Ending Care Relationships in the Mental Health Setting

by Rhonda Lawes, PhD, RN

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    00:01 Hi, I'm Dr. Rhonda Lawes, and today we're going to discuss a pretty difficult topic.

    00:06 We're going to look at ending care relationships in the mental health setting.

    00:10 Now, in the world of mental health care, the relationship between a patient and their therapist or psychiatric mental health provider is super important.

    00:19 It's built on trust, openness, and a mutual desire to work through the patient's challenges.

    00:24 However, there are times when this relationship might need to come to an end.

    00:30 Now, this is what we call terminating the provider-patient care relationship.

    00:34 Think of it like a TV series that sometimes needs to conclude, whether it's because the story has naturally come to an end or because the circumstances have changed.

    00:43 Now, there's a bunch of reasons why this might happen.

    00:46 Sometimes the patient has made awesome progress and doesn't need therapy anymore.

    00:50 Other times, it might be that the psychiatric mental health provider feels they're not the best fit for the patient's needs, or maybe the patient feels they aren't getting what they need from the provider.

    01:02 In some rare cases, there might be ethical concerns or boundaries crossed that make continuing the relationship impossible.

    01:09 But before we talk about the ways to close the relationship, let's dig a little deeper into some of the reasons why a provider might feel the need to terminate a relationship with a patient.

    01:19 Termination of the treatment relationship is appropriate for any number of reasons.

    01:24 This can include where there's a lack of agreement on treatment plan, the patient no longer requires treatment, the provider is closing his or her practice, or the provider or patient is moving away.

    01:37 Now, sometimes it can be because the provider may feel the patient needs a higher level or more experienced provider.

    01:44 The patient may resist because they feel safe with the person they know and trust.

    01:49 Other times, it may be because of a patient behavior, such as one of these three categories.

    01:55 Maybe it is repeated no-show or no responses to appointments or attempts to contact them.

    02:01 The second, maybe a really uncomfortable one, lack of payment.

    02:05 And the third category, when the patient or the patient's significant other demonstrates potential harm to the provider or staff.

    02:14 Whatever the reason, there is a generally accepted process for ending the treatment relationship in a manner that's designed to protect the interests and well-being of both the patient and you as the provider.

    02:26 This process is what helps you address your concern that you're abandoning your patient, and your risk for professional and legal consequences.

    02:35 So these are the best practices and what are generally accepted.

    02:39 Now, you must provide written and verbal explanation of the reasons for termination of the relationship whenever possible.

    02:46 Give reasonable notice. This is generally 30 days.

    02:50 However, this is highly dependent on whether there are continuation resources available to the patient or not.

    02:56 Document the plan for transfer of care services as you've discussed them with the patient.

    03:01 Remember, there is risk when stopping psychiatric treatments and medications, and having a transfer plan documented shows your level of professionalism and care.

    03:12 So, document what resources were provided to the patient and whether it was written, verbal, or electronic, or hopefully, all three.

    03:20 Provide and document that your team organized referrals and shared patient records as needed to facilitate the continuity of care in a timely and confidential manner.

    03:30 The provider should prescribe an appropriate amount of medication that will last until the patient can establish care with a new provider.

    03:37 This may involve issuing a final prescription with enough refills to cover the transition period.

    03:42 This is typically ranging from a few weeks to a couple of months, depending on the medication and the patient's needs.

    03:48 Now, it is really important that you note that ending this relationship is a process that needs to be handled with care.

    03:55 It's not about just saying, "Well, looks like we're done here and parting ways." It involves discussions about the reasons for termination, planning for the patient's future care needs, and making sure the transition is as smooth as possible.

    04:10 Your goal is to ensure that the patient feels supported and has a plan moving forward, whether that's with a new therapist or with other resources.

    04:19 In summary, as we wrap up this discussion, always keep in mind terminating a provider-patient relationship in mental health settings is a very delicate process.

    04:31 Now you take this step when it's in the best interest of the patient.

    04:36 Or necessary due to the other factors we've discussed.

    04:39 It's all about making sure the patient continues to receive support they need, just in a different form.

    04:45 It's also important that you, as a provider, accurately document the steps you've taken to ensure the support was provided, even if it was refused.

    About the Lecture

    The lecture Ending Care Relationships in the Mental Health Setting by Rhonda Lawes, PhD, RN is from the course Role Transitions (APRN).

    Included Quiz Questions

    1. The provider's practice is closing.
    2. The provider disagrees with the patient's personal beliefs.
    3. The patient challenges the provider's diagnosis.
    4. The patient expresses dissatisfaction with the provider's communication style.
    5. The patient belongs to a particular demographic group.
    1. Establishing a documented plan for the transfer of care and resources
    2. Not explaining the reason for termination to avoid potential conflicts
    3. Giving less than one week's notice to the patient of termination
    4. Documenting patient records without sharing them for care continuity
    5. Ignoring state medical board rules regarding notification of emergency care services

    Author of lecture Ending Care Relationships in the Mental Health Setting

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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