title: Impact and management of dual relationships in metropolitan, regional and rural mental health practice.
abstract: OBJECTIVE
  To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships.
  
  
  METHODS
  Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed.
  
  
  RESULTS
  Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience.
  
  
  CONCLUSIONS
  No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.
authors.affiliation: School of Nursing and Midwifery, La Trobe University, Bendigo Health Care Group, Victoria, Australia. r.endacott@latrobe.edu.au
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.forename: Anita
authors.initials: A
authors.lastname: Wood
authors.forename: Fiona
authors.initials: F
authors.lastname: Judd
authors.forename: Carol
authors.initials: C
authors.lastname: Hulbert
authors.forename: Ben
authors.initials: B
authors.lastname: Thomas
authors.forename: Margaret
authors.initials: M
authors.lastname: Grigg
mesh_terms: D000328:Adult; D001315:Australia; D002391:Catchment Area, Health; D003156:Community Mental Health Services / Q000941:ethics*; D004992:Ethics, Medical; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000941:ethics*; D008875:Middle Aged; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D018907:Privacy; D012017:Referral and Consultation / Q000941:ethics; D012423:Rural Health / Q000592:standards*; D012919:Social Behavior; D014504:Urban Health / Q000592:standards*