Professional Ethics in Behavioral Health

This article offers important guidance on some frequently encountered ethical issues – competency, informed consent, confidentiality, and conflicts of interest – and provides resources for you to learn more about professional ethics in your state. As a SonderMind network professional, you are expected to adhere to the highest professional and ethical standards. This article provides guidance on how to do just that. Unethical conduct may result in termination from the SonderMind network. It may also result in discipline from your licensing board. Penalties may range from fines to license revocation. 

Competency

SonderMind considers professional competence a provider's ability to treat clients successfully and efficiently within the bounds of their education and experience. Providers shall only practice within the boundaries of their competence, based on their education, training, supervised experience, credentials, and appropriate professional experience. Specialty areas of practice may require additional education, training, credentials, and experience. Some pointers:

• Consultations with other providers can help ensure competent treatment. 
• Refer patients who need care outside the bounds of your competence. 
• Use clinical questionnaires to monitor the effectiveness of your treatment. 
• Check out these resources: Using clinical questionnaires with SonderMind.
• Continue professional education and development. 
• Do not practice while impaired. 
  

Informed Consent

Providers must obtain informed consent before engaging in treatment. Informed consent requirements can vary by state, mode of therapy (telehealth vs. in-person), and the client's age (minor vs. adult). Check with your local board for age of consent requirements. Also, see "What Disclosures Do I Need to Provide?." 

Informed consent may require addressing the following issues:

• The risks and benefits of treatment.
• If the therapy is via telehealth, the risks and benefits of telehealth (security privacy risks and the possibility of technology failure). 
• Alternate methods of treatment.
• Anticipated response time.
• Emergency procedures to follow when a counselor is not available.
• Instances in which confidentiality may be broken.
  

Confidentiality, the Duty to Warn, and the Duty to Protect

In general, behavioral health providers should keep all the content of therapy sessions strictly confidential. When you treat a client – either in person or via telehealth – make sure the space is private and secure to protect confidentiality. (See Tips for office design; Online therapy home office set up). 

There are only two instances when a provider may reveal a client's confidential information: (1) when you have the client's permission, and (2) when you are subject to mandatory or permissive reporting laws.

You may be required to report a client when you believe a client is a danger to themself or others. A provider may also need to write an emergency mental health hold for a client in imminent danger of self-harm and give it to the police or EMS when they arrive. Therapists should not transport clients to a crisis or emergency facility in their personal vehicles. 

Keep in mind that mandatory reporting laws vary by state and profession. While some states require providers to warn others when there is a risk of harm or danger, other states allow providers to decide what to do. Some states forbid any breach of confidentiality. There are also separate reporting requirements for minors subject to harm and abuse. Here is a 50 state survey of duty to warn laws in mental health. Check with your local board and legal counsel for specific requirements and up-to-date information. 

Conflicts of Interest

Providers should avoid a conflict of interest. Even the appearance of a conflict of interest can weaken the efficacy of treatment and harm the client. Here are some common conflicts to watch out for: 

• Improper referral and financial arrangements (e.g., kickbacks for referrals or fee-splitting with unlicensed individuals).
• Treating both parties of an abusive relationship.
• Engaging in a sexual relationship with a client or with someone close to the client.
• Conducting business with a client outside of therapy. 
• Treating a friend or family member.
• "Friending" or "following" a client on social media.
• Improperly abandoning a client without notice or a care transition plan. 
  

Treating clients with opposing beliefs to your own may also create a conflict of interest. Consider being transparent about your beliefs and practices if a client inquires about these.

Professionalism and Boundaries

Read up on creating boundaries to maintain professional relationships with clients here.

How to Resolve Ethical Issues?

1. Adhere to an ethical decision-making model. (See Practitioner's Guide to Ethical Decision Making; ACA Ethical Dilemma Poster).
2. Consult with other licensed professionals.
3. Check the ethical code adopted by your licensing board or by your professional association (see below).
4. Contact your local licensing board (see below for links to regulatory boards in your state).
5. Seek legal counsel.
   

Codes of Ethics

• American Medical Association Code of Medical Ethics
• American Nurses Association Code of Ethics
• American Psychological Association Ethical Principles of Psychologists and Code of Conduct
• American Counseling Association Code of Ethics
• American Association for Marriage and Family Therapy Code of Ethics
• National Association of Social Workers Code of Ethics
• National Association of Alcoholism Counselors and Trainers Code of Ethics
  

Codes of Ethics in Your State

Here are links and citations to the codes of conduct enacted by your local regulatory/licensing board. Boards may also rely on ethical codes developed by professional associations.