Have you ever been to a mental health agency where everything appeared to be disorganized, unethical, and perhaps even illegal? Did a loved one receive mediocre mental health services, inadequate services, or no help at all? If so, you are not alone.This week we are focusing on the personal stories of families, caregivers, and individuals who have experienced mental illness. While considering a topic for this week, I spoke with a former colleague who has worked in the position of residential advisor for 15 years. She has always been leery about the practices she has seen in previous positions in which she worked. She shared a story about a mother whose son was killed through asphyxiation during a physical restraint in a group home. He was only 17-years-old when three, medium build young guys, pinned him to the floor face down and held his arms down. Despite multiple cries for help and complaints of not being able to breath, this young man died. It wasn’t until the restraint was over that staff could clearly see that this young man wasn’t breathing.
Believe it or not, hospital medical errors and incompetent procedures have become the 3rd leading cause of death in the U.S. It’s a public health concern that many families face each year. As a result, it is important that you understand how to protect your loved one.
Sadly, agency-based political structure and organizational favoritism often lies at the heart of unethical practices. Unethical, incompetent, and mediocre practices within mental health services are not new issues to mental health professionals. In fact, cover up and “hush-“hush” practices probably occur each day. It is something that can spike great debate across the nation for many reasons. One reason is that many mental health professionals hold strongly to the idea that we must uphold our profession, even if our profession engages in unethical or incompetent behaviors. A second reason is because many mental health agencies promote a “hush-hush” mentality that prevents even the most ethical and knowledgeable of professionals to speak out on unethical practices within the agency. Although many agencies promote the idea that an employee can file a grievance (a complaint that reaches an authority figure at an agency) or report an incident anonymously(“Whistleblower” Protection Act) to protect themselves from backlash, the reality is that someone knows someone within an agency and many alliances are built. Sadly, within many mental health agencies across the nation, alliances are often built upon years of secrecy, favoritism, and commonalities. In other words, families, friendships, and even romances are built within these agencies and this makes reporting anyone very, very difficult. In many cases, families are often working within the same agency, making it even more difficult for workers to report incidents of an unethical nature. It’s sad to say that unethical behavior can become contagious within an agency and before you know it, almost all employees are engaging in unethical behaviors.
Despite the fact that mental health professionals are held to what is known as the professional ethics code, many often neglect to review these codes and even share them, if they hold a supervisory role within an agency, with employees. Today, most agencies develop their own ethics codes for employees to follow but this does not and should not replace the professions ethics code.
What is an ethics code?
An ethics code includes a set of moral and legal standards that mental health professionals are encouraged to follow in order to uphold the dignity and integrity of the field, protect client welfare, and avoid legal consequences. Most health care professions have an ethics code. You can find an ethics code for psychologists at the American Psychological Association or for professional counselors and mental health therapists at the American Counseling Association. It’s helpful to become knowledgeable about ethics codes and how you are to be treated as a client.
What are common unethical practices?
It’s difficult for many families to determine what is ethical and what is unethical. Here is a list of unethical behaviors that often occur in mental health facilities:
- Neglecting to meet with clients during a set time. Life happens and emergencies happen where meeting at 2:30 every Wednesday may be difficult. But a therapist should call you in advance or make every effort to reschedule.
- Changing information in a contract or client’s file to make a mental health agency or professional look professional.
- Neglecting to respond to crisis calls or visits
- Having a dual relationship with a client (having a sexual relationship with a client or supervisee, going on a date with a client, developing an ongoing friendship with a client, going shopping with a client on a regular basis, or attending a client’s wedding party). The topic of dual relationships has always been controversial because some of the above practices are acceptable in certain scenarios, except for the sexual relationship with a client. For example, a child therapist may go shopping with her client to help her with social anxiety or to reward her 13-year-old client. However, a therapist who attends her client’s wedding party and mingles with the client’s friends and family and happens to get drunk is crossing the line big time!
- Maintaining a client-therapist relationship for the sole purpose of getting paid through insurance. For example, once you have worked on the issues that brought you into therapy and you’ve developed appropriate skills, it’s time to end the relationship. A therapist should not meet with you “just to see you” or “talk” if there is nothing to work on. This is insurance fraud.
- Hiring and paying an incompetent mental health therapist and covering their multiple mistakes. It’s okay to make mistakes, many professionals do. But when a few mistakes become multiple mistakes and the therapist is not either trained or disciplined, this is a problem.
