Published in the Loudoun Times-Mirror in April, 2010


Several sources show an increase in mental health services since the recession – increases in crisis line calls, employee assistance program counseling sessions and inpatient psychiatric hospitalizations.  This is not surprising given that the unemployment rate remains around 10 percent nationally – as a nation, these are indeed stressful times.  But the national numbers for mental health treatment don’t reflect an important subset of individuals (both in the private and public sectors) that put the concern for their job ahead of their mental health needs.  Some of these individuals are even choosing to forgo needed treatment in fear of workplace discrimination or harassment.

As the director of a private mental health clinic in Northern Virginia, I am per force in the role of screening initial inquires for assessment and treatment.  One of the rising main areas of concern for individuals reaching out for help is confidentiality.  There is a growing fear amongst callers that their employers will learn of their mental health treatment and their job security will in turn be compromised.

I am repeatedly asked by callers “Can you guarantee me that my chart will never be released to my employer?” and “Would my government clearances be impacted by coming to therapy?” and “Could anyone get access to my prescription history?” One recent caller stated that her boss would see her as being “weak and unreliable” if he learned of her need for treatment for anxiety.  While this caller initially scheduled a medication consultation with one of our psychiatrist’s, she later cancelled her appointment due to her confidentiality concerns.

In my opinion, there is a troubling irony to these calls and to the dynamic itself in that private mental health treatment is supposed to decrease stress not increase it.

What individuals should know is that their private mental health treatment records typically remain private under the Health Insurance Portability and Availability Act of 1996 (HIPAA).  Moreover, the stigma for mental health treatment is dissipating with education and many companies now promote wellness and take a proactive and positive stance to their employees’ mental health.  The following should help readers better understand their privacy rights as both patients and employees.

  • One of the main purposes of HIPAA is privacy protection for patients.  Per HIPPA, employees have no obligation to share their general mental health history or condition with their employer.  Ordinarily, employers do not have the right to ask you about your mental health history or functioning as an employee.
  • Many companies offer counseling through an Employee Assistance Program (EAP).  EAP counseling is an employee benefit in that it is typically brief and free of charge to the employee in need.  Confidentially in EAP counseling is maintained in accordance with professional ethical standards and privacy laws.
  • Individuals applying for, or who already have, a security clearance do not have a right to complete privacy regarding private mental health treatment.  Those individuals must answer basic questions regarding their mental health treatment history and investigators are also permitted to ask private clinicians’ basic questions about an employee’s private mental health treatment and functioning for the purpose of ensuring national security.
  • Third party insurers (managed care companies and insurance companies) often require a diagnosis in order for treatment to be approved and covered.  While this information is considered to be private, many patients elect not to use their mental health benefits to avoid a mental health diagnostic label on their record or the risk of that information ever being available to an employer.  Many individuals opt out of their insurance plans entirely and pay out of pocket for therapy and/or psychiatric medication to avoid any sort of insurance paper trail to their care.
  • Employees applying for a mental health disability, employees with significant absenteeism or job performance struggles, and employees involved in a Court preceding, could lose their right to complete mental health treatment privacy depending on the circumstances.

For more information on your privacy rights and protecting your mental health treatment, contact SAMHSA’s National Mental Health Information Center at:  SAMHSA, P.O. Box 42557, Washington, DC 20015.  Telephone: 800-789-2647.  E-mail: and Webpage:

Dr. Oberschneider, Director

Ashburn Psychological and Psychiatric Services