Can I Communicate With My Adult Patient’s Caregiver?

Caregivers (who many times are family/friends/guardians) of adult individuals with mental illness can play a vital role in the patient’s psychiatric treatment, often providing important background information that may not be gleaned from an in-office visit, such as information related to patient compliance and troubling behavior patterns, as well as providing physical care and support for the patient. A recent study, however, indicated that a large percentage of these caregivers felt excluded from the patient’s care because health care providers refused to discuss the patient’s condition with them due to concerns about violating federal/state privacy laws.

Generally, under the Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws, although providers can always receive information about their patients, they cannot disclose patient information without patient consent, particularly mental health/substance use information. Under certain circumstances, however, the HIPAA privacy rule recognizes the integral role that family and friends play in a patient’s health care, and allows routine—and often critical—communications between health care providers and some third parties. While there are no easy answers, the Department of Health and Human Services addresses these situations and answers the following questions in detail about HIPAA and mental health on its website at http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/.

Remember that state privacy laws apply and often require more stringent protections than HIPAA; thus, it is important for you to be aware of all applicable laws. Please note also that “psychotherapy notes” as defined and maintained under HIPAA receive a heightened level of protection from disclosure and may not be disclosed without patient authorization.

Before disclosing patient information to an adult patient’s caregiver, psychiatrists should keep in mind the following risk management considerations:

Lawful communication with an adult patient’s caregivers can often help psychiatrists deliver quality care and is not necessarily prohibited by federal and state privacy laws. Psychiatrists should understand their obligations under applicable privacy laws and should consult their local attorney or risk management professional before disclosing information without the patient’s or legal guardian’s consent.

For other risk management topics, please see the online risk management courses available on APA’s Learning Center risk management page. ■