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

JenniferPhotoJennifer 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.

What does HIPAA mean for patients with mental health disorders?
Normally you have the right to inspect, review, and receive copies of your medical records, with the exception of psychotherapy notes. HIPAA defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session. Such notes are kept separate from the patient’s medical and billing records and cannot be requested for inspection or review by the patient. The Privacy Rule also greatly limits a provider from disclosing psychotherapy notes to others without a patient’s authorization. This includes disclosures to other health care providers or family members.

This does not mean that information about your mental health condition cannot be shared with other health care providers, insurance companies, or family members. The restrictions on psychotherapy notes do not exclude the sharing of information about medication prescription and monitoring, counseling session start and stop times, the types and frequencies of treatments, results of clinical tests, summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date.

What about disclosure of information to family members or other persons?
HIPAA treats the disclosure of health information to family members the same, regardless of the health condition of the patient. HIPAA allows a health provider to share or discuss a patient’s mental health information with family members as long as the patient does not object to the sharing or disclosure. If a patient objects, the health care provider is under a legal and ethical duty to comply with the wishes of the patient.

Even with authorization from the patient, a health care provider may only share or discuss information to the extent that family members need to know to assist in the patient’s care or payment for care, unless specifically authorized by the patient to provide additional information. For example, a therapist may discuss a patient’s medication regime to ensure compliance with treatment for schizophrenia, but the therapist would not be authorized to discuss private conversations between the therapist and the patient related to the patient’s symptoms, such as visual or auditory hallucinations experienced by the patient.

The next post in this series discusses some specific concerns that family members of patients with mental illness often have concerning HIPAA and gaining access to their loved one’s health information.

Your Turn

  • What experience, negative or positive, have you had in dealing with HIPAA while obtaining mental health care?
  • What do you think needs to change about the HIPAA law?
  • How do you think the balance should be struck between patient rights and families seeking to ensure prompt and appropriate treatment?

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39 comments
Crying for help
Crying for help

My husband have schizophrenia and depression i didn't know until after we were married his Mother never said anything until things staring get really bad with us and i was ready start to leave him now she's give bits and pieces of his issues so i looked some things up im trying to get him help now because hes a good person when he can i guess focus he doesn't think anything's wrong with himself its everyone else that has a problem but he'started taking about hurting himself even killing himself and i dont know how to get him to get treatment please help us

David Clark 1969
David Clark 1969

My girlfriend was rapped then put in jail and was forgotten about till I came up with bond money she is also autistic. She was Baker acted from the jail when she arrived at the hospital she hadn't eaten or drank in about four or more days she couldn't speak or walk. Her mother for once came to the hospital that night only for about20 mins I stayed with her all night the next day I had her singing eating and talking a little the I saw the mother when she finally showed up that afthernoon video taping her daughter and I knew it was for the purpose of a lawsuit. And with me out of the way she could have her daughter committed and take all control of any money from lawsuit so I was pushed away because my girlfriend was deemed incompetent now she is going down hill fast and I can't do nothing she can't hardly speak she is drooling now. Her mother has done nothing since we been together till greed came in play please help I don't have money for a lawyer and I know with me in her life she is always happy

Eis
Eis

I need to know if I have a right to know if I have a psychiatric diagnosis. I know this sounds odd. The caregiver I am seeing now treats me that way. Are they legally bound to share this with me if it is secondary information shared with them? Is there one source that I can contact that will reveal this information? Thanks for your help!

cpbbanna
cpbbanna

My husband violently committed suicide exactly one week after visiting a psychiatrist. Because he did not give permission for his details to be shared with anyone, including his wife and son, we can get no information and this to me is wrong because just maybe this tragedy could have been prevented. I so feel for any close relative in this position.

TamiR1959
TamiR1959

My cousin just lost her husband to suicide 2 weeks ago, we live in California, she wants his medical records from his therapist, have you had any luck?

