Authored by: Melissa S. Caldwell, PhD, CCHP-MH – Director of Mental Health Services

Published: 19 October 2018

“I did it.” An incarcerated patient has just confessed to hurting someone. Child abuse, rape, murder? What should the healthcare professional do with this information?

Correctional healthcare professionals work with patients who are legally involved – arrested and detained on suspicion of criminal behavior or violations of legal sanctions (probation/parole). The compassion of a nurse, physician, or therapist may lead the patient to divulge involvement in criminal acts. Although it can vary state to state, there are legal and ethical mandates regarding what a healthcare professional must do with these utterances.*

Healthcare professionals can (or must) break confidentiality and take other appropriate actions if the patient threatens to cause bodily harm or death to another person. The professional is required by law to take reasonable care to protect that person. This may include telling law enforcement agencies, such as jail administration personnel. Likewise, if there is cause to believe that a child or “at risk adult” has been abused or neglected, the professional may be required, by law, to report this to a designated agency or local law enforcement. Finally, the professional may be required to report to law enforcement if a patient confesses to sexual assault or murder in cases that have not been adjudicated. When in doubt about when or what to report, it is recommended that the nurse, physician, or mental health professional confer with their supervisor before information is disclosed.

Here are tips, for healthcare professionals, to avoid causing an exception to confidentiality:

  • Explain to the patient the limits to confidentiality, as appropriate.
  • Don’t insert oneself into law enforcement or legal proceedings (e.g., offering to write the courts or testify).
  • Don’t ask a patient for details about criminal behavior.
  • Don’t solicit confessions.
  • Interrupt and redirect the patient who starts to discuss information that may need to be disclosed.
  • For mental health professionals, focus on patient’s feelings and adjustment rather than specifics of criminal events.

Healthcare professionals should be mindful that their role is to provide healthcare, not to be criminal investigators. As much as possible, they must avoid initiating conversations that will likely lead to a mandated report. Failure to maintain clinical-legal boundaries can hamper the legal process. Additionally, the healthcare focus and role become blurred and the professional to patient relationship can be negatively impacted.

*Please note that laws are subject to revision and that the scenarios mentioned do not represent all the current exceptions to confidentiality.

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All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis.

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