Ministry Orders Mental Health Clinics to Give HMOs Patient Information

Senior mental health professionals say the directive obliges therapists to violate one of the most basic principles of their ethical code – therapist-patient confidentiality.

Ido Efrati
Ido Efrati
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An illustrative image of an HMO clinic. Credit: Olivier Fitoussi
Ido Efrati
Ido Efrati

The Health Ministry has instructed its mental health clinics to give the health maintenance organizations information about tens of thousands of patients without obtaining their consent, a ministry document shows.

The information will include diagnoses, past treatments, prognoses and suggestions for future treatment.

The ministry has instructed the clinics to inform patients of the planned information transfer and give them the opportunity to refuse permission. But patients will not be required to sign an “informed consent” form to authorize the transfer; the information will be passed on unless they explicitly refuse consent.
Senior mental health professionals say the directive infringes on patients’ privacy and obliges therapists to violate one of the most basic principles of their ethical code – therapist-patient confidentiality.

The Health Ministry’s mental health division head wrote a letter to mental health clinics nationwide telling them to pass on detailed information about all their patients by January 1 2015 to the HMOs. The move is part of a planned mental health reform, under which the HMOs will take over a considerable part of the mental health clinics’ activity as of July 2015.

Disclosing information about patients is intended to enable therapeutic continuity, the ministry says. However, the letter says nothing about protecting patients’ privacy and deals mainly with the technical issues of passing on the information.

The ministry said in response that it has instructed clinics to advise patients about the information’s disclosure and distributed information for the public in three languages to the clinics. The clinics have been instructed to explain the process and if anyone refuses to have information about him disclosed, he must be told of the consequences and his refusal must be documented, the statement said.

Some 60,000 Israelis are treated in the Health Ministry’s mental health clinics and a considerable number of them will become HMO patients as of July. The current procedure requires advising the patient and securing his agreement as to which therapist would receive information about him and for what reason.

In some cases patients waive the confidentiality voluntarily, mainly when they need medical treatment. In such cases the family doctor is familiar with their mental health, provides them with a regular drug prescription and checks whether the drugs are compatible with other medicine the patient may be taking.

But many psychologists and therapists argue that a wholesale transfer of information is a completely different ballgame.

“This instruction contradicts the code of ethics and the Patients’ Rights Law,” said Hannah Strum-Cohen, a senior clinical psychologist and chairwoman of the psychologists’ and social workers’ forum for mental health reform. “The Health Ministry itself has obliged us for decades to get the patients to sign confidentiality waivers in cases where information about a patient is transferred. But in this case, it thinks it’s above the law.

“We don’t know where the patient will be in six months’ time. Nor is it clear from the HMOs who will see the information or where it will end up,” she said.

The ministry insists that giving patients an opportunity to refuse consent is sufficient. It also says this is the only way to enable the HMOs to prepare properly for the day when thousands of patients are transferred to their care.

But as the deadline for transferring the information draws near, opposition to it among psychologists and therapists is only gathering steam.

MK Dov Khenin wrote a letter to Prime Minister Benjamin Netanyahu this week urging him to change the directive so that no personal or confidential information is disclosed without the patient’s permission and unless he signs a confidentiality waiver.

“Patients’ right to privacy undoubtedly trumps making the entry into force of the reform of the mental health system more efficient, and such a wholesale transfer of information certainly isn’t happening at their request or with their consent,” he wrote. “Therefore, I urge you to urgently reconsider this order and alter it so that no personal and confidential information will be transferred without the patient’s consent and without his signature on a confidentiality waiver form.”

Over the weekend, the Association for Civil Rights in Israel also sent a letter of protest to the ministry. 

“The Health Ministry’s blatant disregard for the patients’ right to privacy, dignity and the confidentiality of their medical information violates a series of laws, court rulings, regulations and ethical principles, and especially the Patients’ Rights Law, which enshrines therapists’ obligation to keep information about patients that has reached them through their work confidential,” said attorney Tal Hassin of ACRI. “The patient’s informed consent can’t be based on ‘notifying’ him, and also can’t be given tacitly or by failing to object, but only by expressing positive consent, in writing, after being given all the information needed to make an educated decision.

“This order is especially surprising given that earlier this year, on orders from the attorney general, a circular by the Health Ministry director general mandating a transfer of information among medical institutions for the sake of building a national medical registry was frozen,” Hassin continued. “One would have thought the lesson would have been learned.”

The Health Ministry said in response that the mental health reform is an important step for patients and a historic step for Israelis. “For the first time the soul and body will be united and mental health will be administered as in other medical treatment by the four HMOs,” the ministry’s statement said.

The information disclosure is the minimal necessary to ensure continuinty of treatment, and does not include all the sensitive information in the patient’s file. It is intended to ensure therapeutic continuity and enables the HMOs to take full responsibility – clinical, legal and insurance-related – for the patients, the statement said.

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