Confidentiality and disclosure : assessment and intervention issues

This portfolio addresses the moral, ethical and legal issues that impact upon decisions to maintain or disclose confidential communications. The tensions and moral dilemmas that are created when a conflict between these aspects arises are considered. Risk assessment procedures that inform decisions to maintain or disclose confidential information are discussed, as are issues related to the practical implementation of planned interventions. The topic is addressed by firstly reviewing professional codes of conduct and legal requirements to maintain confidentiality. The limits of confidentiality and privileged communication are then reviewed together with legal requirements of “duty to warn” or “duty of care”. These requirements are then related to risk assessment procedures and relevant interventions. Four case studies that illustrate the practical application of assessment techniques in the decision process and planned interventions are presented. They cover such diverse topics as disclosure and suicidal intent, threat of harm to a third party, risk of transmission of the AIDS virus and “duty to warn” and maintenance of a minor’s confidential communications. The ways in which these issues were addressed and the outcome is presented. NOTE: All names and details that have the potential to identify the people whose cases are presented here have been changed to protect their anonymity.