Ethical Considerations in Referrals to Mental Health Agencies

You are a diligent school counselor working with numerous students each day. One student in particular has become a frequent flyer and you are becoming more concerned about the student’s mental health each time you talk. So, when and how do you decide when a referral to an outside community mental health agency is warranted for this student?

Professional judgment and discernment are needed to make this decision.  Ethically, a referral to outside therapy is usually warranted when:

• the student’s presenting problems require us to go beyond our professional guideline of three to five visits
• needs exceed the scope of your expertise
• issues require a long-term therapy approach
• school interventions are not working or helping
• the family needs to be part of the therapy
• the student is overly emotional and has a difficult time regrouping to return to class after visiting your office
• the student needs more privacy than you can provide at the school
• diagnostic evaluations or medication may be necessary
• very specialized group or individual therapy is needed

When referring to outside therapy resources and agencies, you should always follow the American School Counselor Association (ASCA) Ethical Standards for appropriate referrals and advocacy, and follow your school district's policies and procedures for making referrals. These policies will guide you to a standard list of agencies the district provides or a list you maintain to provide referrals on you own. Keep your referral list current and relevant, and vet the outside providers on your list. Best practice is to provide the student/family with at least three appropriate options from the list of outside referral resources. Avoid recommending or endorsing only one individual or agency. Assist parents/guardians in advocating for their child by encouraging them to contact several of the referrals you have provided in order to make a well-informed choice. A strong therapeutic match will increase the likelihood that the therapy will be successful.

Working hand-in-hand with the student and their parents/guardians will go a long way to ensuring the transition to another counseling professional goes smoothly. It might also help to consult or share information with the outside agency, but you must have a signed release of information form from the student/parent/guardian in order to do this. Discuss this option with them and follow your school district’s policies for obtaining a release of information that allows you to release information to and/or obtain information from the individual or agency working with the student. 

Finally, follow up with the student and parent/guardian to continue to support your student and get feedback about the referral agency they utilized. Maintain a supportive relationship with the student – they trust you and count on you for many other things at school. This student may change from being a frequent flyer to wanting an occasional check-in. Follow the student’s lead when determining how your support will look moving forward.