Consultation for Treatment of Serious Mental Illness

Guideline 11: Consultation for Treatment of Serious Mental Illness

The Education Law and Regents Rules define the practice of the professions of creative arts therapy, marriage and family therapy, mental health counseling and psychoanalysis, and a licensee may only engage in those activities within the scope of practice in which the licensee is competent. In the course of providing professional services, a licensee may encounter situations or conditions that are beyond his or her competence or authorized practice. In these situations, it is the licensee's responsibility to ensure that the patient is referred appropriately for further assessment or treatment.

Prior to providing professional services, you should inform the patient about the services you are authorized to provide under law. You may wish to review in particular the practice guidelines developed by the State Board in relation to:

• Defining the terms for providing professional services (Guideline 1);
• Documenting the provision of services (Guideline 4); and
• Consultation with other professionals (Guideline 7).

When providing professional services to patients or prospective patients, it may be appropriate to note that the Education Law and Regents Rules place restrictions on services that may be provided. For instance, a licensee may not prescribe or administer drugs or use invasive procedures that involve cutting or altering human tissue as a treatment, therapy or professional service.

The Education Law and Regents Rules specify that it is unprofessional conduct for a creative arts therapist, marriage and family therapist, mental health counselor, or psychoanalyst to provide any mental health service for a serious mental illness on a continuous and sustained basis without a medical evaluation of the illness by, and consultation with, a physician regarding such illness. The law defines serious mental illness as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, and autism. You may wish to include in your informed consent forms or other agreements information about the statutory requirement for you to consult with a physician when treating a patient for serious mental illness on a continuous and sustained basis and obtain permission to consult with the patient's physician.

Your initial assessment of a patient should include questions about recent or on-going medical treatment for serious mental illness, and the responses should be noted in the file. If, in the course of assessment and treatment, you suspect that the patient has a serious mental illness, you should discuss with the patient the value of a medical evaluation to determine whether medical care is indicated for the mental illness. You should document in the patient chart any and all discussions with the patient regarding continued treatment of a serious mental illness, the legal requirement for a medical evaluation by, and consultation with, a physician and whether this may affect your ability to continue to provide services to the patient.

The Education Law and Regents Rules do not define "continuous and sustained basis" or establish a fixed standard for all cases. The determination is subject to the professional judgment of the licensed mental health practitioner, based on his or her assessment of the patient and the treatment provided.

When it is determined that the patient has a serious mental illness, it is your responsibility to inform the patient of the requirement for a medical evaluation and consultation to determine and advise whether any medical care is indicated for the illness. For instance, a patient with major depressive disorder that does not respond to psychotherapy may have an underlying medical condition that could only be determined by a physician. The medical evaluation may be completed by a licensed physician and it is not necessary that a psychiatrist conduct the evaluation.

A patient may refuse to be evaluated by a physician or deny consent to allow the physician to consult with the licensed mental health counselor, marriage and family therapist, creative arts therapist or psychoanalyst. The licensed mental health practitioner should note the patient's refusal in the record and provide the patient with an appropriate recommendation or referral for treatment. If the licensee continues treatment for a serious mental illness, the licensee faces the possibility of being charged with unprofessional conduct.

If the physician's evaluation recommends a medical treatment that the patient refuses to accept, the licensed mental health practitioner should consult with the physician and determine whether the licensee is competent to continue to provide treatment within the licensee's profession. Section 29.1(a)(9) of Regents Rules requires a licensee to ensure that he or she is practicing within the scope of the professional license and competent to provide the services.

If it is determined that the patient should be referred to another practitioner or you are discontinuing services, you should provide treatment summaries or other information requested by the patient, in accordance with applicable laws and regulations for confidential communication.

Citations of Pertinent Law, Rules or Regulations:

• Education Law, section 6509(2) - practicing beyond the scope
• Education Law, section 8407 - boundaries of professional competency
• Regents Rules, part 29.1(b)(9) - practicing or offering to practice beyond the authorized scope
• Regents Rules, part 29.2(a)(3) - record of treatment and evaluation
• Regents Rules, part 29.1(b)(9) - practicing beyond competency
• Regents Rules, part 29.15 - special provisions for the professions of creative arts therapy, marriage and family therapy, mental health counseling and psychoanalysis