The Germanwings crash opens a discussion of privacy, safety and self-disclosure in mental health

airplane

The above the fold news of the tragic deaths of 150 people by the crash of a Germanwings pilot has become more disturbing as more information has come on the scene. There was evidence that the pilot had a mental disorder history that he concealed from both his employer and colleagues.

Aviation regulatory agencies do have health screening processes that determine the fitness of a pilot to fly a plane. But critics are now debating if the yearly exams pilots undergo to prove fitness to fly are less than ideal.

In the U.S. a physical exam is performed yearly if you are under 40 and every 6 months if you are over 40 but they have mainly focused on the physical exam; although, safety procedures performed by an FAA medical examiner do look for clues of erratic behavior, medications and family history during the exam.  Disclosure of a mental health issue has largely relied on the pilot writing the answers to typical questions for example, if they ever had a suicide attempt, mental disorder or substance abuse.  But we have to hope that the pilot is not afraid to answer it honestly.

Let’s exclude the heavy hitters such as substance abuse and suicidal tendencies. Depression alone has not excluded pilots or other people whose professions involve the safety of other people from performing their jobs, so why then would an individual not answer honestly? What makes them so afraid? Could it be the fear of stigma and discrimination or the concern for privacy?

Here in the U.S. we have a privacy policy known as HIPPA, or the Health Insurance Portability and Information Act. HIPPA is a Federal law passed by Congress in 1996 and put into place in order to protect the privacy of your health information as well as determine just how your medical records are used and disclosed. Although, your doctor can’t give your private health information to an employer or anyone else without your consent, there are circumstances when HIPPA laws allow sharing your health information to ensure that you receive the best treatments or for your health and safety.

For instance, your treatment records may be shared with another physician so that results can be seen and tests are not repeated.

An exception to HIPPA that allows your information to be shared are psychotherapy notes. They are given additional privacy protection unless overridden by stringent laws that can vary from state to state. Because psychotherapy notes do not contain information regarding medications, diagnosis or treatment, they are not maintained in any medical or electronic records;     affording not only privacy but insuring client-therapist confidentiality.

However, if there is something that happens that the therapist has to report, they will be required to break this rule.

In the U.S in many states mental health professionals are mandated by the “Tarisoff” rule. The rule states a mental health professional has a duty to warn as well as protect if they have a reasonable suspicion that their client intends to actually harm somebody.

In general, this ruling has created conflict and debate among clinicians with the choice between protecting themselves from a breach of confidentiality and doing what is moral and ethical by reporting. The knee jerk reaction is that the system is flawed. For when exactly does HIPPA begin and Tarisoff leave off?

This perhaps explains why self-disclosure may be difficult for those with mental illness to do. We can well imagine that the social climate at the time of disclosure and prior discrimination by others might all play a role.

But hopefully, these open dialogues on mental illness will encourage professionals in the field to develop strategies to reduce stigma and discrimination while encouraging the teaching of how and when to disclose.

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