Funder by the Department of Human Services Auspiced by Our Community

DEALING WITH INAPPROPRIATE BEHAVOIUR BY CLINICIANS

Terrible things sometimes happen in relationships between clinicians and 'their' patients or clients. Even the use of the possessive pronoun gives away the built-in problem of the power differentiation between clinicians and consumers (often with a layer of gender power thrown in on top).

Really terrible and/or criminal abuse of that power is, thankfully, rare (or, at least, rarely reported).


Private practice

Consumers don't often talk about their experiences of falling in love with psychiatrists or clinical psychologists, but when you bring a group of consumers together we often do share stories (if reluctantly at first) of quite intimate emotional relationships.

The clinicians have fancy language for all of this but remember, it is their responsibility to resolve, contain, intuit, empathise and own their own part in any miscommunication that takes place. They are responsible for dealing with the situation without causing further harm.

A practicing clinical psychologist or psychiatrist knows that their relationship with those people who trust them sufficiently to share very intimate detail of their lives must never, under any circumstances, develop into something more than a clinical relationship.

Doctors make a Hippocratic Oath, which spells out that which is therapeutic and that which becomes ethically abhorrent. Clinical psychologists are also bound by strict ethics that do not include any sort of inappropriate touching, staring, rearrangement of furniture, sexual advances, or sexualised language or interpretations of their clients' observations.

One of the safety mechanisms in place is an activity called 'supervision'. This recognises that therapeutic relationships are fraught. It's a difficult, often isolated, job. Supervision is mandated in clinical psychology and also used in psychotherapeutic psychiatry. It enables less experienced clinicians to have regular meetings with experienced clinicians on a one-to-one basis. Hopefully through this process many potential boundary violations can be caught before any damage is done.

Some clinicians also choose to meet regularly as a group. This is also an attempt to alleviate the isolating potential of single-person practice.

Despite all the safeguards, unfortunately, sexualised behaviour by clinicians does sometimes happen. This is always totally inappropriate.


In hospital

It is important to note that physical assault is as inappropriate as any unwanted (or even wanted) sexual behaviour.

Inappropriate behaviours can include (but are not restricted to) forcibly pulling people along, shoving people into seclusion rooms, inappropriate comments or touching, allowing sexual abuse by other patients, overuse of unqualified guards, removing clothing or bedding with force, or sexual assault including sexual penetration.

Some people who have really high or over-excited (what the doctors call 'elevated') moods sometimes behave in ways that are sexualised much more than they would normally but this is no excuse for staff of any kind (psychiatric nurses, occupational therapists, social workers, psychiatrists or clinical psychologists - anyone) abusing their power.

Public psychiatric hospitals can be ugly, unkempt, violent places where nasty things happen to people. The majority of people are there against their will and the angst is palpable. It's a place on a knife edge. Private hospitals can be individualised, rarefied environments where enhanced power differentials are institutionally protected and sometimes less scrutiny of spaces and people occurs.

Within such environments, things can happen and go unreported. Staff can become intimidated and traumatised by other patients and staff. Again, often this is not reported, even when staff know it is happening. Managers of clinical teams may make efforts to support whistleblowers but it doesn't always work.

Even if reported, sometimes clinical misdemeanours are excused. It's not uncommon for patients' reports of assault to be found in their histories as evidence of pathology.


What can you do?

The thing of most importance is your safety and security from the perpetrator. Stay safe. Do what you can to get away from the person who is making you feel unsafe.

If you are feeling up to taking action, there are some other things you can do. As a starting point, it's not a bad idea to keep a business card from the Victorian Mental Illness Awareness Council (VMIAC) on you at all times. You can call them if you are in trouble (phone 03 9380 3900). This is particularly useful for those of us who are on a Community Treatment Order (CTO) or are being case managed by public services.

See 'where to go for help' below for more options.

In hospital

If you are an involuntary patient locked in the same unit in which the perpetrator works, there are some added difficulties. Get away if you can. Certainly contact VMIAC.

If you can't leave, you can try reporting the problem to other staff, particularly clinicians who you like and trust. Good clinicians will protect you, will make sure the complaint is taken seriously and will stand in the way of retribution aimed at you. If you trust them then trust your instincts.

Remember, however, that clinicians are responsible to their team and are obliged (in principal) to report what is said to them. Ask them if they intend to report what you've said to others, to whom, when, and for what purposes.

