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Counselling by text message (09HDC01409)

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(09HDC01409, 24 May 2010)

Counsellor ~ Mental health team ~ District health board ~ Depression ~ Text message ~ Medication ~ Standard of care ~ Co-operation among providers ~ No suicide contracts ~ Rights 4(1), 4(5)

The mother of an 18-year-old man who committed suicide complained that a counsellor (a) told her son not to take medication, and (b) requested through her son that she also undergo counselling.

The young man had seen a psychotherapist, who diagnosed him as schizophrenic/psychotic and urgently referred him to a youth mental health team. Prior to his appointment with the mental health team, his mother took him to a counsellor, who had been recommended by a friend. The counsellor took a brief history, which did not include his drug use, and wrote out a brief "no suicide" contract. She gave the only copy of the contract to him, as her photocopier was not working. She diagnosed him with depression/grief and identity issues. She gave him the contact details of another counsellor and asked him to tell his mother that she should also undergo counselling as part of his treatment. The young man's mother subsequently contacted the counsellor and advised her that her son was under the care of the youth mental health team.

The community mental health team prescribed him with an antipsychotic medication and referred him to an Early Psychosis Intervention Team. The young man continued to be in contact with the counsellor by text message and asked whether he should take his medication. She told him by text message not to take his medication provided he was undergoing regular counselling. The young man became increasingly depressed, and committed suicide.

It was held that the counsellor breached Right 4(1) by using text messages to give advice concerning medication, without seeing the young man and consulting with other providers. Her failure to consult with others regarding the man's care was a breach of Right 4(5).

This case particularly highlights the importance of consulting other health professionals working with a consumer, the dangers of providing advice by text message, and the risks associated with no suicide contracts.