EDC 601: Clinical Mental Health Counseling is terrifying. And intense. And a little disheartening. Every Monday night, I get to hear firsthand stories from my professor about the ugly, horrific, unjust bullshit that happens to psychiatrists, counselors, therapists, etc and/or to the mentally ill. But the lectures are invaluable to my education, so I shake off these very concerning, real issues I will be facing soon with all the naivety and hope I can muster. After all, this is real advice from real counselors in real situations.
I am learning that arguably one of the biggest difficulties in this field is inconsistency in laws from state to state. We are learning how imperative it is to be aware of the laws and ethical codes within the state we end up practicing in, because they vary greatly. The state in which you get your education, degree and certification from does not necessarily carry over from state to state. Being licensed in New York does not mean you can simply transfer that license over if you move to somewhere else in the U.S. Also, laws that cover you in New York State do not exist in others.
Believe it or not, not all governments are ethical. *Gasp* Therefore, sometimes laws and ethical codes do not align with one another (this is true throughout history, but let’s just talk state to state mental health counseling laws). One such current instance is “duty to warn” verses confidentiality between a patient and his/her doctor, therapist, counselor, etc. Basically, duty to warn is a legal obligation (in only SOME states apparently) to take reasonable action to help protect innocent people from becoming victims of serious, potential harm if one becomes privy to that information from the patient/client. It’s one of the only instances where the whole “confidentiality” thing may be overridden. To me this is both common sense and good intention; if a patient/client has openly stated they are going to harm/kill people or themselves, I should report that to the proper authorities. But guess what, everybody: if a therapist chooses to do that very (seemingly) acceptable response in the wrong state, they can be sued and potentially lose their license for breaching confidentiality.
In interest of not seeming one sided, I will say that it’s a goal and priority to establish a safe space with clients. It is why confidentiality laws exist in the mental health profession. If clients feel they are restricted or with an untrustworthy counselor, they won’t discuss their thoughts and feelings and therefore cannot thoroughly address their problems. This is where the disagreement with “duty to warn” is coming from. Again, it’s rooted in good intention.
For an example of when all state laws not being consistent is a huge problem (and utter bullshit), I will use the story I heard this evening:
A patient at a hospital in West Virginia who was presenting as suicidal stated in a session with his counselor that when he gets released, he may take a semi-automatic rifle and shoot into a crowd of people at an upcoming high school football game with the plan of dying by police shooting. This was documented by my professor and reported to the necessary personnel, upon which the patient was arrested on the day of his release from the hospital. Under the “duty to warn” law (in states like New York) it is mandatory to bring something like this to the attention of the hospital supervisors and the authorities. Unfortunately… my professor was not in New York. And a shit storm ensued.
“This person was in jail for nine months until his trial, which resulted in him being acquitted. He and his attorney then turned right around and sued the hospital and his counselors for releasing confidential information. And he won. One million dollars.”
My professor himself was sued for $500,000 of that one million. He was simply being an ethical human being and tried to keep a lot of people from potentially becoming victims of a mass shooting. He had to appear in court and pay that 500,000 because the court ruled in favor of confidentiality over potential harm to others. He went on record to say that if he knew the outcome of the trial, he wouldn’t do anything differently. And I get it. If he were to have ignored those statements and not reported it, it is possible that the shooting could have happened. We can’t definitively say. But what I can say is this:
Malpractice insurance is important AF.
Intent matters ZERO percent in therapeutic relationships and court cases.
Know. State. Laws.
Being an ethical human being in face of the law is more difficult in West Virginia, Alaska, Connecticut, Rhode Island, Washington D.C., South Carolina, North Carolina, Georgia, Florida, Texas, Oklahoma, Kansas, Arkansas, Nevada, Maine, Mississippi, North Dakota, South Dakota, Oregon, New Mexico, Wyoming and Hawaii.
Apparently confidentially is the golden rule in Nevada, Georgia, Maine, North Carolina, and North Dakota. If you breach confidentially for sake of the greater good, you can be taken to the cleaners. “No duty to protect or warn” is stamped all over those lands.