Utah knows there is a “safety issue” with mental health workers. Here’s where experts say it’s okay for your therapist to touch you.

Utah has a “security problem” when it comes to the state’s licensed mental health professionals, officials conceded in a recent lawmakers’ hearing — and lawmakers could soon be debating whether steps should be taken to better protect patients.

Jeff Shumway, director of Utah’s new Office of Professional Licensure Review, cited data showing that Utah far exceeds the median in reporting to a national database of licensed mental health professionals.

The National Practitioner Data Bank is a confidential information clearinghouse established by Congress to track “adverse acts” — such as losing a license — and medical malpractice payments to healthcare professionals.

Shumway pointed out to lawmakers that not only is the recidivism rate of these practitioners higher in Utah, it is “very high” — 44.5% have another ad on the database, compared to the statewide average of 25%.

That puts Utah fourth in the nation with the highest rate of such repeat offenders, he said.

Some of his office’s suggestions for how Utah can improve include: Requiring mental health workers to provide patients with more safety information, such as: B. how to look up a professional’s license status online, how to file a complaint with state licensors – and which is never proper care.

This year, The Salt Lake Tribune and ProPublica examine cases in which Utah health care workers are alleged to have abused their patients and the obstacles those patients face on the road to justice. Our research found that of the nearly 200 mental health professionals fined by licensors since 2012, more than a third have been fined for sexual misconduct. We have identified at least five mental health professionals who have received multiple punishments for sexual misconduct.

Our latest research report highlights the experiences of several former patients who say their therapist sexually abused them. Some of the men we spoke to expressed that they felt uncomfortable during the therapy sessions, but said that at that moment they did not understand that the way they were being touched might have been inappropriate.

[Read more: A Utah Therapist Built a Reputation for Helping Gay Latter-day Saints. These Men Say He Sexually Abused Them.]

We created a guide to help others understand what physical boundaries experts say should exist between a therapist and a patient. It is not intended to be medical or legal advice.

To be clear, victims are never responsible for sexual assault. And Utah law states that patients cannot consent to sexual contact in a medical setting if the touch is in the guise of therapy or as part of a treatment plan.

Romantic relationships between a therapist and his patient are inappropriate

Utah licensors say any sexual or romantic relationship between a patient and a psychologist is considered improper conduct, which can result in the therapist losing their license or being given a suspended sentence.

State regulations also state that a psychiatrist may not have a sexual relationship with a previous patient within two years of the last treatment.

Sexual touching is never acceptable during a therapy session

Sexual touching in a therapy session is considered unethical by all major mental health professional organizations. And two experts The Tribune polled about appropriate limits said there’s never a legitimate reason for a therapist to touch their patients’ genitals.

“There’s no conceivable reason,” said Jacob Appel, director of psychiatric ethics education at Mount Sinai School of Medicine. “Even in a psychiatric emergency room, if ever the need arises, I will call a medical consultant to do this type of work.”

Utah law states that patients cannot consent to sexual activity with a healthcare professional if they believe the touching was part of a “medically or professionally appropriate diagnosis, consultation, or treatment.”

Hugs and handshakes can be okay — if you’re comfortable with them

Hugging in talk therapy is more of a gray area. Appel said a hug is ethical if it’s patient-initiated and ideally occurs when someone else is in the room. He gave an example of an elderly woman he treated who asked for a goodbye hug at the end of her last session. He was comfortable with that kind of touch, he said, because the woman’s daughter was also in the room.

Gary Schoener, a Minnesota clinical psychologist who has counseled on professional boundary issues for 50 years, said hugs beyond a brief hug become problematic.

“If you ask therapists if you ever touch your clients, you get a subset that says ‘never.’ There’s a subgroup that says ‘Sometimes,'” he said. “However, if you ask about specific things like hugs, hugging is actually not easy to define. Is it a side arm around the shoulder? Which parts of the body are touching? And where are the hands and what are they doing? What is said?

[Help The Salt Lake Tribune and ProPublica investigate sexual assault in Utah health care settings. Tell us your story here.]

Longer hugs of any kind are not appropriate, said Schoener. And Appel warned that any regular physical contact with a therapist crosses a line. He added that there is an unequal power dynamic in the therapist-patient relationship, which can make it difficult for a patient to voice a concern.

“The power dynamic is just one-sided,” Appel said. “As a result, patients may not feel comfortable telling their doctor, ‘That’s what makes me uncomfortable.’ So there is actually a burden on the provider not to even test the limits.”

What to do if you think your therapist touched you inappropriately

Appel said if you’re a patient who feels a touch in therapy was wrong or inappropriate, trust your instincts.

“It’s very unlikely that everything just happens in your head,” he said. “It is very unlikely that you are the only person who has been victimized in this way.”

Appel said patients don’t need to confront their therapist about perceived inappropriate touching, but he advises they tell someone — whether it’s a clinic manager or the state medical board. Patients in Utah also have the option to contact the police.

He added that a patient does not have to explain to their therapist why they are stopping treatment if they are unwell. You can offer an apology—like moving away—or simply tell your therapist that it’s not something you want to talk about and that you want a referral for someone else.

If you’re not sure where to start, you can speak to someone trained to assist at the National Sexual Assault Hotline at 800-656-HOPE (4673) or chat online at online.rainn.org.

To report a licensed professional in Utah, you can file an online complaint form with the Division of Professional Licensing. If you live outside of Utah, find your local medical association here.

A licensing authority can respond to a case faster than a police investigation. Your procedure protects patient privacy and may require the submission of a single report. If licensors determine that there has been wrongdoing, the department may revoke a therapist’s license or issue a suspended sentence. Reporting to a state health agency does not initiate a criminal investigation, and Utah licensors are not required to report suspected abuse to the police.

Reporting to the local police may take longer and you may be asked to re-report events more than once. In the event of a court hearing, your privacy cannot be guaranteed. If a therapist is found guilty, they can be jailed or fined.