{"formatVersion":"1.1","id":"https://www.mentalhealth.com/library/confidentiality-in-mental-health","path":"/library/confidentiality-in-mental-health","url":"https://www.mentalhealth.com/library/confidentiality-in-mental-health","title":"The Duty of Confidentiality in Mental Health","family":"Library detail","description":"Mental health professionals have a duty of care towards their patients, which includes confidentiality, although there can be exceptions. Learn more here.","language":"en-US","access":{"audience":"public","indexable":true},"provenance":{"sourceUrl":"https://www.mentalhealth.com/library/confidentiality-in-mental-health","wordpressId":"612","contentCompleteness":"complete","dateScope":"original-source"},"authors":[{"@type":"Person","@id":"https://www.mentalhealth.com/people/naomi-carr#person","name":"Naomi Carr","url":"https://www.mentalhealth.com/people/naomi-carr"}],"reviewer":{"@type":"Person","@id":"https://www.mentalhealth.com/people/morgan-blair#person","name":"Morgan Blair","url":"https://www.mentalhealth.com/people/morgan-blair"},"dates":{"datePublished":"2023-09-21T08:02:13Z","dateModified":"2025-08-27T12:43:30Z","lastReviewed":"2023-09-21"},"content":{"html":"

The Duty of Confidentiality in Mental Health

Written by \"\"Naomi CarrMedically reviewed by \"\"Morgan Blair

Published on · Updated on

Mental health professionals must maintain confidentiality when working with clients to keep health information private. However, there are some cases in which information can be shared to protect the client or others, and there are varying rules around this.

\"A

Key takeaways

  • Confidentiality protects personal information shared in mental health care and supports trust in treatment.
  • Exceptions can permit or require disclosure in situations involving serious harm, abuse, or legal obligations.
  • Disclosure duties vary by jurisdiction and circumstance, making clear discussion of confidentiality limits important.

What is client confidentiality?

Confidentiality laws apply to all healthcare professionals and refer to the privacy of an individual’s information and health records. Client confidentiality prevents professionals from sharing information about an individual without consent, aside from specific necessary circumstances⁠[1].

Confidentiality in mental health care ensures the privacy of information relating to the diagnosis and treatment of the individual, as well as specific details, such as conversations within therapy sessions. Breaching confidentiality agreements can result in legal repercussions, which can be instigated by the state or affected individuals⁠[2][3].

Subject matter expert

\"\"

Carlos Protzel Psy.D.

Integrative mental health care

What are the client confidentiality laws for mental health therapists in the U.S.?

HIPAA is a federal law that protects certain health information. Its Privacy Rule applies to covered entities, including healthcare providers who transmit health information electronically for specified transactions⁠[4]. This law outlines the regulations around sharing any health information and details by setting specific privacy rules relating to information discussed in psychotherapy⁠[3].

Before commencing therapy sessions, the therapist must inform the client of confidentiality laws. This may involve the use of a form detailing the rules around information privacy and the exceptions in which information can be shared⁠[2].

The client will be informed that they have the following rights⁠[1][5]:

  • They are permitted to access their own records and information.
  • Their information will only be shared with others if they provide consent.
  • Information may be shared with other agencies should the client pose a significant risk to themselves or others or if the information is required for legal reasons.
  • If the therapist breaches confidentiality, the client has the right to pursue legal action.

The client must be able to read and understand this information before signing the agreement if they have the capacity to do so. They may also consent to share information with specific family members, friends, or people involved in their care⁠[5].

It should be noted that the age of consent for mental health services varies state to state. Depending on the state’s age requirement, the child’s guardian will have to complete the form regardless of the minor’s ability to do so.

If the client does not have capacity, which may occur in the case of those with severe mental illness or cognitive impairment, it could be in their best interest for a guardian or caregiver to be informed of the details around their mental health. This may include information relating to their diagnosis and treatment plan⁠[3].

However, this will likely depend on the circumstances, and the therapist is not permitted to share specific details of information discussed within their sessions⁠[6][7].