Lisa
Lisa

In the depths of frustration and at the end of the road in dealing with a nephew that refuses to believe that he suffers from schizophrenia (schizo-affective) and repeated going off medication every year - we as family members have absolutely no rights.  We are the ones left to pick up the debris and chaos this condition brings to the afflicted - yet we have to live by the protocol directed by the person suffering who cannot make sound decisions where money (disability) related to his care and concern and quality of life.  We have no choice but to turn away and disown this person who did not ask for this condition.  We are the ones that care the most - and we are forced to disown them as it is impossible for them to make decisions for their wellbeing without proper re-training in how to deal with the condition.  We are repeatedly abused by the HPAA laws - that allow this mentally ill person to advocate for themselves - and the lack of insight to their health condition and not allowing them to maintain a healthy or functional lifestyle.  Repeatedly and year after year they are able to go off medication and we suffer their abuse - and we have no rights to significant knowledge of their condition or treatment or long term care prognosis.  If the afflicted feel that they have unfairly (paranoid) been diagnosed with this illness, the condition does not allow them to share information with their family members as we are the ones always trying to keep them on their meds - when they do not believe they need it or are in denial of the diagnosis.  Also, having the afflicted be videotaped (as they never believe that they behaved or said such awful things) to play back when they are stable, might be valuable in their realization how they look and feel to us when in an episode and off medication.  When committing crimes that officials overlook as they don't want them back in the commitment process - when the only other road they are on is clearly jail - where there will be no rehabilitation provided.  It is a horror story that never ends - and you never wake up.  It clearly doesn't work for the afflicted or the family members.  Why should they get to time and time again - just stop taking meds - and it is up to the rest of us to suffer the consequences.  Money should not be given to them - when they cannot handle applying it to their care and concern and staying on their meds.  After two relapses - a family member should be brought in - we shouldn't have to fight for guardianship to assist them in this funding going towards their living arrangements - not gas, fast food, cigarettes, etc.  We are enablers - are we are victims as we have to sort through the chaos in their minds to decipher what is real and true ... and what is not because we are not allowed information to the treatment, condition or rehabilitation of the afflicted. 



AhmadAmerica
AhmadAmerica

Why can't I see a copy of my own 730 mental health evaluation?


Why can my attorney see it?


Why can the judge see it?


Why can the DA see it?


Why can my probation officer see it?


And none of them are mental health professionals...


But I am not allowed to see it?


I am considering going pro per in my case - and representing myself... so, in effect, I would become my own legal counsel... and FORCE the issue - namely, force the doctor and the court to release this 730 report to my person so I can have all the information necessary to prepare an appropriate legal defense.


I am a political activist who has been under attack from the establishment for years. I am being slandered and defamed - publicly and privately and through full use of the law. I went against the military industrial machine and the international banking cartels since I was a college student interviewing Gulf War veterans for documentaries. I'm fighting the good fight. I'd appreciate any help in trying to clear my name and continue serving my country in truth.


Needless to say, when I publicly said certain powerful officials deserved to be arrested and tried for treason against the United States of America... I was suddenly labelled mentally ill - a bright, intelligent young man who made it 26 years as an honor roll student and entrepreneur.


Thank you for your time.

Mean2me
Mean2me

I went to a doc-in-the-box for some very serious pain in my shoulder neck and arm. I've had a migraine for over a week, I've taken ibuprofen every single day, and when I turn my head, nerves bulge from my neck. The dog in the Box listened to my breath sounds, and actually slapped me in the neck from which my pain was coming and told me it was just "tense or pulled muscles". He actually never gave me a diagnosis. I actually feel like it's something more severe. I've had pulled muscles and this is not it. This is been going on over a week. He prescribed me a steroid and told me he refuses to give me anything else because he was able to see that my psychiatrist prescribes Klonopin for me due to dysautonomia / panic disorder. I felt outraged and upset because he shouldn't have known that I go to a psychiatrist. I didn't ask him for any sort of narcotic or any other medications but when I asked him if the steroids he prescribed would take down the inflammation and help my neck, he told me that he knew that I took Klonopin. I'm outraged at this HIPAA law. It's BS. It's invasive and now I've been stereotyped. There's such a stigma attached to going to a psychiatrist and having a disorder that it makes it embarrassing to tell the doctor. The milligram of Klonopin that I take is a very low dosage. My mother being a nurse, knows that if it is muscle pain then a normal dose of muscle relaxer would make me feel better; it would not result in any fatal overdose. I feel so embarrassed and ashamed and I do not believe that it is anybody's business what goes on in my head and with my doctors that I discuss things with. I didn't choose to have this disorder it happened to me. Sincerely, outraged and embarrassed

