Unethical Mental Health Practices: What do they look like?

I recently spoke with a former colleague who shared a story of a young 17-year-old who was killed during a physical restraint (stay tuned for my Personal Stories Week on Psychcentral, coming August 17th-24th, for more on this story). She was not only disgusted by her colleagues but shocked that the agency suspended these three men with pay. This story sparked another story which sparked a series of questions about unethical behaviors and what they look like within mental health agencies. I have taken the opportunity to list a few below. Please feel free to share your experiences of unethical behaviors within mental health agencies in the comments section below.

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.