The therapist is legally required to ensure that health information records must be inaccessible to others, such as in locked drawers or on password-protected computers. Additionally, they must ensure that communication with their client remains private, such as not mentioning confidential information in voicemails or messages⁠[2].

Are there any exceptions to confidentiality in mental health therapy?

There are exceptions to the confidentiality laws applicable to mental health therapists. Information disclosed in therapy sessions may be shared with others if⁠[3][8]:

  • The individual demonstrates that they are at serious risk of suicide.
  • The individual discloses intentions of committing a crime.
  • The individual discloses intentions of severely harming another person.
  • The client is a child or vulnerable adult who is suspected to be at risk of abuse or other criminal activity.

In these circumstances, the therapist is legally required to disclose information about a client’s health or therapy discussions to ensure the individual’s and others’ safety. This is commonly called the Duty to Warn or Duty to Protect⁠[9].

Additionally, confidential information may be shared if⁠[8]:

  • Information is required for a legal evaluation of the individual’s mental state or competence.
  • Information is required for any other legal proceeding.

In these circumstances, health records and information shared in therapy sessions may be presented as evidence in court or used to evaluate the individual’s mental state⁠[10].

Duty to Warn/Protect

The mental health professional is likely to be immune from legal repercussions for breaching confidentiality if information is shared to prevent harm. However, the mental health professional may face liability if they fail to report a potential risk.

Information that can be disclosed includes⁠[9][11]:

Suicide risk

The therapist might disclose this information to the individual’s next of kin or caregiver in order to ensure their safety and prevent harm. If the client is deemed a high risk of suicide, it may be necessary for the therapist to arrange hospitalization. Therefore, this information must be shared to ensure the client receives appropriate treatment and their safety is maintained.

Risk of harming a victim or group

If the client discloses that they intend to harm a specific person or commit an act that could cause harm to several people, the therapist can report this information.

They might disclose this information to the potential victim to alert them of the potential risk and allow them to take precautions or instigate safety measures. If necessary, the therapist might report this risk to law enforcement, so appropriate action can be taken to prevent severe harm, such as removing firearms or weapons.

Risk of child abuse

This information can be reported if the client is a child believed to be encountering abuse or neglect. Similarly, if the client is an adult discussing a past occurrence or intention of child abuse, this can also be reported.

The therapist can disclose this information to Child Protection Services, law enforcement, or the parent or guardian of the child if they are not the suspected abuser and it is appropriate to do so.

State differences

This law varies from state to state. In some states, the Duty to Warn/Protect is mandatory, and a professional can be held liable for failing to disclose a risk of harm.

Because of the potential for liability, the rules around this are very specific. The professional is required to disclose information if there is an imminent or inevitable risk and if a specific victim can be identified⁠[9].

States in which the Duty to Warn/Protect is mandatory include⁠[11]:

  • Washington
  • California
  • Colorado
  • Ohio

In some states, the Duty to Warn is permissive, so a professional can use their discretion to decide the level of risk and if information needs to be shared. In these states, information can be legally disclosed if there is any potential risk of harm.

Additionally, the professional might be protected from being held liable for failing to report a potential threat if they did not consider the risk inevitable⁠[9].

States in which the Duty to Warn/Protect is permissive include⁠[11]:

  • Oregon
  • Arizona
  • Texas
  • Florida

Some states do not allow any breach of confidentiality, so the Duty to Warn/Protect is not applicable. This is the case in⁠[11]:

  • North Dakota
  • Maine
  • North Carolina

State laws also vary concerning⁠[9][11]:

  • The type of professional they apply to, such as psychologists, social workers, and counselors
  • How the certainty of risk is determined
  • How and to whom the risk can be reported

There are conflicting opinions about the enforcement of information disclosure. Some professionals consider mandatory reporting a barrier to care, as it may prevent individuals from attending therapy or disclosing their intentions. Additionally, it could discourage therapists from working with potentially violent individuals for fear of facing liability if they fail to report risk.

Permissive disclosure allows the professional to use their professional judgment and determine the individual’s level of risk. This may be beneficial in some cases, allowing for confidentiality to be maintained and preventing damaging therapeutic relationships. Although for others, it may cause a failure to report risks that are later acted upon and may have been prevented⁠[9][11].

