ClinicalWill.app

What is a Clinical Will, and do I need one?

What is a Clinical Will?

A Clinical Will is a set of instructions made by a therapist, counsellor or coach for what will happen to their practice in the event that they are no longer able to work due to sudden illness or death. As a minimum, it lays out how clients can be contacted and supported if a practitioner is unable to do so themselves. Additionally, a Clinical Will might also include details of other people or organisations related to a practitioner’s business that might need to be notified.

Importantly, the requirement is not only to make sure clients are notified if their therapist or counsellor is taken ill or dies, but that any contact is made by an appropriate person and takes place within the limits of clinical confidentiality. This person, usually known as a Clinical Trustee, might also help clients think about finding a new therapist, or simply support them in coming to terms with an unplanned end to their therapy. Therefore, the person we appoint to contact our clients on our behalf is usually a trusted colleague.

Why do I need a Clinical Will?

Imagine a client coming to a session to find that their therapist isn’t there. No one answers the door. They have a phone number or email address they can use to contact their therapist, but there is no reply. A few days later, they still haven’t heard from their therapist. The client is in the dark and unsure about whether to come for their next session, or even whether the therapy will continue.

What the client doesn’t know is that their therapist was taken ill suddenly and won’t be able to contact their clients until they recover. This really happens, or worse; therapists, like all people, sometimes die unexpectedly. In cases like these, clients are left unsupported and likely worried or distressed about what might have happened to their therapist. Often, the only person who knows where to find a comprehensive list of client contact details is the practitioner themselves.

Ethical practice is the foundation of our work as therapists, counsellors and coaches, and is based on our commitment to always act in the best interests of our clients. As part of our duty of care towards our clients, we have to consider what will happen in the event that we are suddenly unable to carry on working with them. For many clients, an unexpected or unexplained ending in the therapeutic process might be disturbing or damaging. For these reasons, Clinical Wills are explicitly mandated in the ethical frameworks of all major professional membership organisations such as the BACP, UKCP and BPC, as well as many training organisations.

A separate function of a Clinical Will is to reduce the administrative and emotional burden on family or friends if we fall ill or die, especially as they may be anxious or grieving, or preoccupied with other duties relating to our illness or death. In the same way that we take our ethical responsibilities seriously as practitioners, we should also consider how to minimise the impact of our illness or death on those closest to us - a Clinical Will helps do this.

What do the BACP, UKCP, BABCP and BPC specifically say about Clinical Wills?

In the event of death or illness of sufficient severity to prevent the practitioner communicating directly with clients, we will have appointed someone to communicate with clients and support them in making alternative arrangements where this is desired. The person undertaking this work will be bound by the confidentiality agreed between the practitioner and client, and will usually be a trusted colleague, a specially appointed trustee or a supervisor.
BACP Code of Ethics and Professional Practice

As a practitioner you must... have arrangements in place for informing clients and, where appropriate, providing them with support in the event of your illness or death.
UKCP Code of Ethics and Professional Practice

You must have a process in place to ensure that appropriate action will be taken if you were to unexpectedly become unavailable, for example, due to serious illness, death, suspension or dismissal. This is usually referred to as having a ‘clinical will’. Arrangements include identifying who will be responsible for informing and arranging support for your clients if you are suddenly unavailable, and ensure that any other relevant person or organisation such as a referring agency is also informed. Employers may have a policy to make sure that this happens, independent practitioners must arrange their own. Therapists must declare that they have arrangements in place that cover their practice.
BABCP Clinical Wills Policy

Registrants must nominate two colleagues to hold a list of their patients and supervisees in confidence, in the event of death or an inability to work.
BPC Code of Ethics

More recently, the BPC has drawn up additional, detailed guidance on Clinical Wills and how to give instructions to Clinical Trustees, available here.

How does using ClinicalWill.app help?

Any Clinical Will needs to meet the following requirements to be fit for purpose:

The information contained in a Clinical Will needs to be easily accessible by a Clinical Trustee, so that they can contact and support clients if a practitioner is unable to do so themselves.

Practitioners need to store all client records, including those contained in a Clinical Will in line with data protection regulations such as the UK GDPR and DPA 2018. This means giving a Clinical Trustee access to records that include process notes or other information not related to the function of a Clinical Will would breach these regulations, as would making client information available to anyone not acting as your Clinical Trustee.

A Clinical Will also needs to be up-to-date. This means making necessary changes to client details as soon as possible. Forgetting to do this might mean that your Clinical Trustee does not contact a client you have taken on recently or mistakenly contacts a client you have already finished working with.

ClinicalWill.app is designed with these requirements in mind.

How do I set up a Clinical Will?

If you work as a practitioner in an organisational setting, there may be a formal procedure in place in case you fall ill or die. However, if you work in private practice you will need to take responsibility for your own Clinical Will. This may also apply if you work for a smaller organisation. If you are unsure, it is your responsibility to check, as it is unlikely anyone else will do so on your behalf.

