ADVICE
Redefining Duty of Care in Aesthetic Medicine: Mental Health and the Legal Landscape
In an industry where aesthetic outcomes are increasingly intertwined with emotional wellbeing, the connection between mental health and cosmetic treatment has become central to both ethical responsibility and legal accountability. Our collaboration with PREPÆRE™ highlights the importance of a dual approach to redefining the duty of care in aesthetic medicine – balancing clinical expertise with emotional intelligence and legal diligence.
Understanding Body Dysmorphic Disorder (BDD) in Aesthetic Medicine
Body Dysmorphic Disorder (BDD) is a recognised mental health condition that affects around 1 in 50 people in the UK. For aesthetic practitioners, it presents a particular challenge due to its hallmarks: an obsessive focus on perceived flaws, dissatisfaction regardless of results, and frequent requests for treatment where no clinical justification exists.
Our article, ‘Aesthetic Medicine’s Role in Identifying Body Dysmorphia’, explores the signs practitioners can look out for and the supportive steps they can take.
What we explore here, however, is the legal and insurance landscape surrounding such scenarios – where the risks extend beyond the treatment room.
Legal Duty of Care in Aesthetic Practice
All aesthetic practitioners in the UK have a legal duty of care to their patients. This includes ensuring individuals are mentally competent to make informed decisions and are appropriate candidates for treatment. Since the landmark Montgomery v Lanarkshire Health Board ruling in 2015, informed consent now requires professionals to present risks through the lens of what the patient might find significant, rather than just what the practitioner believes is important.
Failing to consider psychological suitability as part of this duty can result in claims of negligence, reputational damage, and regulatory consequences.
Case Study: When Good Intentions Still Carry Risk
Context:
A reputable London clinic provided multiple aesthetic treatments over a 12-month period to a client who consistently expressed dissatisfaction, despite visibly positive outcomes. The patient had a history of previous procedures and voiced significant concern about her appearance at every visit.
What happened:
Eventually, she pursued legal action for psychological distress, claiming that the treatments had exacerbated her mental health. Upon review, the insurer found no notes indicating that the clinic had explored emotional readiness, past dissatisfaction, or suitability for repeated procedures. While all treatments were technically sound, the lack of emotional due diligence led to an out-of-court settlement and increased premiums.
Reflections:
- Repeated requests for treatment and consistent dissatisfaction should prompt deeper conversations and pause for reflection.
- Clear, compassionate documentation of patient interactions and decision-making helps support both ethical care and legal defence.
- Indemnity protection often hinges on a practitioner’s ability to show they acted in the patient’s best overall interest – not just clinically, but emotionally.
Changing the Narrative Around Skin Health in Aesthetics
Historically, discussions around skin cancer have been siloed from the aesthetic space. Yet more clients are asking about moles or requesting removal of blemishes without medical clearance. Without a clear referral pathway, there’s a risk of inadvertently treating skin cancers as cosmetic concerns.
By adopting a preventative, patient-first approach, clinics can elevate their standard of care – moving from purely cosmetic services to a more holistic, ethical model of practice.
From the Insurer’s Perspective: A Shift Toward Relationship-Centred Risk Management
Insurers are seeing more claims where mental health concerns play a significant role. As a result, underwriters are placing growing importance on practices that demonstrate:
1. Emotional Awareness Within Consultations
Rather than formal tools, insurers value clinics that foster open dialogue and build trust – helping patients feel seen beyond their aesthetic goals.
2. Supporting Clients Without Overstepping
Safeguarding shouldn’t feel like a tick-box exercise. It should feel like care. PREPÆRE™ offers a model that integrates naturally into the patient journey. One example is their wellbeing check-in – a private, pre-consultation prompt that invites patients to reflect on their mindset. This light-touch approach doesn’t feel clinical or invasive; instead, it helps patients share authentically, while giving practitioners a better sense of emotional readiness.
3. Soft Referrals: Helping Without Labelling
Not every patient is ready – or willing – to be referred to a therapist. Some may perceive it as stigmatising or confrontational. Soft referrals, like sharing reading materials, wellbeing resources, or pointing patients toward PREPÆRE™’s mental health toolkit, offer a non-judgemental path to support.
This kind of guidance can be instrumental in helping patients begin to process body image concerns in a healthy way – without the pressure of formal labelling.
4. Ethical Boundaries and Documentation
When practitioners say “no” to treatment, or choose to delay it, it should be documented clearly and empathetically. Insurers strongly favour clinics that can demonstrate sound rationale for their decisions – particularly when those decisions prioritise patient wellbeing over short-term outcomes.
5. Continued Learning and CPD
Insurers increasingly recommend mental health awareness training as part of CPD. Not only does this support safer practice, but it aligns with a more modern, patient-centred approach to care.
6. Referral Relationships and Community Links
Having informal links with local GPs, therapists, or digital support platforms strengthens both your clinical ecosystem and your defensibility in the event of a claim. Patients who feel supported holistically are less likely to escalate dissatisfaction into litigation.
Recommendations for Clinics and Practitioners
1. Ecourage Psychological Awareness Among All Staff
Encourage your team to listen carefully, note language that hints at emotional distress, and discuss concerns as a team before proceeding with treatment.
2. Build Trusted Referral Networks
Know which local GPs, mental health professionals, or support services you can refer patients to – ideally ones who understand the aesthetics context.
3. Develop an Ethical Treatment Framework
Create a written policy that supports turning away treatments that may do more harm than good. Patients often return later with gratitude when this is handled with care.
A Dual Duty of Care in Aesthetic Medicine
Insurers are evolving to reflect this shift. We’re not just here to respond to claims – we are partners in ethical, sustainable practice. By working in alignment with Cosmetic Insure, and with organisations like PREPÆRE™, the sector can move forward with confidence, compassion, and clarity.
Note: Duty of Care in Aesthetic Medicine – The information provided is for educational purposes and should not be construed as legal advice. Practitioners are advised to consult with legal professionals and relevant regulatory bodies for guidance specific to their practice.
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Please note that this information does not constitute medical advice. Any reliance you place on the content found within the Cosmetic Insure Treatment Guides, Cosmetic Insure blog articles, or on any part of cosmeticinsure.com is done so entirely at your own discretion.
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