenge because the burden of key decisions can be distributed. Lastly, ethical disagreements are likely to emerge in healthcare settings, which raises the issue of how they should be resolved. The application of the code of ethics may appear inadequate, and further actions are often needed.


Ethical and policy issues in mental healthcare are serious considerations in the coordination of care. First, the fact that a significant percentage of the population is affected means serious efforts need to be made to address the problems. The development of policies has illustrated that current policies are inadequate because they leave critical gaps that affect access and delivery of care. Deinstitutionalization has not been accompanied by adequate provisions for access, which includes healthcare insurance for patients. Therefore, the lack of access results in the underutilization of mental healthcare facilities. Ethical challenges emerge in psychiatry because mentally ill patients are sensitive. Such issues as autonomy may fail to apply due to the behavior and condition of the clients. Therefore, ethical dilemmas are a common occurrence even with the application of the code.


Bonnie, R., & Zelle, H. (2019). Ethics in mental health care: A public health perspective. In A. Mastroianni, J. Kahn, & N. Kass (Eds.), The Oxford handbook of public health ethics (pp. 205-217). Oxford Books Online.

D’Lima, D., Crawford, M., Darzi, A., & Archer, S. (2017). Patient safety and quality of care in mental health: A world of its own? BJPsych Bulletin, 41(5), 241-243. Web.

Haddad, L., & Geiger, R. (2021). Nursing ethical considerations. NCBI. Web.

Jain, S., Kuppili, P., Pattanayak, R., & Sagar, R. Ethics in psychiatric research: Issues and recommendations. Indian Journal of Psychological Medicine, 39(5), 558-565. Web.

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