While changing consumer demands, technology, and treatment options increase liability risks for mental health providers, they can leverage resources to continue providing quality care.
The pandemic is putting a significant strain on the healthcare system, and some of its effects are still ongoing. Especially in the field of mental health and behavioral health, there has been an influx of patients, which has increased the responsibility of doctors who are already under stress.
The pandemic raised everyone’s stress levels. We know that more and more people are coming to seek behavioral health services, and as in all fields, staff are struggling with retention and recruitment. Burnout is definitely a problem for mental health professionals, which increases the fragility of the system and the possibility of errors. “We’ve seen a lot of suicide, abuse and neglect risks in this area,” said Valerie Beatrice, CPCU, product specialist for Philadelphia Insurance.
Beatrice explains the nuances of these exposures and what mental and behavioral health professionals can do to reduce their risk.
The biggest liability risks in mental healthcare
One big change caused by the pandemic was the transition to telemedicine. Although it grew in popularity as a means of maintaining social distance, it has remained in place due to its convenience and cost-effectiveness. In some cases, however, virtual visits can reduce the quality of care.
Knowing that a virtual service doesn’t offer the same sense of intimacy or connection as an in-person conversation can bring new challenges, Beatrice said.
When visits are not face-to-face, it can be more difficult for doctors such as psychiatrists and psychologists to establish the rapport that is critical to understanding the patient and providing appropriate care. Also, since the same level of privacy is not as easily achieved with a virtual visit, patients may not feel free to speak freely. These factors can lead to inadequate or inappropriate treatment.
One of the most serious exposures of mental health telemedicine is the increased risk of suicide. The treatment of every suicide victim is certainly subject to scrutiny. If the patient may not have been prescribed the most effective medication or dose, this oversight could raise medical malpractice claims.
Other forms of self-harm, abuse or violent behavior can also lead to questions about the adequacy of treatment or the appropriateness of the treatment environment.
Unfortunately, there is a possibility of abuse in areas of vulnerability. This can be physical or sexual abuse between the practitioner and client, or even between clients in a group, Beatrice said.
While this risk is not new, it may be more prevalent now that mental and behavioral practices are experiencing recruitment and retention difficulties like most industries.
This exposure has increased today due to the pressure on staff. There is a risk that background checks may be rushed or policies not followed in order to keep the front desk on staff, Beatrice said. This increases the likelihood that abusers with a documented history can slip through the cracks.
Finally, there are new risks associated with new treatments such as ketamine or transcranial magnetic stimulation (TMS), an FDA-approved treatment for depression.
There are new treatments coming out that practitioners have had great success with, but they are still new, Beatrice said. As drivers, we need to assess exposures carefully. One issue is determining for whom these treatments are most appropriate and how to monitor and manage side effects.
Risk management strategies
Even in the face of new trends, mental and behavioral health care providers can often rely on proven strategies to reduce their liability.
When it comes to the risk of malpractice, for example, accident prevention starts with strong management direction and top-down enforcement of an accident response policy.
It’s critical to drive an anti-abuse culture and create written policies and procedures so the organization has a position on what would happen if an incident of abuse did occur, Beatrice said.
Organizations can also rely on risk management resources from their transport partners, such as practitioner training on suicide and self-harm recognition and prevention.
Philadelphia Insurance has a partnership with Abuse Prevention Systems where our policyholders can access free abuse training each year. We also work with the Suicide Prevention Resource Center (SPRC). It has an initiative called Zero Suicide Academy, which aims to have zero suicides in the organization. It’s based on the belief that suicides are preventable, and it gives behavioral health professionals the knowledge to identify at-risk groups and understand how to act, Beatrice said.
The SPRC includes online library resources such as tools, fact sheets, and reports to keep providers informed. Other resources available include the CDC’s suicide prevention website, which has a section on support for teens and young adults, and the National Institute of Mental Healths (NIMH) website, which discusses signs and symptoms, risk factors, and ongoing research.
In the field of virtual medicine, Beatrice said there is no substitute for personal interaction, especially for the first visit.
I think it makes sense if the patient’s eligibility for virtual services has been properly assessed. But when it comes to the insurance policy, we definitely prefer doing the in-person assessment first and then the virtual services, because of the nuances of the care you’re doing virtually, he said.
Service providers can also make use of CMS’s telehealth toolkit, which outlines the appropriate ways to use telehealth and gives tips for adapting virtual health services to the needs of different population groups.
As the need for mental health services increases, providers can provide better care and protect themselves by being proactive and utilizing all of these available resources. &
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