All practitioners strive to provide relevant, ethical mental health care. However, some issues arise that highlight the complexity of this goal when working with adults with chronic mental illness. Issues such as confidentiality, involuntary hospitalization, managing social stigma, coercion and decision-making capacity are some of the areas that generate ethical concerns. Given the vulnerability this population experiences, it is imperative that practitioners reflect on these issues and use sound ethical reasoning to ensure that appropriate care is provided.