Mental Health Practitioners

Practice Guidelines

Consultation for Treatment of Serious Mental Illness (draft)

Law, rules and regulations, not guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of this guideline and available on this site.

The Education Law and Regents Rules specify that it is unprofessional conduct for a licensed 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.

Serious mental illness is defined as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, and autism.

Education Law and Regents rules state the purpose of the medical evaluation and consultation shall be to determine and advise whether any medical care is indicated for such illness. It is not necessary that a psychiatrist conduct the evaluation, as the law requires the medical evaluation to be completed by a physician

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.

A licensed mental health practitioner is authorized by the scope of practice to assess and evaluate patients to identify and evaluate dysfunction and disorders for the purpose of providing appropriate services. Based upon such evaluations, a licensed mental health practitioner should determine whether the patient has a serious mental illness that requires medical evaluation by, and consultation with, a physician for continued treatment.

If a patient refuses to be evaluated by a physician or denies consent to allow the physician to consult with the licensed mental health counselor, marriage and family therapist, creative arts therapist or psychoanalyst, and the licensee continues treatment for a serious mental illness the licensee could be charged with unprofessional conduct. 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 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. Part 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.

In order to comply with these legal requirements, you should consider incorporating the following procedures into your assessment and treatment of your patient:

• Your initial assessment of a patient should include questions about recent or on-going medical treatment for serious mental illness. You should document the patient's self-report 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;
• 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.
• 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.

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”