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Key points
- MHPs who terminate services due to personal reasons may be at risk of malpractice lawsuits.
- MHPs should consider alternatives to terminating services, including ways to address underlying concerns.
- Risk management strategies include consultation, documentation, risk assessment, referral, and follow-up.
This post is part 2 of a series. Part I identified the components of malpractice and explored how mental health professionals (MHPs) may be liable for malpractice if they terminate work due to personal reasons such as health issues, moving, or family issues. Part 1 also identified situations in which it may be legally and ethically justifiable to terminate services due to personal reasons. Part 2 continues below with examples of inappropriate reasons to terminate, as well as steps that MHPs can take to mitigate the risks of a malpractice lawsuit.
Inappropriate Reasons to Terminate
While there are a number of published malpractice cases to help us understand when it may be justifiable to terminate services, there is little literature regarding when it may be inappropriate to terminate services due to personal or family reasons. For instance, would it be inappropriate for MHPs to terminate services simply because they did not like a patient’s disability status, political beliefs, sexual orientation, annoying manner of asking questions, or body odor? Professional ethics suggest that MHPs should prioritize clients’ welfare over their own in such situations. But could MHPs argue that their obligation to self-care means that they may prioritize which clients they see, in part, based on which clients provide them with the least stress or perhaps the greatest sense of fulfillment?
Note there is a difference between the decision on whether to accept a client for services and a decision to terminate work with an existing client. MHPs do not have the same obligation to serve potential clients as they have to continue to serve people who are already clients. In either situation, MHPs should not discriminate against clients, and they should ensure clients have access to services (which may be facilitated through referrals). Still, once MHPs have established a working relationship with a client, they have the added responsibility of continuing to provide the client with appropriate professional care.
When considering termination as a means of self-care, MHPs should also consider alternate means of self-care that may meet their own needs as well as those of their clients. For instance, if work with a client is triggering emotionally disturbing countertransference, the MHP might engage in therapy to work through their emotional issues. If the MHP is feeling overwhelmed, then perhaps a vacation or fewer client appointments might be helpful. If the MHP is feeling stressed because the client is crossing boundaries with them, then the MHP may be able to re-establish appropriate boundaries without having to terminate services. If alternate self-care strategies are unavailable or ineffective, then the MHP has a stronger case regarding the prudence of terminating.
Conclusion
Typically, MHPs are expected to prioritize their clients' needs; however, there are circumstances in which it is both legally and ethically justifiable for MHPs to terminate their work with clients in order to prioritize their own well-being. Self-care is not just for the good of MHPs themselves; it also helps clients by ensuring that MHPs are doing what they need to do to continue to provide clients with quality services (Barsky, 2023). Historically, MHPs have not had much guidance about when and how to terminate work with clients for personal and family reasons.
Clearer guidance from professional associations could help MHPs navigate potential conflicts between the interests of clients and those of MHPs, particularly when the MHPs are experiencing significant personal issues. When termination is deemed appropriate, MHPs may reduce the risks of incurring malpractice claims by engaging in clinical supervision and legal consultation, conducting risk assessments, effecting appropriate referrals, contracting the process of termination with the client, and documenting their consultation processes, actions, rationale for termination, and steps taken to ensure continuity of appropriate care for the client. As with all areas of practice, MHPs should act with self-awareness, diligence, integrity, and compassion.
References
American Counseling Association [ACA]. (2014). Code of ethics.
American Psychological Association [APA. (2017). Ethical principles of psychologists and code of conduct.
Barsky, A. E. (2024). Clinicians in Court: A Guide to Subpoenas, Depositions, Testifying, and Everything Else You Need to Know. Guilford Press.
Barsky, A. E. (2023). Essential Ethics for Social Work Practice. Oxford University Press.
Jacobson, G. (2017). Practice and malpractice in the evaluation of suicidal patients. In R. Schouten (ed.), Mental Health Practice and the Law. Oxford University Press. https://doi.org/10.1093/med/9780199387106.003.0004
National Association of Social Workers [NASW]. (2021). Code of ethics.
Reamer, F. G. (2023). Risk Management in the Behavioral Health Professions: A Guide to Preventing Malpractice and Licensing Board Complaints. Columbia University Press.