- Fabricating data from mental health tests or clinical studies. The case of Diederik Stapel is a prime example of fabricated clinical data. Stapel was the lead scientist on many articles published in prestigious research journals. Not only did he manipulate data useful for understanding his studies, but he also fabricated the entire study. Outright lying and manipulating the results of a study is fraud. The fraudulent data was used in at least 30 published articles that were reviewed by a jury of his peers, that is, other professionals in his field who trusted his study. Even though he was touted as a prominent social psychologist with a passion for educating students, he dropped to an all-time low in his profession. He not only misled the public, but lied to his peers, other professionals, and the profession itself.
- Changing a mental health diagnosis in order to receive insurance reimbursement(s). Again, once therapy is over, it is over. Nothing should be changed, altered, or fabricated in order to continue therapy services.
- Changing billing information to reflect more time spent in therapy than truly spent in order to receive more money. For example, a therapist may get paid $75.00 for every 45min session and for every 60min session, get paid $100. A therapist who draws therapy out to 60min just to get paid more money is engaging in an unethical practice. A therapist who sees you for 20 minutes but tells insurance companies that you were seen for 45 minutes is also engaging in fraud.
- Having a client perform personal work (work on a therapist’s car, home, etc.) in exchange for therapy services is also unethical. This is called bartering.
- Spying on a client through Facebook, Myspace, Twitter, or any other social medial platform. This behavior can certainly extend over into legal areas and become stalking.
These are just a few common unethical practices that can occur within mental health agencies or among mental health professionals.
How do I protect myself?
It is important that you educate yourself to who your mental health professional is, what their history is, and what is going on within an agency where you intend to receive treatment. This information may be difficult to locate but you can always search for answers through word-of-mouth. There is always someone who knows someone. Another thing you can do is contact the American Medical Association (AMA) to research your psychiatrist. You can also contact your State Board for psychiatrists, family therapists, and professional counselors. A simple google search for your state board may yield results. For example, the Rhode Island Board of Medical Licensure and Discipline and Alabama State Board of Medical Examiners and Medical Licensure Commission lists public actions taken against professionals over the past three months or more. The Arizona Board of Medical Examiners website allows you to verify credentials, while the Pennsylvania State Board of Psychology allows you to verify a license and see any legal actions taken against a professional. You must also be aware of the fact that you can contact your local disability rights network (if you have one) to file a complaint. Find more information at the National Disability Rights Network here: http://www.ndrn.org/.
It’s also important to keep in mind that not every mental health professional within an agency is unethical, and not every agency is unethical as well. But when and if you do spot an unethical apple, it’s good to know what to do. All of the pressure should not reside on your shoulders, however. More information needs to be provided to the public by agencies, state boards, and associations. You deserve fair treatment. You certainly do not want to stalk, harass, or invade the privacy of a therapist or agency. But you have the right to ask questions when you feel leery of someone who is offering you services.
Next week we’ll talk about the steps you can take to file an ethics violation complaint. In the meantime, stay tuned for tomorrow’s personal story about a mom in Canada who has taken her pain and created a foundation that would support mothers and father’s dealing with suicide everywhere.
As always, I wish you well
Editor’s note: It is important for me to mention that there are both ethical and legal codes that mental health professionals and agencies must abide by. The legal codes are often more strict than the ethics codes. Ethics codes guide behavior and often provides “suggestions” on how agencies or professionals should approach providing treatment. Some situations are entirely dependent upon a therapist’s or mental health agency’s discretion. What you might consider unethical might be considered ethical by the agency or professional treating you. The ethics code has been a very controversial topic for mental health professionals because there is often a lot of gray area and not black and white answers or approaches.
American Psychological Association. (2011). The case of Diederik Stapel. Retrieved August 9, 2014, from http://www.apa.org/science/about/psa/2011/12/diederik-stapel.aspx.
Mental Health Association in New York State. (2014). When You need to file a complaint against a mental health care provider or facility. Retrieved August 9, 2014, from http://www.mhanys.org/publications/factsheets/fscompliants.htm.
Reamer, F. (2013). Help! My supervisor is unethical. Eye on ethics. Social Work Today. Retrieved August 9, 2014, from http://www.socialworktoday.com/news/eoe_062113.shtml.