Psychiatric Confidentiality: Our Laws are Only as Good as Our Resolve

I wrote the following in response to a question about confidentiality on a Mental Health Discussion Board/Support Group I belong to.

In the thread about effective treatment someone had written they were afraid of their employer or potential employers finding out they were depressed. The site is managed by a psychiatrist and he wrote, in part, the following:

"It is medical malpractice to release your medical records to anyone without your permission. The only exception is that your psychiatrist is expected to send your referring family physician a consultation letter, and then progress notes every few months.

Employers, schools, government officials are not allowed (at least in the western world) to have access to your private medical records."

This has not been my experience.

First, when I went off on disability my employer was given my diagnosis and medical info because I had to consent to their receiving it in order to receive short term disability payments which they paid.

Second, I am on LTD and receive some of my money from the government. In order to receive those payments I had to provide my health information to the government and I had to sign a release form allowing the government access to my medical records.

Third, I have recently had a serious dilemma in terms of my employer's Long Term Disability Insurer. I will describe what follows as "coerced consent":

Last year my employer's insurance company sent me a document requesting that I release ALL my psychiatrists notes to them, not just a brief description or progress report...instead, every single thing he ever wrote about me.. In the release form they explained I could only continue receiving my insurance payments if I signed the document. Given I have no income without their payments and I have to eat/live and am unable to work; because of my precarious financial situation I did not have the resolve to say no to the insurance company. I feel I was COERCED into signing the document.

Lucky for me my pdoc does have the resolve to stand up and say no. My Pdoc has refused to send his notes to them. He says he will send what he has always sent...a brief recap of treatment, but he will not send his notes.

I feel I am very lucky to have a pdoc who has my best interests in mind, but I am not certain many Pdocs would take his stance, especially when the patient has signed such a broad ranging release form.

As you can imagine, the Insurance Company's request has impacted what I feel safe talking about in my therapy sessions. Even knowing they receive ANY information is upsetting and makes me very cautious about what I say in my sessions. Knowing they could potentially receive every note my pdoc writes makes it impossible for me to talk about some things.

Fourth, the other difficulty I have had in terms of confidentiality and potential abuse of power is that while I have been off on disability my employer's disability insurance company has changed 3 different times, so now, rather than one huge Canadian insurance company having my disability/mental health records, the three biggest insurance carriers in Canada have my mental health records. I find this very disturbing.

It may impact my ability to find work when I am well, especially if my potential employer uses one of those insurance carriers. I know the psychiatric records are supposed to be confidential, but employer's and insurance companies are well versed in finding ways around this and I just want everyone to be aware of this.