Hettie1863
Hettie1863

I have a question.  I was admitted to hospital for a wound infection (let me preface by saying I am a middle-aged adult of sound mind who has never had any psychiatric issues or psychiatric diagnosis my entire life) and my surgeon questioned if I was "picking" at the wound; which I was not.  It turned out to be a suture allergy-not self mutilation.  However, before this diagnosis he requested I speak with a psychiatrist which I agreed to do. However, without my consent or knowledge the psychiatrist took it upon himself to contact my elderly parents and not only have 2 phone conversations with them but meet with them and discuss me.  The psychiatrist did not advise me that he wanted to do this.  I found this information out several days later.  As you can imagine, this has caused some serious family issues.  I am wondering if my HIPAA rights were violated by the psychiatrist not advising me of his "intent" to discuss me with my family?  The reason I ask is that anytime a provider came into my room and my family was present, they asked if it was alright if my family stayed present or if I would like them to step out of the room.  I feel as if my rights were violated and am disgusted at the turmoil this situation has caused within my family. Any advice would be appreciated.  I did file a formal complaint with HHS and I will be filing a complaint with the hospital itself with their Compliance Officer tomorrow. 

shannon
shannon

@Hettie1863

You need to file a complaint with the American Psychiatric Association and the American Medical Association against both the primary doctor and the psychiatrist as well.  The psychiatrist especially violated their legal & ethical boundaries by contacting your parents like that and should be put on restriction if not lose their license.  Please file complaints immediately, your rights were SERIOUSLY violated.  

kimmy32
kimmy32

I was told by dhs that I'm not allowed to have the test results from my psychiatric evaluation. I don't see how this is possible since for one it's my evaluation and my health insurance paid for it. I couldn't care less what the doctors notes are. I want the results from the IQ test as well as the 500 some odd questioner I did. And now this is being denied to me. Is this legal? What about my rights to my own mental health information?

shannon
shannon

@kimmy32 Put the request in writing and send the request to the Director, the supervisor, the records department, and the person who did the evaluation.  

Leah8884
Leah8884

If the report was requested by you and not, say, your employer, you are entitled to a copy of the report. You are not entitled to any raw data from the assessments.

FernElizabethFisher
FernElizabethFisher

Oh and I'm tired of supporting doctors drug companies and negative feedback

thomachuck
thomachuck

From the point of view of a caregiver and a biological relative, I would be interested in how you get past the gatekeeper in the doctor's office. There is a pretty clearly defined point at which a caregiver has the absolute "need to know" what prognosis is and what cautions need to be observed.

MentallyCorrect
MentallyCorrect

I'm. Changing my name. Maybe then medical perfessionals will treat me as a human and not a blind test subject. # Mental Illness new age slavery and americas new scapegoat.

MentallyCorrect
MentallyCorrect

I believe that we have a two tier system. As SMI I am still my best bet for understanding me. Ever since I was diagnosed what I disliked the most was with holding the opinions of my therapy. If I can't participte 100 percent in my treatment or completely know whats going on with my care . I feel like my civil rights have been violated. Criminals have more access to te medical records than I do.

Jackie
Jackie

 I have had many negative interactions with healthcare professionals who "have the right to know about mental health diagnoses so that they can provide me with better care".  ... Like the (TMJ) specialist, who examined me &

 said he needs 2 special MRIs to make a custom dental devise to stabilize my jaw after an accident. "your jaw 

doesn't know where to land".  He sent me to an ENT (ear,nose, throat) specialist only to make sure there weren't any other problems. A R/O; i.e. none where expected. This ENT began looking @ my Medications demanding to know "why do I take this, & why do I take that??" Then he briefly examined me, said "there's nothing Wrong with you. &  

walked out of the exam room.

 The next time I saw the TMJ specialist, he began grilling me in the same condescending, demanding tone of voice.

Why are you taking this medication, & that medication… then he said “I’m not doing the MRIs. If you want us to make you a brace we will. If you don’t we won’t”. I tried to say quote him from the inijtial visit. He looked @ me like I was a piece of …. & walked away followed by the students/interns who had taken part in my initial exam. 

