Challenges Related to Ensuring the Privacy of Patient Medical Information

            Psychiatrist is a physician with a medical degree or osteopathic degree and at least four years of specialized training or study in psychiatry. Psychiatrists are licensed to practice medicine by individual states. A psychiatrist who is “Board Certified” has passed the national examination given by the American Board of Psychiatry and Neurology.

The duty of a psychiatrist is to: “provide medical and psychiatric evaluations, treat psychiatric disorders, provide psychotherapy, and prescribe and monitor medications” to the mental health patient (Types of Mental, 2008). A psychiatrist may have a private practice or may work in a hospital or health care institution.

As a mental health care provider, there are several problems commonly encountered whether in private practice or in health care institutions. One of the most common problems is ensuring the privacy of patient medical information. This issue has always been the importance of protecting the right of the patient over addressing any other societal goals.

This became very apparent in the recent issue of National Health Information Network. In 2005, Russ Newman, Ph.D, J.D., executive director for professional practice, on behalf of the American Psychological Association, discussed concerns about the need to maintain high level of privacy of mental health records. Dr. Newman acknowledged the potential of the National Health Information Network in improving the quality of care however he pointed out that it raised several concerns on the issue of privacy and confidentially of mental health records (Bossolo & Wilson, 2005).

He emphasized that in mental health records are particularly sensitive since they contain the innermost thoughts, emotions and personal information of the patients. There is also the stigma attached to mental illness and mental health treatments that will make any breach of privacy particularly devastating to the patient.

Based on these premises, mental health records are quite different from other mental health records. Moreover, disclosure of records may also interfere with the treatment of the patient. Any established open communication of the psychiatrist with the patient will be damaged and will hinder the development of the treatment.

Another part of concern for confidentiality of medical records is the communication between the patient and the psychiatrist. In the controversial case of Tarasoff v. Regents of the University of California, the court declared, “We conclude that the public policy favoring protection of the confidential character of patient-psychotherapist communications must yield to the extent to which disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins (Herbert, 2004)”. This puts the psychotherapist in danger of being sued for not disclosing information about the patient in case the patient harms himself or a third party.

Though initially intended to prevent any harm form occurring, Tarassoff has now evolved quite differently since it was first ruled in 1976. What was otherwise confidential communication between the patient and the psychotherapist is now being used to convict psychiatric patients of criminal offenses.

More than that, what constitutes an otherwise patient seeking psychiatric help for feelings of anger and violent ideation can now lead to the patient being incarcerated. This was seen in the following case:

“Upon leaving the courthouse [she] began thinking about stabbing the judge in the throat. She did not have a weapon. [She] was concerned about the violent thoughts, so she took a bus to a local hospital and asked to be seen in psychiatric emergency services. At the hospital [she] continued to express thoughts of harming the judge. The staff placed her on an involuntary hold and in accordance with Tarasoff, notified the police and warned the judge. Later that night she was arrested and transferred to the county jail, charged with making criminal threats. [She] eventually agreed to plead no contest to a misdemeanor and was released on probation after several months in jail (Herbert, 2004)”.

There is another ruling though, which puts the issue even more confusing for the psychiatrists and the patients. In 1996, the United States Supreme Court established a special privilege for the communications between the patient and the psychotherapist or psychiatrist but states that there are certain exceptions to the ruling.

Moreover, the Supreme Court ruling of the Jaffe v Redmond Case of 1996 recognized the psychotherapist-patient privilege (Mosher & Swire, 2002) and yet “stated in a footnote that an exception to the privilege would exist if a serious threat of harm to the patient could be averted only by means of disclosure by the therapist (Weinstock, Leong & Silva, 2001).

The issue of patient-psychotherapy confidentiality and determining the balance between public interest and the right of the individual to privacy is not merely limited to the violation of rights of the individual. The issue involves the gradual collapse of psychotherapy as treatment for mental health patient. Supposing the same is applied to lawyer-client confidentiality, the whole legal system will collapse.  

As it is, medical treatment for mental health patient is being compromised; and so, as final project, I shall address the problem of confidentiality of communication between the patient and the psychotherapist.

Works Cited

Bossolo, Luana & Wilson, Peter 2005. APA Raises Privacy Concerns on Mental Health Records.

American Psychology Association. Retrieve 17 January 2008 from

http://www.apa.org/releases/patientprivacy.html

Herbert, Paul B., M.D., J.D. 2004 Psychotherapy as Law Enforcement. The Journal of the

American Academy of Psychiatry and the Law. Retrieve 17 January 2008 from

http://www.jaapl.org/cgi/reprint/32/1/91

Mosher, PW & Swire, PP. 2002. The ethical and legal implications of Jaffee v Redmond and the

HIPAA medical privacy rule for psychotherapy and general psychiatry. Pubmed.

Retrieve 17 January 2008 from

http://www.ncbi.nlm.nih.gov/pubmed/12232971

Types of Mental Health Professionals. 2008. National Alliance on Mental Illness.

Retrieve 17 January 2008 from

http://www.nami.org/Content/ContentGroups/Helpline1/Mental_Health_Professionals_Who_They_Are_and_How_to_Find_One.htm

Weinstock, R, Leong, GB & Silva, JA. 2001. Potential erosion of psychotherapist-patient

privilege beyond California: dangers of "criminalizing" Tarasoff.

Retrieve 17 January 2008 from

http://www.ncbi.nlm.nih.gov/pubmed/11443702?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus