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Eye on Ethics

The Dark Side of Social Work: Ethical Misconduct
By Frederic G. Reamer, PhD
May 17, 2012

Let’s begin with the good news: Very few social workers engage in ethical misconduct. Nearly all social workers are honorable, dedicated, and principled practitioners who would never knowingly harm clients or the public at large. With relatively few exceptions, social workers care deeply about their clients’ well-being and uphold the public’s trust.

Sadly, during social work’s history, some practitioners have crossed the line and caused great harm, as illustrated by these situations:

• Recently, a Pennsylvania social worker was convicted in state court of involuntary manslaughter, child endangerment, reckless endangerment, perjury, criminal conspiracy, and forgery. This tragic case involved the death of a 14-year-old Philadelphia girl with cerebral palsy whose care was entrusted to the social worker’s behavioral health agency, which had a contract with the city department of human services to provide the child with in-home services. The social worker is also serving a 17 1/2-year federal prison term for healthcare fraud.

• A Michigan social worker employed by a well-known teaching hospital provided clinical services to brain-injured patients. He was convicted of sexually molesting a patient and is currently serving a sentence in state prison.

• A Louisiana social worker is serving a 15-month federal prison sentence for defrauding the Medicare program by submitting fraudulent claims for psychotherapy services that were never provided.

Sadly, this is but a partial list of professionally educated social workers who have engaged in egregious ethical misconduct.

The Nature of Ethical Misconduct
Social work is not alone; national headlines reveal a disturbing array of ethical misconduct involving physicians, clergy, teachers, lawyers, nurses, dentists, psychologists, mental health counselors, and drug and alcohol treatment professionals convicted of fraud, sexual misconduct, misappropriation of funds, and murder.

Understandably, the social work profession needs to know why a small percentage of their colleagues head down this untoward and blatantly destructive path; there is, of course, no simple, one-size-fits-all explanation for such misconduct. The reasons are remarkably complex. As with social workers’ clients who engage in harmful, sometimes self-destructive, behavior, the causes are diverse. In my experience as a consultant and expert witness in cases involving social worker misconduct, there are several prominent themes, as follows:

• Desperation: Some social workers in difficult financial straits seek to remedy their predicament through fraud or other illegal activity, such as drug dealing or submitting false insurance claims using documentation for services never provided to actual or bogus clients. Some of these social workers face personal bankruptcy because of lavish lifestyles or costly personal crises (e.g., illness that has led to a drastic loss of income and excessive debt).

• Greed: Some social workers are motivated by greed more than desperation. This group includes social workers who seek a level of affluence well outside the reach of most practitioners. This greed may lead social workers to engage in fraud designed to enhance revenue. In one case. a social worker embellished DSM codes on a client’s insurance claim to increase reimbursement. In another case, a social worker billed for clinical services on dates when no services were provided.

• Impairment: Social workers, like all professionals, may experience personal impairment that may lead to ethical misconduct. In one instance, a social worker in recovery from substance abuse relapsed and became involved in an ambitious drug dealing operation to support his drug use. In another case, a mental health practitioner who had been diagnosed with bipolar disorder stopped taking his medication, became embroiled in a rage-filled interpersonal dispute while in the midst of a manic episode, and committed second-degree murder.

The most common forms of social worker impairment include major mental illness, addiction (including addiction to substances, sex, and gambling), and professional burnout that leads to ethical misbehavior (e.g., a social worker who feels demoralized about work and is struggling in a troubled marriage throws caution to the wind and becomes involved in a sexual relationship with a client in an unwitting effort to distract himself from his troubles or to feel desirable and powerful).

Preventing Ethical Misbehavior
Social workers can take constructive steps to respond to and, especially, prevent unethical conduct. We must pay close attention to “red flags” in our own lives that might portend impairment and ethical misconduct. Social workers are trained to master our use-of-self skills, including constant reflection on the way we manage ourselves in relationships with clients and workplace colleagues. Social workers who are grappling with personal crises, intense workplace frustration, serious and chronic physical and mental health issues, and troubling legal and financial problems are at greater risk. As it may be very challenging for social workers to acknowledge personal struggles and reach out for help, each practitioner is wise to refer back to the mandates in the NASW Code of Ethics as a guide, as follow:

• Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility (standard 4.05[a]).

• Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others (standard 4.05[b]).

In addition, social workers must pay keen attention to signs of unethical conduct and impairment within ourselves and among our colleagues. The Code of Ethics also makes it clear that, when feasible, social workers have a moral obligation to reach out to colleagues who show signs of impairment or who are behaving unethically. When necessary, social workers must bring their concerns to the attention of people and organizations that are in a position to support social workers and hold them accountable. These may include supervisors, agency administrators, colleague assistance programs and, in extreme cases, licensing boards and regulatory bodies (see standards 2.09[a,b] and 2.11[a-d]).

Social work is a uniquely noble pursuit that clearly attracts extraordinarily compassionate, earnest, and principled practitioners. The unfortunate reality, shared by all professions, that some social workers—thankfully a very small minority—engage in profoundly unethical conduct should not detract from what we know to be true: that the overwhelming majority of social workers give meaning to the word integrity. A critical element of that integrity is a willingness and determination to confront and prevent unethical conduct in our ranks.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.