Ultimately, the therapist must use their professional experience and judgment to decide the best course of action in each individual circumstance⁠[10].

References

  1. Sabatino, C. (2022). Confidentiality and HIPAA. MSD Manual. MSD Manuals. Accessed October 10 2026.
  2. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. APA. American Psychological Association. Accessed October 10 2026.
  3. Centers for Disease Control and Prevention. (2024, September 10). Health Insurance Portability and Accountability Act of 1996 (HIPAA). CDC. CDC. Accessed October 10 2026.
  4. US Department of Health and Human Services. (2022). Your Rights Under HIPAA.HHS. U.S. Department of Health and Human Services. Accessed October 10 2026.
  5. US Department of Health and Human Services. (2017). Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment?HHS. U.S. Department of Health and Human Services. Accessed October 10 2026.
  6. US Department of Health and Human Services. (n.d.). When Can Parents Access Information About Their Minor Child’s Mental Health Treatment? HHS. U.S. Department of Health and Human Services. Accessed October 10 2026.
  7. American Psychological Association. (n.d.). Exceptions to Confidentiality for Mental Health Providers. APA. American Psychological Association. Accessed October 10 2026.
  8. American Psychological Association. (2013). Duty to Protect. APA. Original online source unavailable; citation retained.
  9. Merideth, P. (2007). The Five C's of Confidentiality and How to DEAL with Them. Psychiatry (Edgmont (Pa: Township)), 4(2), 28–29. National Library of Medicine. PubMed Central.
  10. National Conference of State Legislatures. (2022). Mental Health Professionals' Duty to Warn. NCSL. ncsl.org. Accessed October 10 2026.

Medical Content

The Clinical Affairs Team at MentalHealth.com is a dedicated group of medical professionals with diverse and extensive clinical experience. They actively contribute to the development of content, products, and services, and meticulously review all medical material before publication to ensure accuracy and alignment with current research and conversations in mental health. For more information, please visit the Editorial Policy.

About MentalHealth.com

MentalHealth.com helps people understand themselves, build healthier relationships, and access the right care. We bring together mental health education, diagnostics, and care management to support well-being throughout every phase of life.

\"\"

Author

Naomi Carr

Writer

Naomi Carr is a writer with a background in English Literature from Oxford Brookes University.

Published
Updated
\"\"

Medical Reviewer

Morgan Blair, M.A.

MA, LPCC

Morgan Blair is a licensed therapist, writer and medical reviewer, holding a master’s degree in clinical mental health counseling from Northwestern University.

Reviewed
\"\"

Related community

Mental Health

A shared space to explore mental well-being, everyday experiences, and connection.

