Private mental health practices frequently use restrictive employment contracts that treat patients as proprietary assets rather than autonomous individuals, often without patient knowledge or consent. Sarah Cady, a psychiatric nurse practitioner in New York, encountered a contract clause requiring her to pay a practice $7,500 for every patient who chose to continue treatment with her if she left. When she questioned the clause, she was told bluntly: “The practice owns the patients. You do not.”
Such contracts commonly include non-solicitation and non-compete clauses that restrict clinicians from informing departing patients about leaving, prohibit patients from following trusted providers, and impose financial penalties for maintaining continuity of care. Patients never see these agreements and only experience their consequences when a provider disappears and their continuity of care is disrupted.
The impact is especially significant in mental health, where therapeutic relationships built on trust and vulnerability are themselves clinical. Disrupting these relationships for contractual or financial purposes carries real clinical risks, including relapse, retraumatization, destabilization, and disengagement from care. This is particularly harmful for patients with serious mental illness, trauma histories, addiction, or significant psychosocial instability, who are not interchangeable accounts.
These contracts violate core ethical principles. They threaten autonomy because patients cannot meaningfully choose their care providers; they undermine beneficence and non-maleficence because continuity is jeopardized; and they erode justice because vulnerable patients are harmed most. While healthcare typically requires transparency when financial incentives influence treatment, powerful legal agreements determining access to care remain invisible to patients.
Cady argues that if mental health care is truly patient-centered, it cannot conceal the contractual rules governing whether patients can remain with their clinician. At minimum, patients deserve disclosure about whether they may follow their provider, whether financial penalties exist, and whether restrictive covenants prioritize revenue control over continuity. “If a practice truly believes it ‘owns’ the people it treats, the very least it can do is say so out loud—to patients, as plainly as it said it to me.”
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.statnews.com/2026/04/27/mental-health-employment-contracts-proprietary-non-compete-non-solicitation/