Behavioral health providers, from substance abuse treatment to applied behavior analysis (ABA), face some common industry-specific risks. Understanding your behavioral health facility risks and implementing strategies to mitigate them is essential, whether you run a small practice or a larger, multi-location facility.
According to Jeff Schmidt, an executive producer at HUB International, the following are some of the most common behavioral health facility risks.
- Staff shortages and high turnover are common in this industry, which increases your risk for liability claims
- Violence or aggression from patients’ behavioral diagnoses that lead them to harm themselves or others while under your care
- Staff abuse allegations
- Auto accidents while transporting clients
“Compared to other facilities, like senior living, behavioral health facility claims frequency tends to be lower, but the severity of the claims is often just as high,” says Schmidt.
Schmidt has even seen more serious incidents involving a death claim when a group home client left the facility and ran into traffic.
Schmidt offers advice after years of advising behavioral health facilities on reducing risks.
The reality of claims: Not if but when
Regardless of the size of your behavioral health practice, the possibility of a claim is not a question of “if” but “when,” says Schmidt. Even a small practice with a single location can be at risk. “You might be in business for 10 years without any claims, but when the lawsuit does come, it tends to be pretty ugly,” says Schmidt.
Tip: Do your best to mitigate risks, but remain prepared for the possibility of being named in a lawsuit eventually.
Navigate rapid growth with caution
Many behavioral health providers, particularly in areas like ABA and substance abuse treatment, can access state and federal reimbursements that facilitate rapid business growth.
This potential for rapid growth has obvious pitfalls, such as quickly hiring staff without proper vetting and training. “It’s typical to experience a lot of management difficulty when you’re scaling rapidly. That sudden growth can result in an uptick in claims. Make sure your processes, procedures and training are dialed in as they should be,” says Schmidt.
Tip: If you are experiencing rapid growth, be sure to get support to scale your business properly and avoid hiring challenges.
Establish clear protocols to manage volatile patients
There’s been a steady increase in patient aggression and violence in healthcare settings, in general, and among behavioral health patients in particular. A volatile patient who injures himself or others can cause an allegation and claim.
Behavioral health providers must establish clear protocols to assess patient behavior and handle difficult situations. This can include staff training on de-escalation and a system of staff support to prevent incidents from escalating into claims.
Maintaining thorough and accurate records is crucial in these incidents. “When a lawsuit arises, the worst scenario is when you can’t produce clear patient care records. This makes it a pretty easy case for the plaintiff to win,” says Schmidt.
Tip: When an incident occurs, document what happened and how your staff responded according to protocol. Proper documentation is your best defense in legal situations.
Notify your insurance carrier if a claim may arise.
Be sure your whole team is insured
When reviewing your professional liability policy, check the definition of “insured” to determine whether it applies exclusively to mid-level providers or covers psychiatrists and physicians. The policy might often only include mid-level practitioners, leaving others, like the facility’s medical director, unprotected.
Tip: To ensure comprehensive coverage, you may need to schedule all staff roles on the policy separately.
Avoid one-on-one interactions with patients
Abuse claims in behavioral health settings are not uncommon and almost always lead to a lawsuit. Legal fees can quickly get out of hand even if the claim is unsubstantiated. “These cases don’t settle quickly, leading to dozens, if not hundreds, of billable hours, making defense costs very high even when a case is unfounded,” says Schmidt.
Schmidt recommends avoiding being alone with clients when you’re working with vulnerable populations, such as minors or individuals with mental illness. Instead, conduct sessions in the presence of another staff member or a group setting. “When it’s your word against theirs, that’s very difficult to defend,” says Schmidt.
Tip: Be sure abuse and molestation liability coverage is included in your professional liability insurance policy. Consider increasing your limit even higher than the minimum amount included.
Maintain HIPAA compliance
Ensuring strict HIPAA compliance is non-negotiable. While cyber liability insurance can cover breaches, your first line of defense should be robust security protocols and regular staff training on handling sensitive information.
Tip: Staff training can help you avoid a HIPAA violation. A comprehensive cyber liability policy protects you if there is a system breach. an employee breaches protocol.
Be sure you’re covered for telehealth
Telehealth has been a game-changer for behavioral health services, allowing practices to expand their reach and more patients to easily access support. However, telehealth may not be covered under your policy unless specifically scheduled or endorsed onto the policy.
Tip: Be sure to inform their insurance agent when starting telehealth operations so you don’t have coverage gaps.
Institute clear protocols for addressing suicide risk and patient harm
Behavioral health services naturally involve higher-risk clients who may have suicidal ideation, self-harm tendencies or a risk of harming others. It’s important to have robust risk management protocols, including data-driven screening tools, proper documentation, robust staff training and crisis intervention plans.
Strong risk management practices, from clear documentation to comprehensive staff training and proactive crisis management, can help mitigate behavioral health risks. With the best practices and protocols, behavioral health providers can focus on what they do best — delivering quality care to their clients — while safeguarding the practice against unforeseen legal challenges.
Learn more about CM&F Group’s professional liability insurance for behavioral health facilities. CM&F offers professional liability insurance to over 150 types of healthcare professionals. All our coverage options are available online, allowing our clients to obtain liability insurance coverage within minutes.