","text":"Home Library Social Determinants The Duty of Confidentiality in Mental Health The Duty of Confidentiality in Mental Health Written by Naomi CarrMedically reviewed by Morgan Blair Published on September 21, 2023 · Updated on August 27, 2025 Mental health professionals must maintain confidentiality when working with clients to keep health information private. However, there are some cases in which information can be shared to protect the client or others, and there are varying rules around this. Key takeaways Confidentiality protects personal information shared in mental health care and supports trust in treatment. Exceptions can permit or require disclosure in situations involving serious harm, abuse, or legal obligations. Disclosure duties vary by jurisdiction and circumstance, making clear discussion of confidentiality limits important. What is client confidentiality? Confidentiality laws apply to all healthcare professionals and refer to the privacy of an individual’s information and health records. Client confidentiality prevents professionals from sharing information about an individual without consent, aside from specific necessary circumstances⁠[1]. Confidentiality in mental health care ensures the privacy of information relating to the diagnosis and treatment of the individual, as well as specific details, such as conversations within therapy sessions. Breaching confidentiality agreements can result in legal repercussions, which can be instigated by the state or affected individuals⁠[2][3]. Subject matter expert Carlos Protzel Psy.D. Integrative mental health care What are the client confidentiality laws for mental health therapists in the U.S.? HIPAA is a federal law that protects certain health information. Its Privacy Rule applies to covered entities, including healthcare providers who transmit health information electronically for specified transactions⁠[4]. This law outlines the regulations around sharing any health information and details by setting specific privacy rules relating to information discussed in psychotherapy⁠[3]. Before commencing therapy sessions, the therapist must inform the client of confidentiality laws. This may involve the use of a form detailing the rules around information privacy and the exceptions in which information can be shared⁠[2]. The client will be informed that they have the following rights⁠[1][5]: They are permitted to access their own records and information. Their information will only be shared with others if they provide consent. Information may be shared with other agencies should the client pose a significant risk to themselves or others or if the information is required for legal reasons. If the therapist breaches confidentiality, the client has the right to pursue legal action. The client must be able to read and understand this information before signing the agreement if they have the capacity to do so. They may also consent to share information with specific family members, friends, or people involved in their care⁠[5]. It should be noted that the age of consent for mental health services varies state to state. Depending on the state’s age requirement, the child’s guardian will have to complete the form regardless of the minor’s ability to do so. If the client does not have capacity, which may occur in the case of those with severe mental illness or cognitive impairment, it could be in their best interest for a guardian or caregiver to be informed of the details around their mental health. This may include information relating to their diagnosis and treatment plan⁠[3]. However, this will likely depend on the circumstances, and the therapist is not permitted to share specific details of information discussed within their sessions⁠[6][7]. The therapist is legally required to ensure that health information records must be inaccessible to others, such as in locked drawers or on password-protected computers. Additionally, they must ensure that communication with their client remains private, such as not mentioning confidential information in voicemails or messages⁠[2]. Are there any exceptions to confidentiality in mental health therapy? There are exceptions to the confidentiality laws applicable to mental health therapists. Information disclosed in therapy sessions may be shared with others if⁠[3][8]: The individual demonstrates that they are at serious risk of suicide. The individual discloses intentions of committing a crime. The individual discloses intentions of severely harming another person. The client is a child or vulnerable adult who is suspected to be at risk of abuse or other criminal activity. In these circumstances, the therapist is legally required to disclose information about a client’s health or therapy discussions to ensure the individual’s and others’ safety. This is commonly called the Duty to Warn or Duty to Protect⁠[9]. Additionally, confidential information may be shared if⁠[8]: Information is required for a legal evaluation of the individual’s mental state or competence. Information is required for any other legal proceeding. In these circumstances, health records and information shared in therapy sessions may be presented as evidence in court or used to evaluate the individual’s mental state⁠[10]. Duty to Warn/Protect The mental health professional is likely to be immune from legal repercussions for breaching confidentiality if information is shared to prevent harm. However, the mental health professional may face liability if they fail to report a potential risk. Information that can be disclosed includes⁠[9][11]: Suicide risk The therapist might disclose this information to the individual’s next of kin or caregiver in order to ensure their safety and prevent harm. If the client is deemed a high risk of suicide, it may be necessary for the therapist to arrange hospitalization. Therefore, this information must be shared to ensure the client receives appropriate treatment and their safety is maintained. Risk of harming a victim or group If the client discloses that they intend to harm a specific person or commit an act that could cause harm to several people, the therapist can report this information. They