As I read over an employment contract for a job as a psychiatric nurse practitioner, one clause stopped me cold. If I left the practice, I’d owe $7,500 for every patient who chose to continue treatment with me.
When I questioned the clause, the response came quickly, with irritation: “The practice owns the patients. You do not.”
The contract crystallized a disturbing reality: In too many private mental health practices, patients are treated not as autonomous human beings engaged in vulnerable therapeutic relationships, but as proprietary assets to be retained, priced, and controlled. And critically, patients have no idea this is happening.
Private mental health practice employment contracts frequently contain provisions that quietly determine what happens to patients if a clinician leaves. While transitions between providers are sometimes necessary and are typically managed through direct patient communication and coordinated handoffs, some contracts prevent clinicians from informing patients about their departure — particularly when clinicians are required to leave immediately and are bound by non-solicitation clauses.
Even when patients are aware, these contracts can prohibit them from following a trusted provider, impose financial penalties if continuity is maintained, and shift legal and financial risk downward to clinicians while owners retain financial control. Patients never see these agreements. They only experience the consequences when a provider disappears, and continuity of care is abruptly severed. Beliefs about “ownership” should not live buried in legal language or be disguised as administrative policy. The result is a deeper asymmetry: Clinicians are held professionally and ethically responsible for patient care, yet those same patient relationships are treated as assets owned by the practice.
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Restrictive contracts are common across health care. Non-compete clauses limit where clinicians can practice after leaving; non-solicitation clauses restrict contact with former patients. Both are typically justified as protecting business interests. But they limit how freely clinicians can leave or practice across settings, and how easily patients can maintain continuity of care. In mental health, where care depends on trust, vulnerability, and relational safety over time, those disruptions can carry real clinical harm.
Patients in psychiatric and psychological care — especially those with serious mental illness, trauma histories, addiction, or significant psychosocial instability — are not interchangeable accounts. The relationship itself is clinical. Disrupting it for contractual or financial purposes is not neutral; it risks relapse, retraumatization, destabilization, and disengagement from care altogether.
The contractual constraints also violate ethical principles in a discipline where continuity, trust, and relational safety are themselves part of treatment. They threaten autonomy because patients cannot meaningfully choose; they undermine beneficence and non-maleficence because continuity is jeopardized; and they erode justice because those most vulnerable are harmed most. We already require transparency when financial incentives influence treatment, and we emphasize disclosure around clinical risk. Yet we allow powerful legal agreements that directly shape access to care to remain invisible to the very people whose lives they govern.
Patients do not need to read legal contracts. But they deserve basic disclosure: whether they may follow their clinician, whether penalties exist, and whether their mental health care is governed by restrictive covenants that prioritize revenue control over continuity. In practice, this can be built into standard intake materials and transition protocols, making disclosure routine rather than a hidden contractual detail. If mental health care claims to be patient-centered, it cannot simultaneously conceal the contractual rules that determine whether patients are allowed to remain with the person they trust. 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.
Patients are not inventory. Clinicians are not property. And a business model that requires secrecy and ownership claims over human relationships to remain viable is not merely unattractive or impersonal; it is ethically indefensible.
Sarah Cady is a psychiatric nurse practitioner in the New York City area.