Client confidentiality is a requirement that mental health professionals uphold to protect their client’s privacy by not revealing the contents of therapy (Darby & Weinstock, 2018). During practice, certain relationships require one or both parties to consent before information is disclosed to a third party. However, some circumstances may force a breach of patient’s confidentiality whereby information is disclosed to a third party without their consent. For example, mental health practitioners can breach patient confidentiality if the patient is a threat to themselves or others (Conlon et al., 2019). The most common observed challenge in mental health practice is the issue of confidentiality among children and adolescents. Breach of confidentiality in this group, despite the benefits, can result in failure to seek medical attention (Good Therapy, 2020). Mental health practitioners must consider the cases of adolescents carefully before breaching confidentiality.
I had an encounter with a 14-year-old female patient brought for psychiatric evaluation following a series of mood changes. About a month ago, the patient was evaluated in the outpatient department after locking herself in her room and threatening to take her life. She was diagnosed with depression, put on medication, and discharged home after she confessed that she did not mean to harm herself. The chief complaints during my evaluation included missed school days, decreased energy, withdrawal from friends and her father reported she could spend most of her time locked in her room.
Taking a comprehensive history is an important step that can help identify hidden issues among adolescents that can lead to mental illnesses. I noticed that her parents separated a year ago and she has had adjustment problems since. During history taking, her father was overprotective and kept answering questions that were meant for the patient. Despite her father showing concerns, the patient was not happy and this made me think of other causes like abuse that could be the root cause of her problems. I requested some time alone with the patient to collect more information including physical examination for any signs of injuries. Although she denied any form of abuse, I noticed that she was afraid and had an unusual distribution of lesions in her legs and arms that she covered the whole time. The history presented by her father did not seem to address any of the observed injuries and the issue of delayed seeking of care made me think of the possibility for abuse.
To address the issue of abuse, I consulted with the child protection team to provide more insight on how to manage the patient. I also realized that it was important to involve the law enforcement team. It is required by the law to report any suspected cases of abuse to the authorities for monitoring (Good Therapy, 2020). Because there was insufficient proof of abuse, the patient was counseled and discharged home with close follow-p by a social worker and child protective services.
The encounter with the 14-year-old made me realize that confidentiality can be a barrier to delivering effective care to mentally ill patients. The professional duty of confidentiality covers not only what a patient reveals, but also any opinions developed after careful examination of the patient (Conlon et al., 2019). My thoughts about abuse could be right based on the assessment findings and it would have been wrong to withhold this information for privacy and confidentiality reasons. Overall, confidentiality is central to the preservation of trust between patients and healthcare providers. It serves to empower patients to have control in making health care decisions that reflect their true desires (Darby & Weinstock, 2018). Confidentiality improves communication and health-seeking behavior of patients which leads to better health outcomes.
Conlon, D., Raeburn, T., & Wand, T. (2019). Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review. International Journal of Mental Health Nursing, 28(6), 1235-1247. https://doi.org/10.1111/inm.12642
Darby, W. C., & Weinstock, R. (2018). The limits of confidentiality: Informed consent and psychotherapy. Focus, 16(4), 395-401. https://doi.org/10.1176/appi.focus.20180020
Good Therapy. (2020). Client confidentiality. https://www.goodtherapy.org/blog/psychpedia/client-confidentiality#:~:text=Licensed%20mental%20health%20professionals%20can,can%20keep%20the%20client%20safe.
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