 This is not an unusual  reaction from health care professionals.

I am respectfully suggesting that this “sharing for my benefit” be stopped. I am so humiliated by being treated like this that I seriously hesitate to go to doctors, Emergency rooms, etc. Ill go away with poor quality or no care & the humiliation.

Jackie Zinberg, R.N.

'


ergonomic mats
ergonomic mats

If my therapist had refused to give them to me, I would have had them sent to my sister and turned her into a therapist for purposes of getting the notes.  We should have a right to any information contained in our medical record.  Mental health professionals should have the guts to stand behind what they wrote.

frustrated husband
frustrated husband

as the spouse of a mentally ill wife  i find the HIPAA  law frustrating at best I cant talk to her Doctors about her health or conditions But I can pay her bills debts and clean up her messes. but no on will talk to me. so that you HIPAA. 

Vinny1969
Vinny1969

6 months ago I needed to get a psyc evaluation for probation well it's been 6 months and we haven't gotten a report me or my probation how long is too long to wait for a copy is their anything I can do to get a copy faster every week they have a different excuse why it's not done

Worried spouse
Worried spouse

My 52 year old wife has been going through a series of mental/physical issues since she turned 40. About 6 months ago she started having delusions of parasites crawling through her body. She shaved her head and went to the emergency room at 3AM. They sent her to a 72 hour psych hold. Within 24 hours after anti-psychotic meds were administered she was lucid and understood the difference between reality and delusion. She was released and the last 6 months were really good. She cut out all of her meds and seemed to really be in the moment and not drugged for the first time in 12 years. Last week she started having delusions again. She thought i was poisoning her, there were people trying to break into the house and finally she thought that her bladder was leaking in her body. I tried to convince her this was not happening but she did not believe me. She snuck out and starting knocking on neighbor's doors at 2AM. The paramedics came, took her to our local Kaiser Permanente where they kept her overnight, then transferred her to a psych hospital over an hour away. This time she signed a HIPAA agreement and now nobody has contacted me, when i finally found out where she was sent nobody there will answer any of my questions. It is now 6 days since the breakdown and i don't know what to do. I don't know if she is too incapacitated to call me or she is still suffering delusions. I am trying to keep it together for our 2 teenaged daughters, i have lied to my work in order to take care of our girls but i am frantic at this point. I and our kids are not the enemy. I can actually impart important historical information with the doctors treating her. I cannot believe that we have no option other than to wait and see if she ever gets to come home? Can't they see the unbelievable mental stress that they are putting on her own loved ones? What can we do at this point?

careforyourmind
careforyourmind moderator

@Worried spouse We absolutely understand your frustration. For us, it is concerning that the hospital would apparently encourage your spouse to sign an exclusionary agreement in her likely compromised state. They should know that family involvement tends to lead to improved outcomes.

Also, regardless of her wishes, HIPAA directs providers to act outside of a patient's stated wishes if the provider deems it in the "best interest" of the patient. If you are able to support her care and treatment, particularly when her judgment may be impaired, then there is a strong argument that having you involved in medical decision-making is in her best interest.

We are assuming that she has not executed a durable power of attorney or other health directive. If she has, then provide it to the hospital. (If she doesn't have one, then please, when she is stable, have her develop and sign one. Many providers work with their patients to establish a plan for who should do what during a psychiatric emergency.)

Also, if you have contact with her previous mental health provider(s), consider if they can help in any way. They may have an authorization in the file or, depending on how recently this relationship existed, may be able to intervene at the hospital.

To the best of our knowledge, neither HIPAA nor state privacy laws prevent health providers from listening. If you call and say that you know they cannot reveal anything about whether she is there and what is her condition, but in case she is there, you have information you want to provide to support her care. Ask to speak to one of the clinicians and ask them to take notes, in case the information could prove useful.

You could also inquire at the hospital about how to challenge this agreement on the basis that your wife signed it when she was not in a lucid state of mind.

We're sorry that you're going through this difficult situation. Try to organize your thoughts so that you'll be able to use whatever time you have to talk with someone at the hospital productively. It will probably not be a conversation on both sides, but at least you'll be able to provide information that can support her care.


We wish you a successful effort. Take good care.


