Resolving the Dilemma of Multiple Relationships for Primary Care Behavioral Health Providers

Practitioners working in primary care (PC) encounter a different model of patient care than those who practice in a traditional outpatient psychotherapy setting. PC physicians commonly serve multiple members of the family and are typically serving numerous patients in the same community. Given the lack of financial sustainability for the behavioral health provider (BHP) position, it is uncommon that a practice will have more than one BHP and therefore, there is increased likelihood that the BHP will be asked to provide services for a family member or roommate of a patient seen in the recent past. The ethical code regarding multiple relationships can sometimes pose challenges that require careful fore-thought and clinical anticipation. The ethical code, if followed too rigidly in the population-based care model of PC, could potentially be harmful to patients who otherwise have no access to mental health resources or would not seek traditional care. This paper proposes a framework to aid anticipatory decision making regarding multiple relationships in the PC setting, with the goal of reducing potential patient harm and maximizing potential for care opportunities.