Licensed Clinical Mental Health Counselors (LCMHCs) play an important role in supporting the mental health needs of individuals across North Carolina. However, this profession faces particular challenges, especially when it comes to legal and ethical issues that can lead to complaints filed against counselors. In this article, I’ll share some important tips and insights drawn from experience working with licensed clinical mental health counselors in the state, focusing on common complaints and how to avoid them.
The Current Landscape for Mental Health Counselors in North Carolina
First, it’s important to recognize that there is a significant shortage of licensed clinical mental health counselors in North Carolina. This shortage places a heavy burden on the professionals currently practicing, as the demand for mental health services continues to grow. More counselors are needed to help alleviate this pressure and provide the necessary care for those struggling with mental health issues.
Given this context, it’s essential that licensed counselors maintain strong professional and ethical standards. Doing so not only protects the counselor but also ensures the safety and well-being of clients who rely on their expertise.
Common Complaints Against Licensed Clinical Mental Health Counselors
1. Custody Disputes and Authority to Provide Care
One of the most frequent sources of complaints against mental health counselors arises during child custody disputes. Licensed clinical mental health counselors often work with children, and when those children are caught in custody battles between parents, the counselor may be called to testify or become involved in legal proceedings.
The key issue often revolves around the question: Who has the legal authority to consent to mental health treatment for the child? In North Carolina, custody involves two distinct concepts:
- Legal custody: The decision-making authority regarding the child’s welfare.
- Physical custody: The amount of time the child spends with each parent.
Licensed counselors need to carefully verify who holds legal custody before providing services. This means asking clear, direct questions during intake, such as:
- Are both parents involved in co-parenting?
- Do the parents live together?
- Is there a custody agreement or court order in place?
A custody agreement is often part of a separation agreement and may not be court-ordered, while a custody order is a formal court ruling. Counselors should request copies of any custody agreements or orders to confirm who has authority to consent to treatment.
Failing to obtain proper consent can lead to complaints because providing care without legal authorization may violate board rules and ethical standards. Taking these steps demonstrates due diligence and helps protect counselors from allegations of misconduct.
2. Reporting Abuse: Mandatory Reporting Requirements
Another significant area where complaints arise involves the reporting of abuse. Licensed clinical mental health counselors in North Carolina are mandated reporters, obligated to report suspected abuse or neglect of children, as well as abuse involving vulnerable adults, such as victims of domestic violence.
If a counselor suspects abuse, they must report it to the appropriate authorities:
- For children: The Department of Social Services (DSS) must be notified.
- For ongoing abuse: Reporting to law enforcement is also recommended.
Some counselors proactively report suspected abuse, following the law “by the book.” However, despite doing everything correctly, counselors sometimes face complaints from upset family members or others involved. These complaints may arise when a parent disagrees with a report or when there are facts unknown to the counselor that complicate the situation.
It’s important to understand that even if a complaint is filed, having documented evidence that the counselor acted responsibly and in compliance with mandatory reporting laws provides a strong defense. Conversely, failure to report suspected abuse is a serious ethics violation and can lead to disciplinary actions.
Protecting clients, especially children, is paramount, and counselors who carefully follow reporting requirements contribute significantly to client safety and well-being.
3. Protecting Client Information and Maintaining Confidentiality
Confidentiality is a cornerstone of mental health counseling, and failure to adequately protect client information is a common source of complaints. Counselors must take robust measures to secure all client data, including intake forms, session notes, and electronic records. Here are some best practices to ensure confidentiality and data security:
- Secure storage: Use encrypted servers or secure cloud storage solutions designed for healthcare data, such as HIPAA-compliant platforms.
- Firewalls and IT support: Work with IT professionals experienced in healthcare privacy to implement firewalls and other security measures.
- Access controls: Limit access to client records to authorized personnel only.
- Telehealth security: Conduct telehealth sessions in private settings, use secure connections, and avoid public or shared networks.
Many counselors may be tempted to use convenient but insecure methods like Dropbox or Google Drive without additional security. This can lead to breaches of confidentiality and complaints. Engaging with IT professionals familiar with healthcare compliance is highly recommended to avoid these pitfalls.
4. The Importance of Detailed Record Keeping and Note Taking
Taking thorough and accurate notes is essential for effective mental health counseling and legal protection. Good record keeping helps counselors track client progress, communicate with other healthcare providers, and respond to any complaints or investigations.
Although it can be challenging to balance note taking with providing attentive care—especially during back-to-back appointments—counselors should develop strategies to maintain documentation without disrupting the therapeutic relationship.
One useful approach is to inform clients at the start of each session that notes will be taken. For example, counselors can say:
“If you don’t hear me talking for a moment, I’m just jotting down some notes to help us in future sessions.”
This sets expectations and reassures clients that note taking is part of providing quality care. Notes should be concise but thorough enough to capture key information, treatment plans, and any concerns, especially when escalating care to other professionals.
5. Maintaining Professional Boundaries and Confidential Spaces
Professionalism extends beyond documentation and includes the environment in which counseling takes place. Licensed clinical mental health counselors must avoid conducting sessions in public or unsecured locations, such as coffee shops or noisy public spaces.
Confidentiality requires private, secure settings where conversations cannot be overheard. This is similar to attorney-client confidentiality standards in the legal profession. Sessions should ideally occur in a dedicated office or telehealth environment that guarantees privacy.
Failing to maintain these boundaries can lead to complaints about confidentiality breaches and unprofessional conduct. Counselors should also ensure that all communication, whether in person, by phone, or via video, complies with HIPAA regulations.
Additional Tips for Licensed Clinical Mental Health Counselors
- Verify custody and consent: Always confirm legal authority before providing services to minors.
- Report suspected abuse promptly: Follow mandatory reporting laws carefully and document your actions.
- Secure client data: Use HIPAA-compliant technology and consult IT experts to safeguard information.
- Take detailed notes: Develop a note-taking routine that balances client care with accurate record keeping.
- Maintain confidentiality at all times: Conduct sessions in private, secure settings and avoid public spaces.
Conclusion: Supporting Mental Health Counselors While Protecting Clients
The work of licensed clinical mental health counselors in North Carolina is both demanding and indispensable. Given the shortage of counselors in the state, it’s more important than ever to uphold the highest standards of care and professionalism to protect both clients and counselors alike.
By understanding common sources of complaints—such as custody disputes, mandatory reporting, confidentiality breaches, and poor record keeping—counselors can take proactive steps to reduce risk and enhance their practice. These practices not only safeguard counselors from disciplinary action but also ensure that clients receive the best possible care in a safe and respectful environment.
To all the licensed clinical mental health counselors working tirelessly in North Carolina: thank you for the vital service you provide. Your commitment to protecting and supporting clients, especially children and vulnerable populations, makes a real difference in our communities.
If you are a counselor seeking further guidance or have questions about professional responsibilities and complaint prevention, consider consulting with legal experts familiar with mental health law and ethics. Proper advice and preparation can help you navigate complex situations with confidence.
*Nothing in this blog establishes an attorney-client relationship. Nothing in this blog is legal advice. If you have any questions, please check out our other blogs and our Youtube channel. You can also call us at 919-521-8810 with questions.