Suggested Principles for the Reform of ISMHO: Ethical and Competent Management

What Inspired These Suggested Principles?

I’ve been moved to offer these suggested principles by my punishment at the hands of the ISMHO for publishing evidence that one of their board members behaved unethically (“Online Therapist Avoids Censure Over Breach of Client Confidentiality”). Contrary to the personal attacks and insinuations launched by some within the ISMHO ‘old guard’ as a reaction to my publication of this evidence, I had no quarrel with ISMHO itself, nor any particular axe to grind. All I wanted was for the truth to be told, and perhaps — if the ISMHO could manage it — for a civil discussion of the events to take place, from which we might all learn something. Unfortunately, the ISMHO board moved swiftly to crush discussion of the matter and ’shoot the messenger’, so it doesn’t appear — from my perspective, now on the outside of the organization — that the ISMHO board wants anyone to learn anything at all from the events.

However, I have learned a thing or two from how the ISMHO board moved to protect its own, and I now offer the following suggested principles, in good faith, as examples of reforms which I genuinely believe would raise the standard of ethical and competent management within the organization.

These principles are informed not just by my recent experience observing how the ISMHO board handled ethical challenges within its own ranks, but also by several years of activity within the ISMHO membership and a greater volume of actual online clinical experience than most (perhaps all) of the ISMHO board.

Suggested Principle 1: Establish Ethics Procedures

Current ISMHO Standard

The International Society for Mental Health Online currently lacks any published ethics procedures or complaints procedures. When encountering a potential ethical problem, the ISMHO board currently is forced to make it up as they go along; this may mean that they decline to consider any evidence, that they insert themselves into an ethics situation without invitation or adequate preparation, or that they enforce punitive punishments against members without due process.

Suggested ISMHO Principle

The ISMHO should draft, discuss, and then follow a basic framework for handling complaints and/or alleged instances of unethical behaviour. If the ISMHO board is not prepared to specify in advance the standards by which they will handle complaints or alleged instances of unethical behaviour, then they should instead commit in advance not to involve themselves in such matters at all and instead to refer such matters to more qualified professional bodies.

Suggested Principle 2: Prohibit Knowingly Acting Under Conflicts of Interest

Current ISMHO Standard

Currently, the ISMHO lacks any agreed ethical or procedural framework for ISMHO board deliberations. In the absence of any framework for handling board business ethically and prohibiting ISMHO board members from knowingly acting under conflicts of interest, ISMHO board members have declined to recuse themselves from deliberations about alleged ethical violations in which they themselves were involved. In other words, ISMHO board members have taken responsibility for delivering official judgements about the ethics of their own behaviour.

Suggested ISMHO Principle

Draft and enforce ethical guidelines governing ISMHO board procedures which require, at a minimum, that ISMHO board members will recuse themselves from involvement in board deliberations in which they would knowingly be acting under a conflict of interest.

Suggested Principle 3: Deliver Board Accountability

Current ISMHO Standard

Currently, the ISMHO board undertakes any number of ‘closed door’ (i.e., secret) deliberations each year, without informing the ISMHO membership. On those occasions that the board does inform the ISMHO membership of the outcome of such processes, the actual voting records of individual board members are not shared. Much to the consternation of other members who have long complained about the ‘closed door’ policy of the ISMHO board, this behaviour is long-running and is not by any means limited to the board’s recent gagging order regarding evidence of unethical behaviour within their own ranks. As a result of the closed door attitude, no independent oversight of ISMHO board activities exists or can be enforced by the ISMHO membership. During closed door deliberations, no accountability for the behaviour of individual board members exists, because no information is shared about those individual board members’ activities.

Suggested ISMHO Principle

Publish (to the ISMHO membership) minutes of all activities undertaken by the board, including voting records for all formal decisions made by the board. If it is too onerous for the organization’s secretary to summarize board activities and voting records for the ISMHO membership, verbatim records of ISMHO board communications should be made available to ISMHO members.

Suggested Principle 4: Limit Cronyism and Consecutive ISMHO Board Terms

Current ISMHO Standard

Several members have returned over and over again to the ISMHO board, either in the same or different offices. During its 7 or 8 years of existence (as of 2005), a total of just 27 different people have filled the organization’s 10 board posts. Many have continued to cement their influence over the organization for many years by holding different offices consecutively on the ISMHO board; many have been appointed repeatedly by the board to fill key committee positions in addition to their board roles. Notably, the active membership of ISMHO — in terms of the number of people who vote in elections — is usually around 3 dozen. Of that 3 dozen who vote in elections, 10 are board members. To put it differently, most of the people who vote are either on the board or trying to get on the board.

Suggested ISMHO Principle

Limit ISMHO board members to just 1 consecutive term of 3 years and prohibit the repeated return of board members via the route of simply running for a different office after their existing term expires. The ISMHO should work to help develop more than 27 people qualified to fill the organization’s 10 management positions over a period of 7 or 8 years. Committee positions should likewise be limited to 1 consecutive term.

Suggested Principle 5: Commit to Evidence-Based Procedures

Current ISMHO Standard

The ISMHO board is currently under no obligation to conduct board business or deliver board judgements on the basis of available evidence. In the example cited above regarding unethical behaviour, the board refused to consider available evidence and instead delivered its judgement based upon the protestations of a fellow board member. (Also see Suggested Principle 2, on conflicts of interest.)

Suggested ISMHO Principle

Commit to evidence-based procedures for all board business. In practice, this should mean that where evidence is known to exist, the ISMHO board should take it into account.

Suggested Principle 6: Prioritize Consumer Interests First, Personal and Organizational Interests Second

Current ISMHO Standard

The ISMHO board’s decision to expel the whistleblower who published evidence of unethical behaviour by a board member was made explicitly on the grounds that the individual acted contrary to the interests of ISMHO (see “When Mental Health Professionals Cover for Each Other”); the interests of the field or of the general public were not even mentioned in the board’s dictum.

Suggested ISMHO Principle

Make it an explicit requirement that the ISMHO board should act in the interests of the field of mental health and in the interests of the general public, treating their own professional interests and those of the organization itself as secondary. Unless the priorities between these interests are made explicit in advance, then when occasions arise in which they may not be completely aligned, the board will remain unaccountable for how they choose to prioritize.

Suggested Principle 7: Demonstrate Leadership in Ethical Marketing

Current ISMHO Standard

Several ISMHO board members actively promote their online mental health experience — both to their ISMHO peers and to the general public — by citing their number of years in the field. The lack of transparency and ethical murkiness which is perpetuated by this disingenuous marketing practice (see our separate articles on “How Much Online Therapy Really Goes On? Part 1”) may have contributed to the ISMHO’s ruthless reaction to cover up the actual facts about recent mistakes with client confidentiality and informed consent. Those who have marketed themselves in part via an image of great online mental health experience have all the more to lose when the harsh light of reality conflicts with that marketing message.

Suggested ISMHO Principle

ISMHO should demonstrate leadership — or at least try to catch up — in establishing standards of honesty and transparency in representing experience as an online mental health professional, and publish guidelines regarding the truthful representation and marketing of members’ experience as online professionals. Our articles mentioned above, which explore the ethical territory surrounding claims about online mental health experience (“How Much Online Therapy Really Goes On? Part 1”), would make a worthwhile starting point to which ISMHO may be able to add something.