A few years back, in the dead of winter, I decided I might be coming down with the plague and decided to visit my local after-hours clinic.
By Dorothy Cotton
After registering, I was instructed to take a number from the little machine on the wall — like the kind that a deli or a bakery might have so you know when it is your turn to order your pastrami or butter tarts. I commented to the clinic staff that I thought this was a great idea; I just hate it when you sit in a crowded clinic and someone bellows out your name, generally followed by mentioning that the proctologist or psychiatrist is ready to see you1. What ever happened to privacy?
Confidentiality and privacy are certainly emerging to be big issues these days. I personally struggle with computer security, as I of course have client-related info on my various computers. But even leaving aside issues related to technology, I struggle with knowing what I am allowed to say to whom. When I deal with police services, the rules are slightly different depending upon whether I am talking to a federal, provincial or municipal police service, as the laws that govern exchange of information are different depending on which type of police agency is involved. When I need to exchange specific information with someone about a client, I have to think about not only the bazillion laws that govern who I can talk to but I have to guess what laws govern whom they can talk to.
Interestingly, it is slightly different depending on whether I am talking to a physician, social worker, teacher, police officer or family member. Confusing as it may be, it does make some degree of sense that different occupations would be held to slightly different standards in terms of maintaining confidentiality. Partly, it has to do with knowing what a particular profession needs in order to accomplish their job. Obviously, for mental health professionals, it would be virtually impossible to serve a client if the client were not able to assume things that were discussed would not be related outside the bounds of that relationship. Members of the public therefore would have a reasonable expectation that their private business would be kept private if they are talking to a psychologist; the laws and standards that govern the behaviour of mental health professionals therefore reflect this reasonable expectation.
On the other hand, in policing for example, a police officer does indeed have some responsibilities to the individual person they may be dealing with. But it is generally recognized that their larger responsibility is to the public. No one would therefore reasonably expect that police would keep many of the details of their daily encounters completely private. There are limitations of course but there is also a fair bit of latitude for police to share information in order to accomplish their primary mission. Taking a more extreme example, there is no reason at all to think that your local barista would keep any of their observations about your behaviour and idiosyncratic coffee preferences private. (Yes, behind your back they are laughing about your mispronunciation of some word they made up to describe a type of coffee that really does not exist.)
I was astounded to realize recently that border services people really can demand to check your cell phone. In my profession, it is of questionable ethicalness to even Google a client or patient. And we certainly can’t force people or demand that anyone tell us anything.
Police officers (and teachers) often tell me all sort of things about people they interact with — a level of information sharing that would get me in serious trouble with my regulatory body if I did the same thing. Equally problematic is that often other people (like police officers) think I am just being grumpy or rigid if I won’t tell them information about clients of mine, when they (police) are interacting with these very clients. On the one hand, it may be true that I am grumpy and rigid—but that is not actually the issue. The issue is that it is against the law for me to spill the beans. No matter how much I might want to give you some helpful tips about a client, unless the situation is an emergency (and that all depends on how the legislation is worded in your province), I am prevented from sharing.
Curiously, this assumption that information can be shared means people like police are often pretty hesitant about sharing their own personal information with psychologists (or other therapists). When police are wearing the hat of “client” and are seeking assistance, it seems to be a common fear that the psychologist is passing on the juicy bits to one’s higher-ups or colleagues — or at least retelling the good stories over a beer. The fact is the chances of this are negligible. For a psychologist, breaching confidentiality is probably the equivalent of excessive use of force in your field. You really get into trouble if you do that.
So what is the take-home message here? It’s twofold, I guess. First, if you have clients who have mental health issues and you know they are seeing a mental health professional, you can’t assume that the mental health professional will talk to you. In most cases they really should not talk to you… unless (and this a big “unless”) there is consent from that client. However, this is an area where mental health professionals sometimes stop prematurely. If a mental health professional does not have that consent, ask them to try to get it. Most clients will willingly provide the consent. So simply not having consent is not a total roadblock. Try to get consent.
Second, if you need to talk to someone — your anxiety/depression/marriage/drinking/anger is getting to you — confidentiality is really the last thing you need to worry about — as long as you are seeing a regulated health care provider or other counsellor who is registered and regulated by a government body. We are not talking about voluntary membership in an association here — I mean real honest to goodness, vetted-to-make-sure-you-know-the-law-and-ethics-and-how-to-practice kinds of people. It might surprise you to know that in many jurisdictions, anybody can hang out a shingle and call himself or herself some various form of “helper.” It varies by province as to whether people can claim to be a counsellor or psychotherapist without being licensed. Pretty well anyone can claim to be a life coach, for example. Some of these folks know what they are doing, and some don’t. The strict laws that govern health care information bind some, and not others. Unless you have a pretty compelling reason otherwise, I’d stay with a regulated health care provider. Then you can spend your time worrying about whatever your problem actually is rather than worrying about breaches of confidentiality.
1When I made this comment to the clinic staff they laughed and said most people complained about the system as it makes them feel like “just a number” rather than a human being worthy of dignity. I guess you really can’t win.
Dr. Dorothy Cotton is Blue Line’s psychology columnist. She can be contacted at: firstname.lastname@example.org.