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