On Why We Shouldn't Embrace the Concept of Referral Fees

Besides the fact that it is unethical for counselors specifically to do so, there are many very good reasons why we should not embrace an idea that is often used in sales and in other industries.

To be more specific…I am thinking about the reasons why we should not promote affiliate programs or use our status as an affiliate in our recommendations to our clients.

What is an affiliate program you wonder? It is when a business offers a program for customers or colleagues to receive discounts or some other compensation for referring (paying) customers.

Like many people, I participate in personal development programs. Some of these programs are offered by coaches or other personal development providers. The topics generally include things like:

well-being,
relationships,
nutrition,
money,
spirituality,
and time management/organization.

Some of these programs make offers to their customers to become affiliates. If I participated, I would be given a code to share with others. Anytime I refer someone who then makes a purchase and enters my code, I would receive a discount on future purchases or earn points or some form of incentive for the referral.

While there is nothing inherently evil about the programs (a little hyperbole), my concern is the idea that this could be embraced as something that should be allowed to proliferate into the mental health profession.

I think referring to other professionals is one of the trickiest and least discussed tasks we perform as Clinicians.

In general, we have a responsibility to make our referrals in the best interests of our clients. The primary considerations for effective referrals are or should be as follows:

the client’s resources (income, insurance, intellectual ability, transportation);
their location;
the competency of the potential provider and the appropriateness of their niche;
and our own knowledge of the services and character of the provider being offered as a referral.

I have a series of steps that I take as a matter of course.

To provide 2 to 3 options whenever possible.
To offer the information in writing.
To try to insure that the contact information is correct.
To offer assurance that I will provide additional recommendations if for some reason the referrals I provided don’t work out.

I think it is vital to the success of the referral that we metaphorically have a gentle guiding hand on the client’s shoulder, ushering them to “not give up”… reminding them that they were right to reach out and that they will find the support they need.

While I am not personally induced or persuaded to refer for incentives, I believe there is a marketing culture around us that supports this practice. While it may be totally fine and quite enlivening in other fields, it is inherently problematic in mental health.

The referral process I’m describing is more challenging when it comes to inpatient, hospitalization or rehabilitation services. Only because it is difficult to vet settings where there are numerous providers engaged in the services provided. What we can learn over time is the reputation of an organization within the community it serves.

We can also talk with other trusted colleagues who may have more information about the system or institution we plan to recommend.

However, when it comes to private outpatient therapy practices, we have an opportunity to recommend the best possible for the intended client (within their resources, location etc…).

So why should we go through so many considerations when it comes to referrals?

I always ask myself the question “Would I send my loved one there?” If the answer is “no” then that provider is not on my referral list until the answer is a definitive “yes.”

So in consideration of effective and clinically sound referrals, I believe it comes back to the moral principles:

“do no harm,”
“promote good,”
and “be faithful and trustworthy.”

Also known as:

non-maleficence
beneficence
and fidelity

If someone referred me for a health service and I learned later that they got paid for it, I would be left to wonder, “Was this recommendation in my best interest or theirs?”

This writing is in large part an extension of my previous post on “Using Ethical Practices in Mental Health Marketing and Advertising.”

Thanks for the great questions and comments on Linkedin and via e-mail for those of you on my list … keep them coming. Share further thoughts on Linkedin, Facebook, Twitter or log in to one of your accounts below to comment.