Keep calm. Try not to get entrenched in the 'squeaky wheel' culture which often prevails in mental health services (whereby the noisiest people get heard at the expense of others). Try to be polite but persistent.

Sometimes this isn't possible. The violation is so great that all we can do is to curl up in a ball and pretend nothing has happened - hiding our terror. This will almost certainly be pathologised but making ourselves feel safer by recreating the foetal position trumps whatever they want to write in our histories.

Others of us will need to act in the opposite way, increasing the escalation of violence. Again if this is the only way we can stay safe so be it. We must survive somehow.

Outside hospital

It can be devastating when misconduct is perpetrated in private rooms, as part of a private clinical relationship, not the least because most of us have loyalty towards or psychiatrist/therapist. In such circumstances we can experience a total destruction of trust.

We are likely to be frightened and confused because this person, who we totally believed was there for us, has shown that they are actually there for him/herself. To walk away from this relationship means we lose the person who is so often the main support in our lives.

Some of us may try to ignore the problem, hoping that everything will go back to normal, but it rarely does. Bullies may use the power differential to make threats; for example, "If you tell then such-and-such will happen."

If you are in this position, it's important that you do not keep this information to yourself. Private patients may wish to contact the Australian Private Consumer and Carer Network, or the Victorian Mental Illness Awareness Council.

See 'where to go for help' below for other options.


Where to go for help

It may feel like it sometimes, but you are not alone!

Below we have outlined some of the places you can go to seek help and/or redress if you have experienced inappropriate behaviour from a clinician.

Different organisations work in different ways and it's worth doing some research before you choose where to go for help. Do you want help getting away? Do you want a clinician struck off the register? Do you want your day in court? Do you want the whole system put under the magnifying glass?

Knowing the answer to the questions above doesn't mean that you'll get what you want, but it does help you clarify who's the best organisation to help or advise you.

Of course, you don't have to do any of these things. We are all individuals and we have the right to follow whatever course (or not) we want. Seek trusted opinions and support, but make up your own mind.

VMIAC

Anyone who has experienced inappropriate behaviour from a mental health clinician (both public and private patients) can contact the peak group for people with mental Illness in Victoria, the Victorian Mental Illness Awareness Council (VMIAC).

VMIAC has a good name amongst consumers for helping us solve all sorts of complicated and personally devastating problems.

VMIAC may be able to link you up with an advocate. The advocate's job is not to do things for you but to be aware of all of the options available to you, as well as the likely consequences of different options.

VMIAC advocates are always consumers themselves, which means you will be able to benefit from their great skill and first-hand experience. A particular result is not guaranteed, but the advocate will be able to walk beside you down which ever path you choose to follow. They won't push you to make any decision you don't want to make.

Complaining to a service

To make an official complaint directly to a service, you should first find the name of the service (try here).

You then need to find the name of the person responsible for the service and to whom you should address your complaint (often to 'the clinical director'). If it's not clear, you can call and ask to whom a complaint should be addressed. You don't have to provide your name or any details.

See the section below for more on how to make an official complaint.

If you are in hospital and you tell someone about inappropriate behaviour by a clinician, you will generally be directed to make an official complaint. Note, though, that there's no reason why you can't do this at the same time as you are taking other action.

The Office of the Chief Psychiatrist

The chief psychiatrist's responsibilities include monitoring the clinical standards of psychiatric practice and treatment provided by public mental health services, and responding to complaints from consumers, carers and others.

Although Victoria's chief psychiatrist may be employed by the same organisation which employs the staff member you are complaining about, she/he is employed to be (amongst other things) an independent arbitrator (in theory at least).

You can contact the Office of the Chief Psychiatrist by calling 1300 767 299, or by writing to the Chief Psychiatrist, Level 17, 50 Lonsdale Street, Melbourne 3000, Victoria, Australia.

Visit http://health.ic.gov.au/chiefpsychiatrist/ for more information about the chief psychiatrist's role.

The Medical Board of Australia

The Medical Board of Australia has the obligation to inquire into every complaint of major boundary violation by a doctor.

They get all the information from both sides and then arbitrate on the matter. Consumer observation of the functioning of these Boards is that they may be hard to penetrate over anything that appears to them to be 'minor' but have as much interest as we do in getting rid of doctors who physically or sexually abuse consumers. You may well find that the clinician you are complaining about is already known to them and your complaint will help to make their case watertight.

