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. Results and 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.