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Book Forum: FORENSIC PSYCHIATRY   |    
The Portable Lawyer for Mental Health Professionals: An A–Z Guide to Protecting Your Clients, Your Practice, and Yourself
GREGORY B. LEONG, M.D.
Am J Psychiatry 1999;156:965-965.
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by Barton E. Bernstein, J.D., L.M.S.W., and Thomas L. Hartsell, Jr., J.D. New York, John Wiley & Sons, 1998, 274 pp., $39.95.

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Attorneys Barton Bernstein and Thomas Hartsell set out to provide a quick and ready reference to legal and ethical issues faced by mental health professionals of all disciplines. They secondarily hope that their book will serve as a resource for mental health consumers. Although part of the subtitle, "An A–Z Guide," conjures up a reference in which the reader could readily locate a topic alphabetically, the authors instead divide the book along more traditional lines into nine general topical areas: Clinical Records, Confidentiality, Contracts, Fees, Forensic Issues, Practice Models, Malpractice, Managed Care, and Teamwork. Each of these general topic areas is further subdivided into specific topics, which make up the book’s 32 separate chapters. Nearly every chapter opens with one or more interesting vignettes serving as affectively charged, thought-provoking introductions to the material. In each chapter, margin notes provide highlights of the text. At the end of nearly all the chapters, a "Legal Lightbulb" section lists the chapter’s important points.

The book clearly applies a legalistic perspective. The authors provide the disclaimer that their work is educational and not authoritative, and readers are advised to consult their own attorneys. The authors repeat this advice throughout the book, but they do not seem to place enough emphasis on the importance of associating with an attorney who is well versed in mental health practice and law.

The book’s legalistic view paves the way for dissemination of crucial information in dealing with aspects of mental health practice that are far afield from direct clinical practice. The chapters in the Practice Models section are useful guideposts to setting up clinical practice, especially for the uninitiated. These issues are often neglected during residency training. The four appendixes at the end of the book contain illustrative examples of documents associated with the establishment of an independent practice association, partnership, professional corporation, and general corporation. Chapters on "Third Party Payers," "Capitation Agreements," "Gag Rules," "Sliding Fee Scales," and "Recovering Unpaid Fees" provide further practical information about these often contentious matters. For example, the authors outline the dangers of "hold-harmless" clauses and the potential for fraud accusations when deviating from a fee schedule. The authors aptly observe that, in disputes, only the attorneys benefit.

This book is a valurable resource for a variety of other cogent practice-related topics. The chapter on "Electronic Records," in view of the widespread professional use of computers, the Internet, facsimile machines, and answering machines, has current relevance. The chapter on "Acts of Commission" warns the reader about malpractice that arises primarily from boundary and other ethical violations. Ethical violations are an area of increasing concern for mental health professionals.

What is useful about this book, its legalistic approach, is also its drawback. For example, in the "Discharges and Termination" chapter, the authors advocate, in addition to a termination meeting, the use of termination letters, particularly for patients who fail to come to scheduled appointments and who cannot be contacted by phone. They further suggest that both a regular and a certified letter be sent to inform the patient that treatment needs to be continued and providing a list of potential treaters. Even with this advice, they neglect to help those of us who labor in the public sector, where the additional cost of a certified letter would not be budgeted and there are no other referral options. Other shortcomings of the book are the limited reference list and a few typographical errors, including the legal citation to the Tarasoff case (p. 159).

In summary, this book would be particularly useful for those psychiatrists who have minimal or no legal knowledge or who are mystified by the law concerning mental health practice. Although it paints a frightening picture of the legal ramifications of clinical practice, this book can also serve as a vehicle to moderate these fears.

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