...that 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.

**********

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.

Utilitarianism

Utilitarianism focuses on the consequences of actions and emphasises that the 'right' action is the one that produces the most intrinsic good for the majority of those affected. (2) From this perspective, the protection of confidentiality in therapeutic relationships can be justified on the basis that it provides the greatest positive outcome for the greatest number of people. The positive outcome can be viewed as a high standard of health care brought about by open communication. If confidentiality is not preserved, many patients may not disclose essential information to their mental health professionals thus seriously damaging therapeutic relationships. (3)

Deontology

Instead of focusing on the consequences of actions, deontological theories are based on the notion that actions can be evaluated in and of themselves. It can thus be argued that maintaining confidentiality is worth protecting as an intrinsically right action. Regardless of whether a breach in confidentiality results in bad consequences, deontology promotes keeping confidentiality as a universal moral obligation. Even for a good cause, it can be argued that it should not be morally permissible to undermine an intrinsically right action because this would threaten the concept of universal moral obligations. Thus, the relationship between health care professional and patient should be based on the premise that every communication will be kept confidential; otherwise the concept of confidentiality would...

NOTE: All illustrations and photos have been removed from this article.



More articles from Psychiatry, Psychology and Law
Drugs, sex and the risk of recidivism: psychiatry in the witness box.(..., April 01, 2006
Inside Madness.(Book review), April 01, 2006

Looking for additional articles?
Search our database of over 3 million articles.

Looking for more in-depth information on this industry?
Search our complete database of Industry & Market reports by text, subject, publication name or publication date.

About Goliath
Whether you're looking for sales prospects, competitive information, company analysis or best practices in managing your organization, Goliath can help you meet your business needs.

Our extensive business information databases empower business professionals with both the breadth and depth of credible, authoritative information they need to support their business goals. Whether it be strategic planning, sales prospecting, company research or defining management best practices - Goliath is your leading source for accurate information.