Jennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law—Mid-States Region
University of Michigan School of Public Health

We continue our series on the interplay between patient privacy and families’ interest in their loved one’s care. Here, Attorney Jennifer Bernstein covers what two states are doing to allow for increased family involvement.

How Are States Addressing Patient Mental Health Privacy?
Though HIPAA is not necessarily a bar to family members obtaining information about their loved ones with mental illness, the wishes of patients are usually paramount. Some states have adopted more innovative legal provisions to help assist families and patients in both protecting privacy while improving care.

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Family members are an inescapable fact of life for most of us—good and bad. So how do peers navigate personal decisions about their own treatment options and living a life of recovery with their family members? Today we continue our series on HIPAA with peers sharing their thoughts on the role of family members vs the right to direct their own treatment and recovery.

Balancing Family Rights to Know with Patient Rights to Privacy
It can be difficult for family members, who often have the best interest of their loved ones at heart, to provide enough space for their loved one to accept their disorder, seek treatment and build a life of recovery based on personal choice. But when speaking with individuals living with a mood disorder, many state that this is exactly what needs to happen. While it can be tempting to place oneself in a position of “knowing what’s best,” loved ones may need to recognize that they are on their own separate journey with an unknown destination.

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Nancy Sharby

This is the second week of our series discussing HIPAA regulations with regards to mental health care. In this post, we provide a family perspective.

Good and Bad Experience with HIPAA
As a mother, I have had positive and negative experiences with HIPAA, with an example for each.

The negative event happened when my adult son was hospitalized while I was out of town. I knew he was in that particular hospital because that is where the ER told me they were sending him. His doctor, who had permission to talk with me, was the one to tell me which ER he was in. I called the hospital where I knew he was and tried to tell hospital staff about his medications. The staff person kept insisting that they could not confirm or deny that my son was at the hospital, and they refused to hear what I was telling them about his meds. I knew he was there and didn’t need them to confirm it. What I really needed them to do was to take the information about his medications. They would have it to use if he was there, and they could throw it out if he wasn’t.

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Jennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law – Mid-States Region
University of Michigan School of Public Health

This is the second of three posts discussing privacy rights for mental health care provided by Attorney Jennifer Bernstein. Read the first installment from earlier this week. Additionally learn more by reading FAQs from the U.S. Department of Health & Human Services.

When and How Can A Family Member Become Involved in Care?
Now that we have discussed some of the basics of the HIPAA Privacy Rule, let’s consider some specific concerns that family members often have regarding treatment and care of their adult family members with a mental health disorder. Generally, HIPAA gives ultimate deference to a patient’s wishes as to the sharing of their health information. There are some exceptions that are important for the family members of individuals with mental illness.

When does mental illness constitute incapacity under the Privacy Rule?
The HIPAA Privacy Rule does make allowance for when a patient is unable to authorize disclosure due to incapacity. A major determining factor on whether to disclose a patient’s information to the their family, friends or other persons involved in their care is whether or not the disclosure is in the best interests of the patient.  Incapacity criteria may include when a patient is incoherent or suffering from psychosis.

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Jennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law – Mid-States Region
University of Michigan School of Public Health

Patient Privacy in Mental Health: Balancing Rights while Trying to Ensure Appropriate Treatment

Privacy rights and protection of health information take on special meaning in mental health care, whether because of the stigma associated with mental health conditions, or issues of family dynamics, or a variety of other reasons. The on-going debate takes on increased importance in light of the tragedy this past weekend at the University of California at Santa Barbara.

Before we explore particular instances of how patient privacy has affected people with mood disorders and their families, we’ve asked attorney Jennifer Bernstein to provide an overview of privacy in mental health care. 

What is HIPAA?
The Health Insurance Portability and Accountability Act, commonly referred to as HIPAA, provides consumers with privacy rights and protections for their health information, including mental health information. Though enacted in 1996, HIPAA’s Privacy Rule governing individually identifiable health information took effect in 2001. The Privacy Rule seeks to strike a balance between protecting patient’s privacy by safeguarding sensitive health information and allowing for the sharing of a patient’s health information to ensure the best treatment and the health and safety of the patient or others. The following information applies generally to adult patients.

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With today’s post, Dr. King closes out CFYM’s series on youth suicide prevention. We acknowledge the collaboration of National Network of Depression Centers and Active Minds with Care for Your Mind and we appreciate their contributions to our community.

Cheryl King, PhD
Institute for Human Adjustment, University of Michigan

While evidence-based education, prevention, and treatment intervention strategies exist to address the problems underlying youth suicide, significant barriers prevent young people from receiving the kinds of help that can make a difference. Public policy can impact the availability of services, but there’s debate on how to invest resources.

No Single “Right” Approach
When it comes to public policy and funding to address youth suicide prevention, there’s no perfect evidence to indicate a single best or preferred strategy. I personally look at it as a large magnet and, with every strategy, we “pick up” more of those who are at risk.

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Dan Strauss, Executive Director
The Alex Project

Dan Strauss lost his 17-year old son, Alex, to suicide on October 11, 2010. Alex preferred communicating by text rather than by phone, and had texted friends and his counselor on the night of his death. Motivated to eliminate that communication barrier for young people in crisis, Mr. Strauss established The Alex Project, which supports crisis help line services by text. Care for Your Mind interviewed Mr. Strauss about youth suicide prevention and Alex’s experience with mental health care.

We Need to Provide Services that Young People Will Use
Crisis Intervention by Text Message for Preventing Youth Suicides

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Cheryl King, PhD
Institute for Human Adjustment, University of Michigan
National Network of Depression Centers

Suicide is the third-leading cause of death among 15-to-24-year olds, and youth suicide remains a challenging public health problem that is strongly linked with psychiatric disorders and other mental health issues.

Research shows that there are effective education, prevention, and treatment intervention strategies to address this problem. However, there are also barriers that prevent young people from receiving the kind of help that can make a difference.

Some Evidence for Effective Approaches
While it’s a challenge to gather evidence for strategies that address suicide prevention, research indicates that certain approaches lead to increased awareness of risk factors, more referrals to treatment for those at risk, and reduced suicidal thoughts. In some instances, the studies have been large enough to look at reduction in suicide attempts. But we can’t say we have data on treatments and interventions that are actually shown to reduce suicides in youth.

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