Confidentiality Information

Please note that the information provided here is not comprehensive. If you have more detailed concerns about confidentiality, you may wish to consult with a legal professional who is familiar with medical and mental health confidentiality laws.

Risk to Self or Others
If a mental health clinician has a reasonable concern that a client is about to attempt suicide or is at high risk of suicide in the near future, they have a duty to break confidentiality to prevent the client from harming themselves. A therapist also must break confidentiality if they have a reasonable concern that a client is about to physically harm or kill an identifiable person or group of people. A therapist may also break confidentiality if they have reasonable concern that a client will intentionally commit damage to property (e.g., commit arson, detonate a bomb that could harm others). In these situations involving risk to self or others, the therapist may call the client’s emergency contact or another family member or close friend, the client’s psychiatrist or general doctor (if they have one), emergency personnel (such as paramedics), police, and/or other parties in order to prevent harm to the client or to others. Therapists have a duty to warn potential victims if a client makes a threat of bodily harm or death toward an identified victim.

Child, Elder, and Dependent Adult Abuse
Mental health clinicians are mandated reporters for child abuse. This means that if a client tells a therapist that a person (including the client) who is currently under 18 years is being physically or sexually abused or is at likely risk of being abused by a known perpetrator, the mental health professional must report this to child protective services or the police. If a client experienced physical or sexual abuse while they were a minor but are now over 18 years old, the therapist is not mandated to report the past abuse to the authorities but may need to contact child protective services or the police if the person who abused the client is currently abusing minors or has access to minors and is likely to abuse them. Therapists must make a report to child protective services or the police if a client tells them that they have abused or neglected a minor or plan to do so or if the client reports having knowingly viewed child pornography or participated in creating, storing, or distributing child pornography.

Depending on state laws, therapists are mandated reporters for the abuse of elder adults and adults with disabilities that require them to depend on others for their care. In some states, only therapists employed by care facilities where the elder or dependent adult lives and/or receives care are mandated reporters; however, therapists still may break confidentiality to report elder or dependent adult abuse to adult protective services and/or the authorities to prevent harm to a known victim or suspected victim of such abuse.

Minors
Clients under 18 do not have the same right to privacy as adults, and these rights vary by state.

In California, minors 12 and older who are deemed mature enough to intelligently participate in therapy may consent to outpatient therapy on their own. The parent/guardian will be involved in treatment if appropriate; however, if involvement of the parent/guardian in treatment would be inappropriate or harmful to the minor, the parent/guardian may not be involved in treatment. Emancipated minors and minors 15 and older who are living on their own can also consent to treatment without the involvement of a parent/guardian. In these situations, the therapist would need the minor client’s explicit consent to provide any confidential information to a parent/guardian (or other party).

In Pennsylvania, minors 14 and older may consent to outpatient therapy without parental consent or notice. A parent or legal guardian may also consent to outpatient mental health examination and treatment on behalf of a minor without the minor’s consent.

Legal Situations
In the rare occurrence that your therapist is given a court order to release your mental health records for a legal proceeding, the therapist must comply. If you are involved in a legal matter and your lawyer wants your mental health records, the therapist can release them with your explicit permission.

You may request your own therapy records from your mental health provider, and they are legally obligated to provide them; they may discuss any concerns with you about your receiving your records before releasing them. They may provide a treatment summary as an alternative to complete records if you agree to this. They may charge a nominal fee for the time spent and expense of copying and printing records.

Military and Government Employment
People seeking government jobs that require security clearance must disclose any therapy they’ve received over the past seven years to their potential employer. A private therapist who treats a client who is in the military is not required to release information to the client’s chain of command, but if the therapist works for the military and the client is seeing the therapist in a military work setting, the therapist must follow military protocol.

Insurance Companies and Privacy
If you are using insurance to pay for therapy, mental health information (e.g., how many appointments you’ve had, your mental health diagnoses) will be accessible by the insurance company. Your insurance company can determine whether the therapy you seek is medically necessary, and if they determine it is not, they may decline to cover those services.