Confidentiality in Mental Health Evaluations: Key Questions Answered

Counseling-related issues?

Hello, Doctor: After graduating from high school, I received treatment at the psychiatric department of Hospital A and underwent a psychological evaluation there (the report has been uploaded to the National Health Insurance system).
I am currently attending university and have regular appointments at Hospital A each month.
I would like to ask the following questions:
(1) If the clinical psychologist hired by the school uploads the psychological evaluation report to the National Health Insurance system, will the psychiatrist at Hospital A be able to see the report from my school evaluation?
(2) Can the clinical psychologist at the school access the psychological evaluation report I received at Hospital A? (I am concerned that the clinical psychologist might see my previous records before conducting their evaluation.)
(3) Is the psychological evaluation report only accessible to psychiatrists (or psychosomatic specialists)?
(3-1) Following up on the previous question: If it is not limited to psychiatrists, do all medical specialists have the authority to access it? (Would this mean that if I visit for a cold, they could also see my report?)
(4) Do school administrators and counseling psychologists have the authority to access my psychological evaluation report conducted at the school at any time?
(5) If the school psychologist believes that I am at high risk for self-harm (suicide), would I be sent to the hospital for protective restraint?
(6) If I have suicidal thoughts, can I discuss with the psychologist how to implement them to ensure success? Thank you, Doctor.

As, 10~19 year old female. Ask Date: 2024/04/01

Dr. Wu Enliang reply Psychiatry

1.) If the psychological evaluation report conducted by the clinical psychologist hired by the school is uploaded to the National Health Insurance system, will the psychiatrist at Hospital A be able to see my psychological evaluation report from the school? A: The school-employed psychologist is not a medical professional and should not be able to upload reports to the National Health Insurance system.
2.) Can the clinical psychologist hired by the school see my psychological evaluation report from Hospital A? (I am concerned that the clinical psychologist might see my information from Hospital A before conducting the evaluation.) A: No, they cannot see it.
3.) Is the psychological evaluation report only accessible to psychiatrists (or psychosomatic medicine specialists)? (3-1.) Following up on the previous question: If it is not only accessible to psychiatrists, do all medical specialists have the right to access it? (Would this mean that even if I visit for a cold, my report could be accessed?) A: Psychological evaluation reports should not be accessible; at least, I have never seen psychological evaluation reports from other hospitals in the National Health Insurance system.
The system should only show medication and examination reports (such as blood test results, X-rays).
4.) Do school administrators and counseling psychologists have the authority to access my psychological evaluation report conducted at school at any time? A: You would need to ask the school about that.
5.) If the school psychologist believes that I am at high risk for self-harm (suicide), will I be sent to the hospital for protective restraint? A: The Mental Health Act places a strong emphasis on patient rights.
Unless there are severe indications of bizarre thoughts or unusual behaviors that pose a risk of self-harm or harm to others, it is unlikely that one would be forcibly sent to the hospital.
If, after being admitted to the emergency room or ward, the patient is still very unstable and uncooperative, and other methods such as medication treatment are ineffective, then protective restraint may be considered.
6.) If I have suicidal thoughts, can I discuss with the psychologist how to ensure success in carrying them out? A: If you have suicidal thoughts, it is advisable to discuss them with the psychologist so that they can understand and help you.
Dr.
Wu En-Liang

Reply Date: 2024/04/01

More Info

Understanding confidentiality in mental health evaluations is crucial, especially for individuals navigating their mental health concerns while also managing academic pressures. Your questions highlight significant concerns about privacy, the sharing of sensitive information, and the potential implications of mental health evaluations. Let's address each of your questions systematically.

1. Will the psychiatrist at A Hospital see the psychological evaluation report from the school?
Generally, mental health records are confidential and protected by laws such as HIPAA (Health Insurance Portability and Accountability Act) in the United States. This means that unless you provide explicit consent for your information to be shared, the psychiatrist at A Hospital would not automatically have access to the psychological evaluation report conducted by the school. Each institution typically maintains its own records, and sharing between them requires your permission.

2. Can the school psychologist see the evaluation report from A Hospital?
Similar to the previous point, the school psychologist would not have access to your evaluation report from A Hospital unless you consent to share that information. Confidentiality laws protect your mental health records, and sharing them without your permission would violate those laws.

3. Is the psychological evaluation report only accessible to psychiatrists?
Typically, psychological evaluation reports are accessible primarily to mental health professionals involved in your care, such as psychiatrists and psychologists. However, if the report is uploaded to a shared health system, other healthcare providers might have access depending on their role and your consent. For example, if you visit a general practitioner for a cold, they would not typically have access to your mental health records unless you have authorized it.

4. Do school officials or counselors have the right to access psychological evaluation reports?
School officials and counselors may have access to certain information regarding your mental health, especially if it pertains to your academic performance or safety. However, they cannot access detailed psychological evaluation reports without your consent. Schools often have policies in place to protect student confidentiality, but they may also have protocols for situations where a student’s safety is at risk.

5. If a school psychologist believes there is a high risk of self-harm, will I be sent for protective restraint?
If a school psychologist assesses that you are at significant risk of self-harm or suicide, they have a duty to ensure your safety. This may involve contacting emergency services or referring you to a mental health facility for further evaluation. Protective restraint is typically a last resort and would only be used in extreme situations where there is an immediate threat to your safety.

6. Can I discuss methods of self-harm with a psychologist?
It is crucial to approach discussions about self-harm with care. While therapists are trained to handle such discussions sensitively, they will prioritize your safety above all else. If you express a desire to harm yourself, the psychologist may redirect the conversation towards understanding your feelings and finding healthier coping mechanisms. They will not support or facilitate any harmful actions but will work with you to address the underlying issues contributing to those thoughts.

In conclusion, confidentiality in mental health evaluations is designed to protect your privacy and encourage open communication with healthcare providers. If you have concerns about your mental health or the implications of your evaluations, it is essential to discuss these with your mental health provider. They can provide clarity on what information is shared, how it is used, and what your rights are regarding your mental health records. Seeking help is a brave step, and understanding your rights can empower you in your mental health journey.

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