My colleague, Bonnie Goetz, MA, LPC, NCC  wrote in on the Denver Therapists Network online discussion list asking for help .  Having just had this conversation earlier this year in my Peer Consultation and Supervision Group, I asked her if I might address it here on my blog so that others can join the discussion.

Here’s what Bonnie wrote . . . .

I am wondering if anyone out there . . . has found a good way to offer the mandated 24/7 coverage other than being constantly strapped to a cell phone? I know some people use answering services, but from what I understand the service would call the therapist directly in case of emergency anyways.

I would really like to be able to turn off my cell phone at the end of the day, but have not been able to figure out a way to do this and still be in compliance with my [insurance] contracts. Generally I handle this by not taking clients who have high needs between sessions, but I still get the occasional call from people on the weekends or evenings, and I hate checking my phone all the time!

Any thoughts or suggestions would be greatly appreciated!”

Yep, I have a few thoughts and suggestions, Bonnie.  Acts of omission, such as not returning phone calls in a timely manner, are definitely grounds for a malpractice suit.  I’ve heard attorney Bart Bernstein, J.D., LMSW refer to this particular situation many times in his workshops on ethics and counseling.  The example he gives is this . . . .  If a client calls you and gets your answering service or, worse yet, gets an unanswered phone . . . and you as his therapist are the only person the client feels like he can talk to about a particular issue / crisis . . . and you fail to return the phone call in a timely manner i.e. within 24 hours . . . , you have, in effect, abandoned your client.

That’s why your question, Bonnie, is such an important one.  Some therapists believe in error that being available 24 / 7 is stipulated by a particular managed care company.  And, while that may be true, the bigger picture is that your professional associations, your licensing board, and your state laws are also likely to be requiring the same thing – that licensed mental health professionals must respond and be available to clients in a timely manner.

For those reasons, here’s a few of the ways that you can responsibly, ethically, and legally take care of your clients’ needs while also taking care of your own needs, too.

1. Trade off with another trusted colleague.
2. Use a professional answering service.
3. Hire a virtual assistant or office manager to manage the initial contact with your callers.
4. Consider using a paging system.
5. Forward calls to another licensed mental health professional.
6. Create a call group of licensed mental health professionals.
7. Provide a code word for clients to use when they call in case of a crisis.

Or, you can choose to cover your own phone calls 24 / 7.  Just remember that you are ultimately responsible for that coverage.  If you have someone else covering for you, make sure that s/he is competent and trustworthy.  Your clients’ lives, your own reputation, and your own licenses are on the line.

If you have found other ways to meet your clients’ needs 24 / 7, I hope you will take a moment to share with us here!