The third installment of our Mental Health Awareness Month series for healthcare professionals focuses on developing effective consultation practices with mental health specialists while navigating HIPAA requirements that govern these collaborations.
Mental health care in the US faces significant challenges, including limited access to services, shortages of professionals, and systemic barriers. Key statistics include:
Information exchange for mental healthcare involves several specialized HIPAA provisions and exceptions that every healthcare professional should understand. As the HHS resource "HIPAA Privacy Rule and Sharing Information Related to Mental Health" recognizes, "In recognition of the integral role that family and friends play in a patient's health care, the HIPAA Privacy Rule allows these routine – and often critical – communications between health care providers and these persons."
The importance of privacy in mental healthcare cannot be overstated. As noted in "Digital privacy in mental healthcare: current issues and recommendations for technology use," "Mental healthcare has long held that privacy and confidentiality are primary in the service of clients" and "Without privacy and confidentiality, therapy may not be effective."
HIPAA permits disclosure of protected health information (PHI) without specific patient authorization for treatment purposes, including consultation with other providers. Specifically, the HHS resource states that "HIPAA permits health care providers to disclose to other health providers any protected health information (PHI) contained in the medical record about an individual for treatment, case management, and coordination of care and, with few exceptions, treats mental health information the same as other health information." However, this general exception has important limitations for mental health information:
Related: Privacy protection for psychotherapy notes
When sharing mental health information under treatment exceptions, the minimum necessary standard requires particular attention:
Related: How to determine the minimum necessary information
HIPAA includes exceptions that permit disclosure without authorization in emergency circumstances:
As the HHS resource states, "The Privacy Rule permits a health care provider to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when the provider believes the patient presents a serious and imminent threat to self or others." Importantly, "HIPAA expressly defers to the professional judgment of health care professionals when they make determinations about the nature and severity of the threat to health or safety... HIPAA presumes the health care professional is acting in good faith in making this determination."
These exceptions require careful documentation of:
Related: Understanding permissible disclosures in an emergency
Patients may authorize disclosure of their mental health information while placing limitations on what is shared. These partial authorizations must be respected and can include:
Special consideration must be given to situations involving medication adherence. The HHS resource clarifies that "If a health care provider knows that a patient with a serious mental illness has stopped taking a prescribed medication, [the provider] can tell the patient's family members... so long as the patient does not object."
When patients lack capacity to make decisions, the same HHS resource notes that "Where a patient is not present or is incapacitated, a health care provider may share the patient's information with family, friends, or others involved in the patient's care... as long as the health care provider determines, based on professional judgment, that doing so is in the best interests of the patient."
Several consultation models facilitate both clinical effectiveness and streamlined HIPAA compliance.
The Extension for Community Healthcare Outcomes (ECHO) model uses technology to leverage scarce specialist resources:
Operational structure:
HIPAA compliance features:
An article published by the Academy of Consultation-Liaison Psychiatry shows the effectiveness of proactive consultation-liaison (C-L) psychiatry models in hospital settings. These models involve early integration of psychiatric teams into patient care, leading to improved outcomes such as reduced hospital length of stay and better patient and clinician satisfaction .
Service elements:
HIPAA integration:
El Futuro, a nonprofit mental health organization in North Carolina, has implemented a stepped care model to enhance mental health service delivery. This approach matches clinical needs to appropriate resources, ensuring that patients receive the least intensive, yet effective, intervention first, with the ability to escalate care as needed.
Approach:
HIPAA advantages:
Technology platforms facilitate HIPAA compliant mental health collaboration. However, there are challenges for maintaining privacy. As highlighted in Digital privacy in mental healthcare, "the implementation of these advancements in mental healthcare involves consequences to digital privacy and might increase clients' risk of unintended breaches of confidentiality."
Structured eConsult platforms offer several HIPAA compliance advantages:
System features:
Implementation considerations:
Read also: Technology in healthcare
Electronic shared care plan systems enhance coordinated care:
Functionality:
HIPAA safeguards:
Read also: How health plans can share PHI for care coordination
Emerging technologies place patients in control of their information:
Approaches:
Compliance benefits:
Learn more: HIPAA compliant email
Understanding the unique protections for psychotherapy notes is important for mental health collaboration. According to the HHS resource, "Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive information and because they are the personal notes of the therapist... the Privacy Rule requires a covered entity to obtain a patient's authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes."
This distinction is important because psychotherapy notes are separate from the standard medical record and contain the therapist's personal observations and analysis from counseling sessions. Unlike other mental health information that can be shared for treatment purposes under the TPO exception, psychotherapy notes require specific patient authorization even when sharing with other healthcare providers for treatment coordination.
The increasing reliance on technology in mental healthcare requires heightened attention to security measures. According to Digital privacy in mental healthcare, "16.8% of security breaches reportedly occurred due to the loss/theft of a smartphone," This shows the importance of implementing security protocols for all devices and platforms used in mental health consultation and communication.
Providers should be particularly cautious about claims of HIPAA compliance. As further noted in the article, "'HIPAA compliant' is not a regulated or certified term by the Department of Health and Human Services." This means that mental health professionals must thoroughly evaluate the security features and business associate agreements of any technology platform used for consultation or communication.
Yes, parental rights and state laws often influence disclosure rules for minors' mental health records.
Only if the texting platform is secure, encrypted, and meets HIPAA security rule requirements.
Their wishes must be respected unless an emergency or specific legal exception applies.
Only if the patient's identity is protected or consent has been obtained for identifiable disclosures.
Apps may not be HIPAA-covered entities unless they share data with healthcare providers or insurers.