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Disclosure of Past Crimes: An Analysis of Mental Health Professionals’ Attitudes Towards Breaching Confidentiality

Abstract

Ensuring confidentiality is the cornerstone of trust within the doctor–patient relationship. However, health care providers have an obligation to serve not only their patient’s interests but also those of potential victims and society, resulting in circumstances where confidentiality must be breached. This article describes the attitudes of mental health professionals (MHPs) when patients disclose past crimes unknown to the justice system. Twenty-four MHPs working in Swiss prisons were interviewed. They shared their experiences concerning confidentiality practices and attitudes towards breaching confidentiality in prison. Qualitative analysis revealed that MHPs study different factors before deciding whether a past crime should be disclosed, including: (1) the type of therapy the prisoner-patient was seeking (i.e., whether it was court-ordered or voluntary), (2) the type of crime that is revealed (e.g., a serious crime, a crime of a similar nature to the original crime, or a minor crime), and (3) the danger posed by the prisoner-patient. Based on this study’s findings, risk assessment of dangerousness was one of the most important factors determining disclosures of past crimes, taking into consideration both the type of therapy and the crime involved. Attitudes of MHPs varied with regard to confidentiality rules and when to breach confidentiality, and there was thus a lack of consensus as to when and whether past crimes should be reported. Hence, legal and ethical requirements concerning confidentiality breaches must be made clear and known to physicians in order to guide them with difficult cases.

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Notes

  1. 1.

    Tarasoff v. Regents of the University of California (1976) 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14.

  2. 2.

    Gesundheitsgesetz Basel Stadt (GesG). 2012. V. 6 Schweigepflicht § 27 Ausnahmen, Absatz 3. Switzerland.

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Acknowledgments

We thank all participants in the study for their time and commitment. We are grateful to A. Taberska, M. Ummel, and A. Eytan for their comments on the interview guide; V. Lauf, M. Ducotterd, C. Brueggen, and A. Taberska for their help with the interviews and transcriptions; and B. Gravier and A. Eytan for their general support.

Conflict of Interests

The authors declare that there is no conflict of interest.

Funding Support

The study was funded by the Käthe-Zingg-Schwichtenberg Fund of the Swiss Academy of Medical Sciences.

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Correspondence to Tenzin Wangmo.

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Wangmo, T., Handtke, V. & Elger, B.S. Disclosure of Past Crimes: An Analysis of Mental Health Professionals’ Attitudes Towards Breaching Confidentiality. Bioethical Inquiry 11, 347–358 (2014). https://doi.org/10.1007/s11673-014-9546-z

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Keywords

  • Confidentiality
  • Disclosure
  • Prison
  • Forensic doctor
  • Past crimes