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Confidentiality and HIPAA Regulations
Respect for the privacy of patients or clients is a primary concern of psychologists. People must be confident that the information they reveal to their psychologists will be treated with discretion and respect. Professional ethics established by the American Psychological Association (APA) [www.apa.org/ethics/code2002.html] as well as federal and state laws and regulations bind psychologists to a very high standard of conduct in this area. To quote from one of the general principles of the APA code: “Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination.”
In most circumstances, disclosure of information obtained by psychologists only is made with the written authorization of the client or patient. However, sometimes it is necessary to balance this basic standard of confidentiality with other principles and values. Hence, disclosure may be ethically or legally appropriate in some situations without the usual patient authorization. It is not difficult to identify situations in which this would be proper. If a patient is liable to harm him/herself or another person, the psychologist must take action to prevent such a grave act. Similarly, when a person is so impaired by mental illness that he/she is incapable of attending to basic needs, the psychologist may issue a Psychologist Emergency Certificate (PEC) for immediate hospitalization.
It is likewise important to consider privacy and confidentiality in mental health care for a child. Parents are naturally concerned about their child and are ultimately responsible for his/her welfare. They may want to know what psychological issues are being discussed in therapy and how they can help. On the other hand, the psychologist strives to develop rapport with the child without being seen as a “reporter.” Effective treatment balances parental concerns and obligations with the need for the child to trust the psychologist. Hence, confidentiality considerations for children depend on factors such as:
- age of the child
- cognitive ability and maturity of the child
- context or purpose of the treatment or assessment
- potential consequences of revealing or withholding information
Psychologists discuss the limits of confidentiality with all relevant parties at the outset of the consultation or treatment. They understand the concerns of parents as well as the factors that promote effective treatment of the child. They will clarify how they intend to balance these considerations for the ultimate welfare of the child in the family.
To protect especially vulnerable individuals, the state legislature has enacted laws that mandate disclosure to governmental agencies of relevant information obtained by a psychologist and other professionals. Again, it is probably not difficult to discern when such disclosure might be required. If a psychologist becomes aware of information that a child’s physical or mental health is endangered as a result of abuse or neglect, he/she must report that concern to the appropriate state agency for investigation. Psychologists must also report concerns about the abuse or exploitation of an elderly or disabled person.
Good practice often requires health care providers to discuss a patient’s medical conditions among themselves to consider the best course of action. Such collaboration is not only ethically appropriate but is desirable in many situations. Medical psychologists who prescribe medication are actually required by law to collaborate with an individual’s attending or primary care physician [see link to medical psychologists].
The federal government has recently issued wide-ranging regulations governing health care operations and records [see www.hhs.gov/ocr/hipaa/]. Known as HIPAA regulations, the provisions define protected health information (PHI) and set rules and procedures for its use. Among other provisions, HIPAA rules:
- affirm patient access to PHI
- regulate the routine use of PHI
- standardize electronic data transfer and insurance billing procedures
- set standards for disclosure and safeguarding of PHI
Individual health care providers must prepare written statements of policies and procedures consistent with HIPAA rules that they follow in their practices. HIPAA regulations are intended to set minimum standards. They do not supercede state laws that provide stronger privacy protection to individuals.
This brief account is intended to provide an overview of privacy considerations and confidentiality in mental health care. By no means does it cover all situations or address the potential range of individual concerns. Those with particular issues or questions should talk with their psychologists and if appropriate, obtain legal advice from an attorney.
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