Privacy issues in mental health care still elusive

A group of national health leaders that convened in Philadelphia Wednesday is aiming to improve how care providers deal with privacy issues for people with mental illnesses. Striking a balance between respecting patients’ privacy and providing the best care isn’t always so easy.

In the health arena, laws exist to ensure that personal health information is kept confidential. A mainstay of this is the federal Health Insurance Portability and Accountability Act, known as HIPAA. Pretty straightforward, right? Not exactly, according to Nadine Kaslow, chief psychologist at Emery University School of Medicine and president-elect of the American Psychological Association.

“HIPAA is there to protect a patient’s privacy for sure, but it’s also vague on certain issues around under what conditions you can share,” said Kaslow. “And you also need to think about, on the one hand protecting the patient privacy, and on the other hand, ensuring the patient gets the highest quality of care. […] So you’re trying to walk that fine line on a continual basis.”

For example, when is it all right for a therapist to share information with others, such as a family member, without breaching patient confidentiality? While that’s justified in some emergencies, patient advocates want to be sure that such information doesn’t get in the wrong hands, and that the stigma of mental illness doesn’t prevent people from getting care.

A bigger challenge, according to Dr. Arther C. Evans, commissioner for the Philadelphia Department of Behavioral Health and Intellectual Disability Services, is that many practitioners don’t have a clear understanding of these privacy laws — and even misinterpret them.

“One example of that is that a family member calls up and says, ‘Is my father there?’ or brother or sister, and the provider says, ‘I can’t tell you anything,'” Evans said. “But the person [provider] could say, for example, ‘Well, I can’t answer that question now, but if you give me some information now I will see if I can help you.’ And so that gives the person the opportunity to go back and engage in their treatment.”

Complicating the matter even more is that state and local privacy laws may vary, Evans says. And Pennsylvania’s law for sharing information about an individual’s substance use treatment is especially strict.

Both Evans and Kaslow acknowledge these complexities make it hard for consensus around one common approach. The two joined several dozen health and policy leaders from around the country in Philadelphia Wednesday to develop a plan for addressing these mounting challenges. The Scattergood Foundation organized the event.

Participants in the daylong conference acknowledged that the onset of health reform rases the stakes on privacy issues, with more people gaining access to mental health services and dong so in different ways.

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The Scattergood Foundation supports WHYY’s behavioral health coverage.