Yesterday’s Herald contained a sad story about a young man who had been seen by the local mental health team, diagnosed him as potentially psychotic and prescribed an anti-psychotic. His counsellor later told him to stop taking the anti-psychotic and continue with counseling. He subsequently committed suicide.
A young man committed suicide after his counsellor told him by text message not to take his medication, provided he was undergoing regular counselling.
Acting Health and Disability Commissioner Rae Lamb, in a finding issued today, said the case highlighted the importance of consulting other health professionals working with a person, the dangers of providing advice by text message, and the risks associated with “no suicide” contracts.
Now there is a limited amount of information in this article. The HDC report is here. But the newspaper piece makes it sound as though the counsellor in question had been a little sloppy in her duty to her patient. Instead, buried in the HDC report, there is evidence of a serious ethical breach:
It is my opinion that [Ms C’s] provision of advice about medication prescribed by the primary clinical team fell short of what I would expect of a qualified and ethical counsellor and that to do so without discussion with that team breached her professional duty to collaborate with other health providers and uphold the values of responsible caring, as well as breaching the principles of promoting safety and avoiding harm.
I consider that this would provoke severe professional disapproval. [emphasis mine]
Though these are strong words, the breach of ethics here is far more serious than this. This counsellor advised (or, at least colluded with) a patient to stop their medication without knowing either the diagnosis of the medical team, nor the name of the medication. Worse, this person has no ability to prescribe medication and only a lay understanding of their use and purpose.
Now I know that patients take advice all the time from people with no clue at all about the drug or the disease. It drives doctors quite wild to prescribe a medicine only to have a patient tell you (usually when they return, feeling no better) that their aunt Mabel advised them that the medicine you prescribed was useless/bad/evil/not as good as rubbing with juju beads… But it should be emphasised that friends and relatives do not purport to have medical authority in any way. Their advice is purely anecdotal and you take it on that basis.
My concern with this case is that there is a definite therapeutic relationship between this unfortunate young man and his counsellor. The young man would certainly have given weight to his counsellor’s opinion as a professional clinical opinion. To me it seems clear that the counsellor stepped well outside her competency almost to the extent of fraudulent representation. She may not have claimed she was a doctor, or “as good as” a doctor, but she certainly implied that her opinion counted for more than the professional mental health team’s.
Whilst I appreciate the work that most counsellors and psychotherapists do is soundly professional, within their discipline, I have noticed that some seem to assume roles that are dangerously medical, or worse – anti-medical. This is a recipe for precisely this kind of disastrous result. I do not try to provide psychotherapy for my patients. I have no expertise in this at all. Psychotherapists and counsellors should not interfere in medical matters without seeking the opinion of the doctor involved.