might disclose this information to the potential victim to alert them of the potential risk and allow them to take precautions or instigate safety measures. If necessary, the therapist might report this risk to law enforcement, so appropriate action can be taken to prevent severe harm, such as removing firearms or weapons. Risk of child abuse This information can be reported if the client is a child believed to be encountering abuse or neglect. Similarly, if the client is an adult discussing a past occurrence or intention of child abuse, this can also be reported. The therapist can disclose this information to Child Protection Services, law enforcement, or the parent or guardian of the child if they are not the suspected abuser and it is appropriate to do so. State differences This law varies from state to state. In some states, the Duty to Warn/Protect is mandatory, and a professional can be held liable for failing to disclose a risk of harm. Because of the potential for liability, the rules around this are very specific. The professional is required to disclose information if there is an imminent or inevitable risk and if a specific victim can be identified⁠[9]. States in which the Duty to Warn/Protect is mandatory include⁠[11]: Washington California Colorado Ohio In some states, the Duty to Warn is permissive, so a professional can use their discretion to decide the level of risk and if information needs to be shared. In these states, information can be legally disclosed if there is any potential risk of harm. Additionally, the professional might be protected from being held liable for failing to report a potential threat if they did not consider the risk inevitable⁠[9]. States in which the Duty to Warn/Protect is permissive include⁠[11]: Oregon Arizona Texas Florida Some states do not allow any breach of confidentiality, so the Duty to Warn/Protect is not applicable. This is the case in⁠[11]: North Dakota Maine North Carolina State laws also vary concerning⁠[9][11]: The type of professional they apply to, such as psychologists, social workers, and counselors How the certainty of risk is determined How and to whom the risk can be reported There are conflicting opinions about the enforcement of information disclosure. Some professionals consider mandatory reporting a barrier to care, as it may prevent individuals from attending therapy or disclosing their intentions. Additionally, it could discourage therapists from working with potentially violent individuals for fear of facing liability if they fail to report risk. Permissive disclosure allows the professional to use their professional judgment and determine the individual’s level of risk. This may be beneficial in some cases, allowing for confidentiality to be maintained and preventing damaging therapeutic relationships. Although for others, it may cause a failure to report risks that are later acted upon and may have been prevented⁠[9][11]. Ultimately, the therapist must use their professional experience and judgment to decide the best course of action in each individual circumstance⁠[10]. References Sabatino, C. (2022). Confidentiality and HIPAA. MSD Manual. MSD Manuals. Accessed October 10 2026. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. APA. American Psychological Association. Accessed October 10 2026. US Department of Health and Human Services. (n.d.). HIPAA Privacy Rule and Sharing Information Related to Mental Health. HHS. U.S. Department of Health and Human Services. Accessed October 10 2026. Centers for Disease Control and Prevention. (2024, September 10). Health Insurance Portability and Accountability Act of 1996 (HIPAA). CDC. CDC. Accessed October 10 2026. US Department of Health and Human Services. (2022). Your Rights Under HIPAA.HHS. U.S. Department of Health and Human Services. Accessed October 10 2026. US Department of Health and Human Services. (2017). Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment?HHS. U.S. Department of Health and Human Services. Accessed October 10 2026. US Department of Health and Human Services. (n.d.). When Can Parents Access Information About Their Minor Child’s Mental Health Treatment? HHS. U.S. Department of Health and Human Services. Accessed October 10 2026. American Psychological Association. (n.d.). Exceptions to Confidentiality for Mental Health Providers. APA. American Psychological Association. Accessed October 10 2026. American Psychological Association. (2013). Duty to Protect. APA. Original online source unavailable; citation retained. Merideth, P. (2007). The Five C's of Confidentiality and How to DEAL with Them. Psychiatry (Edgmont (Pa: Township)), 4(2), 28–29. National Library of Medicine. PubMed Central. National Conference of State Legislatures. (2022). Mental Health Professionals' Duty to Warn. NCSL. ncsl.org. Accessed October 10 2026. Medical Content The Clinical Affairs Team at MentalHealth.com is a dedicated group of medical professionals with diverse and extensive clinical experience. They actively contribute to the development of content, products, and services, and meticulously review all medical material before publication to ensure accuracy and alignment with current research and conversations in mental health. For more information, please visit the Editorial Policy. About MentalHealth.com MentalHealth.com helps people understand themselves, build healthier relationships, and access the right care. We bring together mental health education, diagnostics, and care management to support well-being throughout every phase of life. Author Naomi Carr Writer Naomi Carr is a writer with a background in English Literature from Oxford Brookes University. Published September 21, 2023 Updated August 27, 2025 Medical Reviewer Morgan Blair, M.A. MA, LPCC Morgan Blair is a licensed therapist, writer and medical reviewer, holding a master’s degree in clinical mental health counseling from Northwestern University. Reviewed September 21, 2023 Related community Mental Health A shared space to explore mental well-being, everyday experiences, and connection. Table of contentsChoose a section What is client confidentiality? 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