All academic health disciplines endeavor to ensure that professionals apply safe and effective interventions to patients, ethically conduct research, and respectfully interact with colleagues and students. Each profession is expected to develop mechanisms to monitor and regulate the performance of its members. Substrates for ethical and professional violations are identified: sexual misconduct, impairment, incompetence, and unethical and unprofessional conduct. Though mental health professionals have the awareness of professional ethics and the acumen to identify unethical practices, a significant number of clinicians remain uncomfortable and reluctant to report or intervene with their unprincipled colleagues. Known as the culture of silence, clinicians struggle with the dilemma of either protecting the privacy and confidentiality of their colleague or securing the safety and well-being of the patient, student, research subject, or public. There are three fundamental reasons for intervening with an impaired, incompetent, or unethical colleague: prevention of harm to patients or others, prevention of harm to one’s profession, and assistance to impaired peers. Specific interventions depend on the professional’s manifest incompetence and unprofessionalism and the level of risk to a patient and others. Interventions can include a dialogue with one’s colleague, referral to a physician assistance program, report to the colleague’s supervisor or administrator, or a report to a licensing board or other oversight entity. It is important for training programs to integrate ethics and professionalism into their curricula and for professions to maintain self-care. This chapter will clarify the gradients of unethical and unprofessional behaviors, the aversion of professionals to ntercede with errant colleagues, proposed interventions, and recommendations for the prevention of ethical misconduct.