From colleague to patient: ethical challenges in integrated primary care

Ethical codes and guidelines for mental health professionals focus on traditional avenues of practice, leaving considerable gaps for clinicians in unique settings, such as behavioral health providers in integrated primary care. In this article, an ethical scenario is presented, where a behavioral health provider is faced with a colleague physician seeking assistance for emotional distress. The scenario highlights important ethical questions about multiple relationships/conflict of interest, impaired colleagues, informed consent, and confidentiality. We review gaps in ethical guidance pertinent to the scenario and provide an eight-step rubric for ethical clinical decision making in integrated primary care.