You can contact the Board by calling 1300 419 495 or via their website: http://www.medicalboard.gov.au/.

Australian Health Practitioners Regulation Agency

The Australian Health Practitioners Regulation Agency covers compliance issues and non-ethical, non-professional practice across the full range of clinicians who work in mental health, including clinical psychologists, social workers, psychiatric nurses and occupational therapists.

This organisation works in parallel with the Medical Board of Australia and has the same powers but is responsible for non-medical clinicians.

Call 1300 419 495 (ask to speak to a Victorian notifications officer) or visit www.ahpra.gov.au/ to download a Notification Form.

The Health Services Commissioner

The Health Services Commissioner's priority is conciliation - bringing the two parties together to work out their differences.

This can be a difficult ordeal for some of us. Sitting face to face with the perpetrator may be an experience that would not be good for our mental health.

However, if this is an option you'd like to explore, visit www.health.vic.gov.au/hsc/.

The Office of the Public Advocate

The Office of the Public Advocate does not usually play a major role in top-end complaints; if you do contact them they might refer you to other organisations.

However, they do have a complaints mechanism and the Public Advocate does have some powers that may be worth exploring.

Community Visitors

The Office of the Public Advocate also sponsors the Community Visitors scheme in Victoria. This scheme employs people to pay frequent visits to public hospitals, speak to patients and hear complaints which are usually personal in nature.

They have the power to report gross acts of violation straight to the Public Advocate or, with our permission, straight to senior management in the organisation.

Giving permission to the Community Visitor to take our complaint further is something to think seriously about, especially if we are held as an involuntary patient.

Visit www.publicadvocate.vic.gov.au/ to find out more.

Professional bodies

Every association representing a clinical group has an internal mechanism for handling complaints against their members (see the help sheet titled Accreditation & Registration for a listing).

Membership of these organisations is related to registration to practice so they have considerable power, though some consumers believe that they're too "cosy-in-house" (they have an inbuilt loyalty to their members) to be of great use. Nonetheless, none of these associations wants inappropriate behaviour by a member to become public knowledge and they also legitimately don't want rogues amongst their membership.

Police, legal action and Community Legal Centres

It's a crime to assault another person, either physically or sexually, whether it happens in the street or a hospital or in a doctor's consulting rooms.

It is absolutely appropriate to report such behaviour to the police (see a list of contact points here). However, some people find this a difficult course to take; for a variety of reasons, including:

It can be a big decision whether or not to take legal action against a clinician. There are many issues to think about. It might be helpful to speak with a VMIAC advocate (see above) or undertake a few sessions with a counsellor to help you think through whether you are happy to take the incident/s into the public arena and to clarify what you want out of litigation.

You may also wish to consult with Victorian Legal Aid, which will in most cases provide advice and subsidise our legal costs if a case is to be made. Legal Aid coordinates a network of community legal centres, whose aim is to provide the best possible legal advice to those in our community who have the least resources.

With some research it's possible to find some private firms which have an interest in sexual crime and/or mental health. There could be firms known to the CASA network (see below) that have a sliding scale of fees.

In some (rare) cases, your legal advisers may be interested in running a class action, which means a group of people with similar complaints are brought together by solicitors to put up a joint case which might lead to some welcome wider repercussions.

Centre Against Sexual Assault (CASA)

Regardless of whether we have a mental illness or not, we are entitled to use all the community resources available to any citizen in Victoria.

For inappropriate behaviour of a sexual nature, you can contact CASA (the Centre Against Sexual Assault). Phone 1800 806 292 or visit www.casa.org.au/ to find details of local centres around Victoria.

Victorian Human Rights Commission

Another place to consider contacting is the Victorian Human Rights Commission - see http://www.humanrightscommission.vic.gov.au.


How consumers can help

We are all different. Nobody can tell anybody else what to do. Even if we have experienced these awful circumstances personally, we can't know what other people will want to do, or be up to doing, or in what time frame.

What we do (or don't do) when these unthinkable things happen is ultimately our choice. There are all sorts of drivers that may stop someone practicing personal safety, or prevent them from seeking justice or retribution. There are many people that prefer to just 'let it go' and many who don't (or can't). We are all individuals and we have the right to do what WE want, unhindered by others - even by others who believe they are 'helping' us.

As consumers, what we can do is be there for our comrades, particularly if they are being accused by the service or clinician of lying, or their distress is being dismissed as being part of their 'mental illness'. We can believe them.