Summary of District of Columbia Laws

 

Miscellaneous Laws

"D.C. Mental Health Information Act of 1978"

 

 

The Law:  The Act makes it unlawful for a mental health professional, facility, or its employees to disclose or permit the disclosure of mental health information without authorization or if an exception applies.  The Act addresses such issues as personal notes, general rules governing disclosures and the prescribed form of authorization, etc.

 

Emergency Exception:  This provision allows mental health information to be disclosed if the mental health professional reasonably believes that the disclosure is necessary to "protect the client or another individual from a substantial risk of imminent and serious physical injury."  See D.C. Code Ann. § 7-1203.03 (a). Also see Vitaly Tarasoff v. Regents of the University of California, 551 P.2d 334; 131 Cal. Rptr. 14 (1976).

 

Cross Reference:  See the federal Confidentiality of Patient Records, 42 U.S.C. § 290dd-2 which sets forth the confidentiality requirements for patient records in connection with substance abuse treatment programs.

 

Disclosure on an emergency basis may be made to one of more of the following: The client's spouse, parent, legal guardian, a duly accredited officer or agent of the District of Columbia in charge of public health, the Department of Mental Health, a provider as defined in § 7-1131.02(27), an officer authorized to make arrests in the District of Columbia or an intended victim if the mental health professional reasonably believes that such disclosure is necessary to initiate or seek emergency hospitalization of the client under § 21-521 or to otherwise protect the client or another individual from a substantial risk of imminent and serious physical injury. There are also limited disclosures, including one for third party payors for the purpose of payment of benefits which is limited to administrative information, diagnostic information, the voluntary or involuntary status of the client, the reason for admission or continuing treatment, and a prognosis limited to the estimated time during which treatment might continue.

 

Recordkeeping: When a disclosure occurs, a notation must be entered and maintained with the patient's record of mental health information. The notation must include the date of disclosure, to whom disclosed, and a description of the contents of the disclosure. In all cases except for disclosure pursuant to the emergency provision, the disclosure must be accompanied by a statement to the effect that: "The unauthorized disclosure of mental health information violates the provision of the District of Columbia Mental Health Information Act of 1978. Disclosures may only be made pursuant to a valid authorization by the client as provided in title III or IV of that Act. The Act provides for civil damages and criminal penalties for violations."

 

Form of written authorization of disclosure

The disclosure must:
   (1) Specify the nature of the information to be disclosed, the type of persons authorized to disclose such information, to whom the information may be disclosed and the specific purposes for which the information may be used both at the time of the disclosure and at any time in the future;
   (2) Advise the client of his right to inspect his record of mental health information;
   (3) State that the consent is subject to revocation, except where an authorization is executed in connection with a client's obtaining a life or noncancellable or guaranteed renewable health insurance policy, in which case the authorization shall be specific as to its expiration date which shall not exceed 2 years from the date of the policy; or where an authorization is executed in connection with the client's obtaining any other form of health insurance in which case the authorization shall be specific as to its expiration date which shall not exceed 1 year from the date of the policy;
   (4) Be signed by the person or persons authorizing the disclosure; and
   (5) Contain the date upon which the authorization was signed and the date on which the authorization will expire, which shall be no longer than 60 days from the date of authorization.

In addition, a copy of the authorization shall be provided to the client and the person authorizing the disclosure; accompany all such disclosures; and be included in the client's record of mental health information.

 

Limitations on client right to access: Personal notes are not subject to the patient right to access rules. Personal notes are defined in the code as mental health information regarding a client which is limited to mental health information disclosed to the mental health professional in confidence by other persons on condition that such information not be disclosed to the client or other persons; and the mental health professional's speculations. In addition, statutory authority exists which grants the mental health professional the ability to limit access to the client in situations where necessary to protect the client or another individual from a substantial risk of imminent and serious physical injury. The client must be told if complete access in not granted. In addition, the mental health professional primarily responsible for treatment may also:

·        refuse to disclose mental health information; or

·        limit disclosure of mental health information

 

This discretion exists even if the client has signed a release, but the mental health professional must believe limited or non-disclosure is necessary to protect the client from a substantial risk of imminent psychological impairment or to protect the client or another individual from a substantial risk of imminent and serious physical injury. Further requirements apply if this provision is utilized by the mental health professional (notification, right to review, etc.) and they can be found in D.C. Code § 7-1202.06.

 

Q:  Can the counseling center provide counseling to minors without parental/guardian consent?

A:  Yes, you can provide counseling to the minors under DC Code §  7-1231.14 and they can consent on their own; however, without parental consent you have to limit it to 90 days and then either make a new determination, terminate, or get parental/guardian consent.

D.C. Code § 7-1231.14:

(b)(1) A provider may deliver outpatient mental health services and mental health supports other than medication to a minor who is voluntarily seeking such services without parental or guardian consent if the provider determines that:

(A) The minor is knowingly and voluntarily seeking the services; and
(B) Provision of the services is clinically indicated for the minor's well-being.
(2) Mental health services and mental health supports provided to a minor without the consent of a parent or guardian pursuant to subsection (b)(1) of this section shall be limited to a period of 90 days. At the end of the 90-day period, the provider shall either:
(A) Make a new determination pursuant to subsection (b)(1) of this section that provision of services to the minor without parental or guardian consent is voluntarily sought by the minor and continues to be clinically indicated;
(B) Terminate the services; or
(C) With the consent of the minor, notify the parent(s) or guardian to obtain consent to provide further outpatient services.
(3) The provider shall fully document the reasons for its determinations regarding delivery of mental health services to minors, and shall include such documentation in the minor's clinical record.
(4) A provider may conduct an initial interview of a minor who appears to be voluntarily seeking outpatient mental health services and mental health supports without parental or guardian consent or involvement in order to determine whether the criteria of subsection (b)(1) of this section are satisfied.

Q:  May a minor’s parents gain access to the minor's records?

A:  They may do so, but it requires joint consent of the minor and the parent/guardian. See D.C. Code § 17.1202.05 which reads: (b) When a client is under the age of 18, but beyond the age of 14, disclosures which require authorization may only be authorized by the joint written authorization of the client and the client's parent or legal guardian.

 

 

 

updated 9/23/05 to add Q and A and update code section
updated 10/3/07 
revised NTC 11-7-07
DC code updated 2/25/08 RAB
links updated 6/9/08 rab