M
M

There's so much bull crap involved in this process. HIPAA does almost nothing for the patient. The patient has no recourse or legal help at all. The "complaint" departments are a joke and any misdiagnosis will be used against the person, even when they try to amend their medical records. Not much can be done really. Sorry folks.


CaseyJones1
CaseyJones1

I am glad that they offer some privacy to people who suffer from mental health issues.  It can be a touchy subject.  It is also hard to find the balance between sharing enough and sharing too much.  You want to make sure enough is shared to keep others safe and let other healthcare officials know what is going on but over sharing can be unethical.

http://www.alphacm.com 

boudiceatx
boudiceatx

While mental health professionals can prevent patients from accessing psychotherapy notes, there are ways to get those notes.  My psychiatrist refused to give me psychotherapy notes, so I just had them sent to a therapist who gave them to me.  If my therapist had refused to give them to me, I would have had them sent to my sister and turned her into a therapist for purposes of getting the notes.  We should have a right to any information contained in our medical record.  Mental health professionals should have the guts to stand behind what they wrote.

player 09
player 09

In comparison to HIPAA regulations I have found that the actually provides such as Doctors's and Psychiatrist or other related medical professions to keep the privacy act up front with no disclosure of personal information to others including family . the Negative side of the story is I have had expereince where personal information was given out undermining my respect and privacy as a a person in treatment and recovery. I also made sure that I reported the intrusion directly to legal services and other organizations. HIPAA Laws have been violated by unwanted users some how the information you think is private is turned into gossip. What I think the HIPAA Act should allow is a personal identification to the consumer when information is asked about yourself , that you are contacted immediately by phone to assure your information. the other idea would be to restrict comminication to unknown agencies that seek idenity theft. No one likes to be used or intruded about their life medical history unless otherwise a consent be signed and approved. When a family member  is concerned about your condition or you have been hospitalized due to illness it would really depend on the individual to accept their family's interested. But in cases where behavioural or mental illness occurs or family suspect that your attitude or behavoral patterns are much different, yes they should have the people addressed immediately at a intervention or crisis faculty. Before attempts are made against the community, themselves other incident people. We have over the past 3 years heard or maybe even witnessed these massive shooting out of desperation from persons needing a mental health checkup and check-out hospital. To much and to many without notice have ended up in the hands of a person seeking treatment. So without a doubt if you in your daily routine see, hear or even become aware of someone elses mental condition. Please take the time to convince them and even go along with them to the hospital to get that needed support. HIPAA laws do not give out unnecessary information they are to protect all people whether able or not to make that decision in time. Never be afraid to speakup or speak-out for yourself and let others know that we are a people of FREEDOM and equal rights.

Phyllis D.CPS,editor

StephenBonin
StephenBonin

First, having just responded to numeratrix, I need to extend empathy. There I was encouraging you about healings/ breakthroughs connecting to effective results with the health profession overall, and I failed to express empathy. We peers need to keep in mind empathy toward every individual we me; if we don't acknowledge compassion for their pain, we cannot make any leeway in pointing them toward hope.

Welcome to this part of CFYM, numeratrix!

numeratrix
numeratrix

When it comes to medical records and alleged privacy rights...I'm alarmed how often I feel like I have no rights. You have any provider characterize you in a careless, mean, hostile, or in any discriminatory fashion really and it's there indefinitely now. You can't have anything removed, and the best you can hope for is a footnote/amendment IF they allow your request to "correct" errors. Providers copy and paste (more and more with large health care companies eating up entire regions), and there is few options to get away from it (and especially with electronic records now). They don't have to tell you much of anything of what's been shared, and if you can't afford to have all your records copied to you you're out of luck (unless you sit for hours reviewing on site). I think of the Seinfeld episode Dr. van Nostrum and Elaine. There is no such thing as a fresh start with a doctor any more. I'm tired of constant discrimination. I've forgone and/or delayed seeking care many times. I have to be in some major pain before I'm not hmmming and hawwwing about going in. Don't even have a primary any more. I wait until it's either time to consider urgent care or an emergency department, and even then I've skipped the ER when the nurse line told me I needed to go in. I've learned to be very guarded about what I share with any provider now.

