Confidentiality 101

Confidentiality 101

• Confidentiality is not absolute. Laws, such as mandatory reporting requirements for the suspicion of child abuse or neglect and the duty to warn and protect when a client makes a threat to harm an identifiable intended victim, supersede the obligation to keep confidence.
• The limits to confidentiality are regulated by law. Each mental health professional should be informed of the specifics of their state’s or jurisdiction’s laws relevant to these issues.
• All limits to confidentiality should be openly discussed with clients at the beginning of the professional relationship as an important part of every client’s informed consent process. Once clients understand the limits to confidentiality and the actions you will take if they disclose or if you suspect certain things, they can freely decide just what they want to share with you.
• Clients must also be informed of other possible limits to confidentiality, such as knowing what information may be shared with their insurance or managed care company should they file for insurance reimbursement for services you provide to them. Similarly, inform your clients if you are a supervisee and will be discussing your work in an identifying way with your supervisor.
• When working with minors, couples, families, and groups, ensure that all participants understand how the involvement of others in their treatment impacts confidentiality. Such issues should always be discussed and explained fully during the informed consent process.

Mental health professionals must have appropriate Office Policies, procedures, and practices to protect against inadvertent breaches to confidentiality. Being proactive about this to protect and preserve each client’s confidentiality is very important.

Examples:

• Training all administrative and support staff about confidentiality and providing them with appropriate oversight to ensure compliance.
• Insuring that all records are stored in a secure location, and that the only people with access to those records have a legitimate need to access them.
• When destroying records in accordance with relevant state law, ensuring this is done in a way that preserves each client’s confidentiality rights, such as shredding the records.
• When consulting with a colleague, doing so only with appropriate consent from the client or after sufficiently disguising their personal information so that their confidentiality is preserved.
• Never discussing clients in a public forum or with individuals not authorized by the client to have access to this confidential information.
• Using technology with an understanding of the possible risks to confidentiality each type of technology may bring with its use. Examples include the use of e-mail, computers, fax machines, and others. It is important to always take appropriate precautions to minimize risk of the inadvertent release of confidential information. This includes, among other things, appropriate computer and file passwords that would be difficult for others to guess.
• Attending to the physical setup of your office, including soundproofing, double doors and/or the use of white noise machines. Additionally, be aware of how the placement of support staff in or near the waiting room may impact protecting confidential information.