Principles underlying a model policy on relationships between staff and service recipients in a mental health system.
OBJECTIVE
The authors participated in a work group to produce a model policy addressing the boundaries of relationships between staff and recipients of service in a public mental health system that provides and regulates services in a variety of treatment settings.


METHODS
The chief medical officer of the New York State Office of Mental Health assembled a work group of administrators, clinicians, state officials, and a representative of service recipients. The group reviewed the professional literature and existing ethics guidelines and policies addressing relationships between staff members and service recipients and made recommendations for a new policy.


CONCLUSIONS
The work group formulated five guiding principles: prevention of the exploitation of recipients of services by staff; the right of recipients to be treated as competent autonomous human beings; recognition that certain developmental stages, treatment settings, and pre-existing relationships increase a service recipient's vulnerability to exploitation and call for more stringent regulation of staff actions; acceptance of a spectrum of permissible relationships for staff and recipients outside of the relationship dictated by the staff member's job description; and recognition of the difference between a relationship focused on treatment or service provision and other professional relationships between providers and current or former recipients. The principles were used to develop a model policy on relationships between staff and recipients that addresses both the organizational complexity and the recipient-centered rehabilitation model of a large state-operated mental health system.
Fisher
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Creedmoor Psychiatric Center, Queens Village, New York 11427, USA. crcnwaf@gw.omh.state.ny.us
Goldsmith
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D003155:Community Mental Health Centers / Q000458:organization & administration*; D004992:Ethics, Medical; D017144:Focus Groups; D006801:Humans; D009518:New York; D016134:Organizational Policy; D010348:Patient Care Team; D011050:Policy Making; D011369:Professional-Patient Relations; D011613:Psychotherapy; D011635:Public Health Administration