Confidentiality in Therapeutic Relationships: The Need to Develop Comprehensive Guidelines for Mental Health Professionals

Article excerpt

This article explores the current ethical and legal standards concerning confidentiality in therapeutic relationships. It examines the existing literature concerning mental health professionals' experiences and attitudes towards confidentiality as well as patients' expectations. It argues that the existing standards are complex and confusing. It is suggested that there is a real need for comprehensive guidelines as to the circumstances in which confidentiality may be breached in order to help mental health professionals provide the best possible health care to their patients. The article outlines the methodology of a project funded by the Australian Research Council which aims to provide comprehensive guidelines for mental health professionals in this area.

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Mental health professionals are confronted with a wide range of ethical and legal issues concerning confidentiality in therapeutic relationships. Their practice frequently intersects with other disciplines, which can lead to conflicts in maintaining confidentiality. For example, from the criminal justice perspective, questions may arise as to whether mental health professionals can maintain the confidentiality of patient information or whether they must comply with police or court requests for access to health records or reports. A related issue is whether mental health professionals should breach confidentiality in relation to patients they consider at risk of harming themselves or others.

Mental health professionals also need to know the limits of confidentiality when the disclosure of information is needed for purposes such as research, the administration of health care organisations, working within a treatment team or in relation to medical insurance. The difficulty in dealing with matters of confidentiality lies not only in determining in what circumstances sensitive information might be disclosed, but also in deciding to whom information must be disclosed and how much of it may be revealed.

Determining when to breach confidentiality is particularly difficult when the public interest is involved. A frequently discussed example is the dilemma of mental health professionals deciding whether to disclose information in order to warn victims or authorities where there is a risk of a patient harming others. If mental health professionals breach confidentiality contrary to ethical or legal principles, the consequences can be severe. Mental health professionals run the risk of being sanctioned by a professional body and they may face legal consequences such as a claim for negligence, breach of contract or breach of confidence.

From the perspective of patients, the disclosure of sensitive personal information may have adverse social consequences. Patients who fear that their personal information will be revealed may be reluctant to disclose certain information, despite openness being essential for effective diagnosis and treatment in mental health care. (1)

This article argues that currently, mental health professionals do not have sufficient guidance as to how to balance the protection of confidentiality and the disclosure of information. It looks at the overall ethical framework for the protection of confidentiality, including current provisions in the relevant codes of ethics and the complex interplay of recent Australian law in this area. It then outlines the methodology of a project funded by the Australian Research Council which aims to provide comprehensive guidelines for mental health professionals in this area.

The Ethical Framework

Confidentiality is generally regarded as fundamental to therapeutic relationships. There are differing schools of moral philosophy that aim to establish standards of conduct that indicate how individuals should behave in certain circumstances and the following is a necessarily brief outline of how these different schools approach the need to maintain confidentiality. …