StephenBonin
StephenBonin

Numeratrix, I am finding after treatment by the mental health profession since 1986, and more consistent treatment by dentist, eye doctor, primary since 2008 that as my healing increases, my attitude improves. I am aware of the trusting, grateful attitudde I am projecting, and the kind professionalism they are returning. Please accept my encouragement to access resources for your hurrts; I promise you that as you even begin to speak with the professional on the phone in a tone of tremendous pleasantness, of newness of the day, that your situation will improve. If your rights are still being violated, working on your faith and hope will equip equip you to pursue justice and remain in control. Thank you for sharing.

M
M

@numeratrix Totally understand where you're coming from. I'm sorry you had to go through this. I'm in a similar (though less dire) situation. Red tape continues to entrap me but I can't let it drag me down. I have to go on living my life (I WON'T LET THEM WIN!).

You can get help, just not from "professionals". You have to form your own support system, this is what I'm learning through: meditation, self-defense, Women's Groups and social causes for justice. Hopefully these online discussions can help. Best wishes for you, Numeratrix and all others who are going through this.

StephenBonin
StephenBonin

The term "private conversations" toward the very end of this first installment brings to mind my experience. Although inpatient communication with medical professionals/ therapists is not specifically addressed, I believe my perceptions are valid. The first example I offer goes back to 1986, my first inpatient. I had refused to see a psychologist since 1979, my first semester at university. My Mom was urging me on the phone to do so. Therefore, a nervous breakdown finally put me in company with mental health professionals after symptoms commenced seven years previous. Upon the first few days of a four-week stay, I was a volcano, spewing obscenities at my psychiatrist connected to sexual trauma. My parents initiated a visit with him, my ex-wife and me and the end of the four weeks. If he would have divulged my nefarious messages, people would have felt hurt. On the contrary, the breakthrough might have happened 27years earlier. Of course, as we read in this article, the mental health professionals realize that our words recorded in psychology notes CANNOT be treated as truth.


Yes, my peers, the situation I just described occurred many years before HIPAA. Because of my trauma my voice was buried. A year after the first hospitalization, I was inpatient again--in a different location. My psychiatrist wanted to send me to the State Hospital because she was so exhausted and confused about me. So, in 1987, my saintly Mom, who did not know about trauma that I was absolutely unable to talk about, intervened by writing a letter to the psych. pleading a case of all my virtues and accomplishments so far in life--up to age 26.


Who knows what would have happened if I would have gone to a place whose very name caused fear and dread in my parents' spirit.


Regarding the third question about balance between patients' rights and families seeking to know,  a year ago, celebrity Pastor Rick Warren's youngest son committed suicide. Reading information online, from Mr. and Mrs. Warren's appearance on a late-night show, they knew he had illegally obtained a gun. Nevertheless, they did not interfere because: 1. he had suffered all his life with severe depression along with a personality disorder; and 2. as born-again Christians who knew their son as a virtuous person  wanting for so long to die and go to Heaven (they adamantly believed that the suicide would  not prevent him going to Heaven). 


My conclusion now: HIPPA guidelines for us and our treatment teams need careful study and ongoing evaluation.

kimgallen
kimgallen

In terms of what I think should change about the HIPPA law, I think that the aspect of providers talking among other providers about the treatment of a patient should take stronger precautions. Though I do grasp why health care staff need to coordinate services, and why they may need to discuss a patient's condition over the phone with family members, providers and/or the patient, I still think that the "reasonable precautions" are not strong enough. Most of the time, reasonable precautions include things like lowered voices or talking away from other people, yet in my experience, this is not really reinforced. For example, I have heard providers talking on the phone about other patients, as the providers or health staff are sitting too close to the lobby window type area. Those of us waiting in the waiting room can hear these conversations. I have also heard providers call out names in a waiting area. In addition, I have heard staff communicate health information as they coordinate services and read aloud from computer screens. Overall, I think that the reasonable precautions on oral communications needs more safeguards. I do not expect absolute protection of protected health information in oral communications, but I do feel that covered entities need stronger policies and procedures in place that reasonably address these concerns. 

