New Guidance Clears Confusion Over Sharing Mental Health Information

The HHS Office for Civil Rights has issued guidance on sharing health information on patients being treated for a mental health condition while complying with the HIPAA privacy rule.

The guidance spells out patients’ privacy rights but also circumstances under which providers can communicate with patients’ families and other caregivers. In particular, “the guidance further clarifies how providers may communicate with family members, law enforcement, or others when the patient presents a serious and imminent threat of harm to themselves or others,” according to OCR.

The six-page guidance covers 13 FAQs on such issues as communicating with certain clinicians, family members and friends when a patient is an adult or minor, assessing a patient’s capacity to object to the sharing of information, involving others to improve patient medication or therapy adherence, appropriate communications when a patient presents an imminent threat of harm, taking to family about a patient’s course of treatment, and allowable communications when a patient is brought in for an emergency psychiatric hold.

In general, the Privacy Rule uniformly applies to protected health information with the exception of psychotherapy notes. These notes, according to the guidance, are treated differently because they contain particularly sensitive information that arise in counseling sessions, and as the personal notes of the therapist they are not required or necessary for treatment, payment or health care operations under HIPAA.

According to the guidance, “Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record.” The guidance is available here.

A story in the July 2013 issue of Health Data Management, titled “Proceed with Caution,” examined the challenges of sharing behavioral health information among clinicians and the benefits that such sharing can bring to patients. For instance, Adam Kaplin, M.D., chief psychiatric consultant at Johns Hopkins Hospital, contends that depression is the biggest killer of heart attack patients in their first year of recovery, but many cardiologists don’t know if a patient has depression.