RN concerned about disclosing psychiatric treatment to state board

Nurse upset by request to disclose psychiatric care history

An RN submitted a question about needing to apply for a license in another state because, as a case manager, her employer requires all RNs to have licenses in the states in which they provide case management.

The state board she applied to asked her to disclose information about any psychiatric treatment and history. The RN said she was quite upset about this request, stating that she had sought treatment voluntarily, went on disability for one year, was successfully treated and returned to work taking her medication.

Moreover, she continued, isn’t one’s psychiatric history confidential unless a complaint is lodged with the state board?

First and foremost, it is important to point out that, generally, a person’s psychiatric history is confidential. States and the federal government assure this with legislative statutes, such as mental health confidentiality laws and through HIPAA provisions. As a result, a treatment facility, for example, cannot share any information about your treatment, such as its outcome or if you are still under treatment, unless you give that facility consent to share that information.

However, the confidentiality we enjoy under these laws is not absolute. For example, if you are thinking of harming another person and you share that information with your therapist, the therapist is required to take steps to ensure, insofar as possible, that the harm does not happen. These steps could include discussing your comments with your psychiatrist, evaluating whether you intend to act on your feelings and, if necessary, notifying law enforcement and/or the person you thought to harm.

In the RN’s situation, however, her treatment facility and those who treated her were not asked to share her history with the board. Rather, the board is asking the RN directly about her psychiatric history. She, then, is the one who would disclose this information, so no breach of confidentiality under any law would be taking place.

As you know, the obligation of any state board of nursing is to protect the public by ensuring that those who are licensed are competent and safe practitioners. As a result, they have the authority to ask applicants, and those who renew their licenses, a great deal of information, including if the applicant has any criminal convictions and has had psychiatric care.

Such questions in and of themselves do not necessarily mean that an applicant or one who is seeking a renewal of their license will not be granted a license. Rather, the information is sought in order to carefully evaluate whether you meet the criteria established by the state board to practice competently and safely.

Often, a board may want to meet personally with an applicant if it has questions about the information provided by the RN.

Because integrity and honesty are essential qualities of a nurse, it is vital that your application for licensure be truthful and complete. Providing all requested information is critical so that your situation can be evaluated with the attention it needs, and the right decision about licensure can be made.

If you are asked about your psychiatric history when you apply for a license in any state, your approach should be to:

Respond honestly and factually to the question(s) asked.

 Attach letters from treatment personnel who can honestly support your success with treatment.

• Attach a letter of recommendation from your current employer discussing your nursing practice and your success at work.

• Attach your latest performance evaluation from your immediate supervisor.

• Remember that if you falsify or intentionally omit information requested, you may be denied the license you are applying for.

• Consult with a nurse attorney or attorney in your state who can help you formulate any required statements, responses to questions asked and documents that are required to be included with your application.

Courses Related to ‘Rights and Responsibilities’

CE513: HIPAA and Confidentiality (1 contact hr)
The federal Health Insurance Portability and Accountability Act was implemented in 1996 and has been revised since then. HIPAA can refer to guidelines that protect your ability to maintain your health insurance as you move from job to job or place to place (“portability”). HIPAA can also refer to efforts to simplify the administration of health insurance. These efforts include the creation of national standards for diagnostic terms, insurance forms and provider identification. Perhaps the most common use of the term for healthcare professionals, however, involves protecting the confidentiality and privacy of healthcare information. In this module, you will learn about parts of HIPAA, especially as they concern nursing and other health professionals and the protection of healthcare information. Because you play a key role in the production of healthcare information, you play a key role in its protection.

CE548: Protect Yourself (1 contact hr)
Nurses have an obligation to keep abreast of current issues surrounding the regulation of the practice of nursing, not only in their respective states, but also across the nation, especially when their nursing practice crosses state borders. Because the practice of nursing is a right granted by a state to protect those who need nursing care, nurses have a duty to patients to practice in a safe, competent and responsible manner. This requires a nurse licensee to practice in conformity with their states statute and regulations. This course outlines information about nurse practice acts and how they affect nursing practice.

About the author
Nancy J. Brent, MS, JD, RN

Nancy J. Brent, MS, JD, RN 

Nancy J. Brent, MS, JD, RN, Nurse.com's legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. To ask Nancy a question, email BrentsLaw@nurse.com.

3 responses to “RN concerned about disclosing psychiatric treatment to state board”

  1. I’m surprised by this. Asking about one’s psychiatrist treatment history is very, very different from asking about a criminal history. And while no confidentiality laws are being broken when you are asked to self-employed disclose your own private health information, it does seem unethical to take away someone’s right to privacy just because he or she has a history or mental illness. If there’s been a complaint or some incident, perhaps, but otherwise it seems discriminatory to collect medical statements or reports about innocent people simply because they received treatment for a mental health condition.

    Unless a nurse behaves unprofessionally or unsafely, there is no reason for his or her BON to ask about any psychiatric records.

  2. I agree with Carolyn. If there has been no complaints or cause for concern, I fail to see how a nurse’s mental health history is relevant. State boards would not ask one to disclose other medical information such as their neurological history or if they had diabetes. Mental illness is a treatable condition and need not be disclosed like any other health condition.

  3. I can understand the importance of making sure a nurse is able to function well on the job. But a person’s psychiatric history is confidential and is NO ONE’S business to know. I agree with both of the comments above. As someone who works in mental health, I know the stigma that is associated with mental illness–this just adds to it. No one asks about someone’s medical history, yet the BON and employers feel that it’s their business to know about someone’s psychiatric history? Confidentiality applies to ALL areas of health–including a psych history.

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