StephenBonin
StephenBonin

@kimgallen  Kim, thank you for sharing. Your example brings to mind my therapist in 2003. Two therapists shared a practice, their doors across from each other, with a carpeted waiting area of sufficient size. Seated and waiting, I could clearly hear the therapy, the details. So, I reported the problem immediately, and they responded by putting speakers at a loud volume transmitting music from a popular station. Also, Kim, you mentioned therapists talking with each other about individual consumers. I empathize with their need to "vent" at times because, for example, sometimes consumers--like me yesterday--are extremely tearful and tense and wordy. I think my therapist did a great job, and I told him so. Still, he is only in his second year, and I would understand if he needs to process with his partners in the treatment team--JUST AS LONG AS HE IS DOING IT CAREFULLY! Protected communication that won't be heard or seen.

I feel invigorated to brainstorm. and look forward to the ensuing articles.


Have a great day, Kim! 

StacyK
StacyK

In response to the question, What experience, negative or positive, have you had in dealing with HIPAA while obtaining mental health care? I'd like to share that as a parent of an older child who lives with mental illness, I find this weeks topic, in regard to patient privacy, extremely important. What I have experienced, in regard to obtaining care for my loved one, has been both negative and positive. On the one hand, I can understand and appreciate the HIPPA act. Due to the act my loved ones health information, mental and physical, is protected, barring any exceptions to the rule. Who wouldn't want their personal health information as well as their loved ones health information protected? This is of course extremely important, and the HIPPA act seems to provide appropriate protection. On the other hand, when my loved one is unstable and in need of crisis intervention services the HIPPA act seems to impede me from getting her the help she needs, especially if she doesn't sign a release of information document allowing her treatment team permission to talk to me. This has happened to us on occasion. What's sad is that families are often very aware when their loved one needs care, but their hands are tied in getting appropriate help, especially if the child is 18 years old or older. I've been told, when my daughter hasn't given permission for her treatment team to talk to me, that if she's a harm to herself or others then I can call 911. That's a problem for several reasons! First, my idea of her being a harm to herself or others may not be the same as a clinicians. Also, that's a frightening proposition. Let me get this straight. It's as if I'm being told that my awareness is not enough. I have to wait until she is a harm to herself or others? What about the precious time being wasted waiting for something tragic to happen? The end result could be catastrophic. Why do we have to wait for catastrophe to happen? What can we do in the interim to avoid such harm? Should we be listening more closely to parents, caregivers, friends and loved ones? Of course, there is no easy answer, but maybe if we solve this issue we can perhaps stop the tragic events we see in the news.

My daughter would like to share her thoughts. She said, "What about creating something like the One Person Law? where only under certain circumstances the one person, picked by the person living with a mental illness, could call and report their concerns, but there is still a protection of rights. Of course the one person would have to be a person they trust and they could only report their concerns and maybe a treatment team could follow up with the person who may be unstable. This is just an idea thrown out there, but it could save a person's life. This is different from advanced directives or a living will. The one person would have no legal rights other than to report mental health concerns for another person which would have to be followed up. Therefore, in the event of an emergency or concern, the one person would have direct contact with the doctor or counselors which would create a ripple effect in essence to mental health care in getting the person evaluated rather than waiting for the person to be a harm to self or others."

StephenBonin
StephenBonin

@StacyK  Stacy, I think your daughter's idea of a "One-Person Law" is logical because the consumer chooses a person he/she trusts. This trustworthy friend knows the consumer well, and, in sympathy and empathy, would carefully disclose information. On the other hand, HIPPA's intent connected to a therapist's notes helps us to ponder the difference between what an unbalanced consumer says and what is really going on. The trained therapist protects the notes so that the literal is not haphazardly handled, thereby hurting other people's feelings, perhaps even causing them to lose hope, to walk out on the consumer. I've revealed trauma which dammed my voice. When I started speaking, I hurled blame about my parents. I am so sorry now that the breakthrough and healing has occurred that I could not prevent my resentment and blame of them from forcefully flowing. Just thinking about a therapist telling them my ground-zero, literal comments sends shivers up my spine. Horrors.


Regarding your first paragraph, you do an outstanding job painting the agonizing aspects of this Act.


Thank you, and Good Day!



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  1. […] the readers who participated in week one’s poll, 64% stated that HIPAA regulations interfered with their helping a loved one deal with a mental […]

  2. […] very few exceptions, the HIPAA Privacy Rule allows the patient and an authorized person to “review, inspect, and receive a copy of the medical […]