Mental health professionals typically have a duty to maintain doctor-patient confidentiality with their clients under HIPAA. This confidentiality covers “privileged communications,” which are discussions between two individuals that involve confidential information. State laws generally recognize a doctor-patient privilege, and this extends to psychotherapists as well. Therefore, in most cases, what you talk about in a therapy session stays in the room.

There are limits to this privilege, however, and this duty of care can be overridden. Therapists are required to break confidentiality in many cases. When does client confidentiality end and public protection begin? Do psychiatrists and therapists have a duty to disclose patient information if a patient poses a threat?

What Types of Threats Must Be Disclosed?

Therapists typically have a duty to report threats when imminent harm is involved. Specifically, they usually have a duty to warn authorities about two main types of threats: threats of harm to others and threats of self-harm.

If a client discloses a plan to cause serious bodily harm to another identifiable person, the therapist is generally required to report this threat to the police. When a patient threatens to kill another person, the psychiatrist is no longer bound by their duty of confidentiality toward the patient. If the patient plans some sort of imminent attack or calamity, the psychiatrist or psychotherapist generally has a duty to disclose the information under most states’ laws. The therapist may also need to warn the intended victim or potentially affected parties directly.

If a client expresses serious intent to harm themselves and has a specific plan to do so, the therapist may need to take steps to intervene. This could include hospitalization or involving emergency services.

But it’s not always clear how this information should be disclosed, or to whom. For example, if a psychiatrist suspects that a patient plans to kill a particular person, should they tell that person? Or should they simply go to the police? It’s a tough call because a psychiatrist often hears about troubled thoughts. It’s not always easy to distinguish which ones pose a real threat and which can be treated through the medical process.

Abuse of Children and Elders

In addition to threats, therapists are also mandated reporters for suspected abuse of vulnerable populations. These include child and elder abuse. Therapists are required by law to report suspected abuse of any child under 18. Many states also have laws mandating therapists to report suspected abuse of dependent adults or elders.

Child Abuse

Therapists play a vital role in identifying and reporting child abuse and neglect. All states have mandatory reporting laws that require professionals, including therapists, to report suspected abuse of a minor to the appropriate authorities.

Therapists typically need to report physical abuse to children, including any injuries (e.g., bruises, burns, fractures) that appear non-accidental or inflicted by another person. They also need to report sexual abuse, including sexual assault or any suspicion of sexual activity between an adult and a child.

In addition to those more obvious and visible forms of abuse, a therapist must also report more subtle forms of child abuse, such as emotional abuse. This could include repeated patterns of belittling, humiliation, or verbal threats towards a child. If a child expresses experiencing or witnessing domestic violence at home and a therapist finds out, they have to report it.

Finally, if a therapist suspects that the child is being neglected, they must report it. This includes the parent or guardian’s failure to provide for a child’s basic needs for food, shelter, clothing, medical care, or supervision, leading to physical or emotional harm.

Elder Abuse

Similar to child abuse, many states have laws mandating therapists report suspected abuse of dependent adults or elders. Elder abuse can take many forms and include physical abuse, emotional abuse, and neglect. Especially when an elder adult is depending on someone else in the family, failing to provide for an elder’s basic needs for food, hygiene, medical care, or medication can be considered neglect.

In addition, elder abuse can include financial exploitation, such as misusing an elder’s money or property for personal gain. Social isolation of an elder adult (restricting an elder’s contact with family and friends) is also considered a form of abuse.

Concerns for Therapists

It’s not always easy for a therapist to report abuse and threats, however. Reporting elder abuse can be complex because elders may be hesitant to come forward due to fear of retaliation, shame, or dependence on the abuser. Therapists need to be sensitive to these concerns while still fulfilling their legal obligation to report suspected abuse.

In some cases, the psychotherapist’s response to a situation in which their patient tells them certain information could subject the therapist to liability. The improper disclosure of these facts or the failure to report threats to law enforcement could have dire consequences for the therapist.

For example, if a patient ends up killing someone, and the psychiatrist knew the client was a danger, then the psychiatrist might be held liable for negligence. Not only could the therapist’s license and professional reputation be at risk in such a case, but it would also be a potential cause of action for a lawsuit from the victim’s family.

On the other hand, while therapists have a responsibility to report suspected abuse, they should also take steps to avoid false allegations. This may involve gathering information from other sources and carefully documenting the client’s disclosures. Therapists are obligated to keep your information confidential, with some exceptions. Disclosing private information without consent could be grounds for a lawsuit.

What’s the lesson from this discussion? Psychiatrists and therapists must check state laws to be clear about their duty to disclose patient information. By doing so, they can potentially save themselves from lawsuits — and perhaps even save someone’s life.

If you are a therapist or suspect child or elder abuse, it’s important to consult with your state’s licensing board or a legal professional to understand the specific reporting requirements in your area. There are also national resources available, such as the National Child Abuse Hotline (1-800-422-4453) and the National Adult Protective Services Association (NAPSA).

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