The following practical points will help you set up a Clinical Will that is fit-for-purpose. As a starting point, decide what information to include. As a minimum, a Clinical Will should contain:

The names and contact details of your current clients
The names and contact details of your Clinical Trustee(s) (see below for more information on selecting who to act as Clinical Trustee).
The names and contact details of your Next of Kin

You may also want to include:

Other clinical information about your clients which your Clinical Trustee might need, such as details of session days or times, and any other relevant information that will help them contact your clients supportively and sensitively. For example, you might want to indicate that illness or death is a trigger for a client, or give details of what you want your Clinical Trustee to tell your clients about what has happened. You might also want to include details for how a client prefers to be contacted, for example by email rather than by phone.
Contact details for past clients, especially if you keep materials they have a right to access after you have finished working together (for example materials produced in art therapy). Some practitioners may also request that past clients are invited to their funerals.
The names and contact details of your supervisees
Instructions for the disposal or deletion of physical or digital client records. This might include details of where to find paper records, or how to log on to devices or accounts that hold digital records containing confidential client information.

Beyond this information, you might also want to include non-clinical details related to your practice, such as:

Details of any other people or organisations you work with, for example, peer supervision or professional development groups, EAPs or insurance companies you work for, professional membership bodies, and you rown therapist.
Details of accounts held with other relevant businesses, such as the landlord or management of your consulting room, your professional insurance provider, website hosting companies, and any therapist directories or social media platforms associated with your practice.

As well as the information your Clinical Will contains, you also need to consider who will make sure your instructions are carried out, and how. Planning this will be your responsibility, therefore you should make sure you:

Ask someone who knows you personally, to act as your Next of Kin or Clinical Will ‘Initiator’. They will be responsible for contacting your Clinical Trustee if you fall ill or die suddenly and will likely be a family member, friend or neighbour you know well. You might want to ask more than one person to act as your Next of Kin or Initiator as this will make it more likely that your Clinical Trustee is contacted as soon as possible if need be.
Ask someone appropriate to act as your Clinical Trustee. They will be responsible for carrying out the instructions in your Clinical Will. As outlined above, a Clinical Trustee needs to be someone with the relevant clinical experience to act on your behalf within the limits of client confidentiality. Therefore, Clinical Trustees are usually other practitioners, such as a colleague or supervisor, most likely working in the same modality or therapeutic approach as you. Sometimes, Clinical Trustees agree to act for each other in a mutual ‘Co-Trustee’ arrangement. Again, you might want to ask more than one person to act as your Clinical Trustee as this will make it more likely that your instructions are carried out as intended - some organisations, like the BPC, formally require you to nominate two Clinical Trustees.
Discuss what is expected of your Clinical Trustee and Next of Kin with them and leave them clear instructions for them about what to do if they need to carry out their responsibilities as agreed with you. You might want to consider including details of whether your Clinical Trustee is expected to deal with outstanding fees, or fees paid in advance, on your behalf. You might also want to offer your Clinical Trustee payment for the time they will spend carrying out your instructions.
Consider carefully where you will leave any information your Clinical Trustee needs to access. You will need to make sure any clinical or other sensitive information, such as passwords for accounts or devices, is stored securely, but is easily accessible by your Clinical Trustee if they need to carry out your instructions. This might involve leaving a physical copy of the relevant information in a safe place they, or giving your Clinical Trustee access to a secure digital copy of the relevant records. Ideally, all the information they need will be in one place that is easy to reach.
Do not give your Next of Kin or Clinical Trustee access to more information than they need. Under data protection regulations such as the UK GDPR and DPA 2018, we are required to make sure we only share information for a good reason (called ‘legitimate interest’). Giving a Clinical Trustee access to records that include process notes or other information not related to the function of a Clinical Will would breach these regulations; importantly, your Next of Kin should usually not have access to any client details at all.
Inform your clients about your Clinical Will arrangements. Not only is this required under data protection regulations, but also forms part of our ethical obligation to communicate with our clients about what would happen in the event of us unexpectedly falling ill or dying, and discussing this with them if they have any questions.
Inform the executor of your personal will about your Clinical Will if necessary, and make sure it allows for any instructions you give your Clinical Trustee, for example permitting access to any relevant documents or personal devices containing client or business details. You might also want to include details of how your Clinical Trustee will be paid if you have offered to do so, or how should manage any payments of outstanding or overpaid session fees.

Once you have set up your Clinical Will, chosen your Clinical Trustees and Next of Kin or Clinical Will Initiator, it is important that you make sure the arrangements you have put in place remain fit-for-purpose as long as you are working. In particular, this means you should:

Keep your Clinical Will up-to-date. Most importantly, this means adding or removing client contact details as soon as possible. Forgetting to do this might mean that your Clinical Trustee does not contact a client you have taken on recently or mistakenly contacts a client you have already finished working with.
Review your agreements with your Next Of Kin or Initiator and Clinical Trustees regularly, inform them of any important changes to your instructions and ask them to tell you if they decide they can’t carry out their responsibilities any longer.
Consider how many other therapists you wish to act as a Clinical Trustee to. Although it is very unlikely, in cases where you need to carry out your responsibilities as Clinical Trustee to more than one practitioner at a time, you may be struggle to do so. Don’t underestimate the amount of work it might take to fully carry out a colleague’s instructions in the way they have requested.

Lastly, it is important to remember that creating your Clinical Will will involve considering circumstances in which you might fall ill or die, or in which you might have to act as a Clinical Trustee for a colleague yourself. You might find doing this isn’t easy, either in relation to yourself, or in considering the likely impact on family, friends, clients and colleagues. As well as the practical planning involved, you might want help in working through the wider implications of what it means to face the possibility of your own death or illness, or that of a colleague. If you feel you need more support, you could speak to your supervisor or therapist about this.