Task
Force
Reports

This is the ninth report in a monograph series authorized by the Board of Trustees of the American Psychiatric Association to give wider dissemination to the findings of the Association's many commissions, committees, and task forces that are called upon from time to time to evaluate the state of the art in a problem area of current concern to the profession, to related disciplines, and to the public.

Manifestly, the findings, opinions, and conclusions of Task Force Reports do not necessarily represent the views of the officers, trustees, or all members of the Association. Each report, however, does represent the thoughtful judgment and consensus of the task force of experts who formulated it. These reports are considered a substantive contribution to the ongoing analysis and evaluation of problems, programs, issues, and practices in a given area of concern.

June, 1975

Judd Marmor, M.D.
President, APA, 1975-1976

Library of Congress Catalogue Card No. 75-5319
Copyright 1975 by the American Psychiatric Association

1700 18th Street, N.W., Washington, D.C. 20009

CONFIDENTIALITY AND
THIRD PARTIES

A Report of the APA Task Force on Confidentiality as It Relates to Third Parties

Maurice Grossman, M.D., Chairperson
Jack D. Barchas, M.D.
Richard G. Johnson, M.D.

Alan L. Krueger, M.D.
Joseph Satten, M.D.

Approved for publication by the Council on
Professions and Associations

Lewis L. Robbins, M.D., Chairperson

Ruth Barnard, M.D.

Robert S. Garber, M.D.

Norman Q. Brill, M.D.

William R. Sorum, M.D.

Martin Booth, M.D. (Observer-Consultant)
Harry H. Brunt, Jr., M.D. (Assembly Liaison)
Donald W. Hammersley, M.D. (Staff Coordinator)

American Psychiatric Association

1700 Eighteenth Street, N.W.
Washington, D.C. 20009

CONTENTS

Introduction: General Principles Governing Confidentiality of
Psychiatric Treatment and Disclosures to Third Parties ...

Definition of Purpose

Recommendations Regarding Education Coordination
With Other Agencies and the Need for an
Ongoing Group

Acknowledgements

Appendices

A. General Principles Governing Confidentiality

B. Proposed Coding for Mental Disorders

C. Position Statement on the Need for Preserving
Confidentiality of Medical Records in Any National Health
Care System

D. Position Statement on The Role of Confidentiality in
Volunteer Military Drug Abuse Treatment Programs
E. Recommendations of the Task Force on Confidentiality as
It Relates to Third Parties to the Council on Professions
and Associations, October, 1971 ...

F. Principles Governing Confidentiality and Disclosures to
Third Parties (September, 1973)

.....

H. Samples of Reports from Psychiatrists of Injuries to
Patients Resulting from Breaches of Confidentiality

G. Testimony (with Addenda) Submitted on Behalf of the
American Psychiatric Association and the American
Academy of Psychiatry and the Law on the Inclusion of a
Strengthened Rule 504 (Psychotherapist-Patient Privilege)
in the Federal Code of Evidence, H.R. 5463

...

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INTRODUCTION

GENERAL PRINCIPLES GOVERNING CONFIDENTIALITY OF
PSYCHIATRIC TREATMENT AND DISCLOSURES TO

THIRD PARTIES

The constitutional right to be secure in home and person is the basis of the general right to privacy all citizens are entitled to. In medicine this extends to the right of the patient to be secure in the privacy of his communications with his physician. In psychiatry, where it is the very essence of the profession to deal with the most private corners of the patient's personal life, security from abuses of privacy form a condition without which it would be difficult to practice psychiatry and psychotherapy at all.

Thus there is concensus in the medical world, the legal community and the general philosophy of our system of government that confidentiality of private communication is a right. In particular, psychiatric treatment requires a secure atmosphere of confidentiality in order to protect the patient's right to the pursuit of health and happiness. To create an affirmative and secure atmosphere of confidentiality will encourage individuals who need help to seek it without fear that there will be destructive disclosure to the rest of the community. In fact, the mere disclosure of the fact of psychiatric treatment is sometimes felt to be a hazard to the patient. Further, some diagnostic terms have discriminating social connotations and can cause injury to patients if made known to others.

The patient himself bears some responsibility to protect his own rights. Our position as the patient's physician also makes us responsible for the preservation of confidentiality. This responsibility is even more crucial when the patient's ability to protect his confidentiality is impaired by temporary regression incident to the therapeutic process, by his psychological state of function, or when, under financial duress, the patient permits release of information the consequences of which he only dimly perceives.

The unfettered ability to maintain absolute confidentiality in psychiatry seems desirable. However, problems are created when third parties have legitimate ethical rights to some information about a patient, his treatment process, or even certain specific elements of the treatment itself. Balancing these conflicting interests thus be

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