Your patient poses a serious risk of harm: should you notify the police?

Jul 21, 2017

You have been treating a young male patient with a history of depression and addiction to opioids. On previous occasions he has reported verbally abusing his mother. About six months ago, he admitted that his mother kicked him out of the house due to his violent outbursts*.

In a recent session, he tells you that his mother has relented and let him back into the house. The session is about to end when he admits that he repeatedly hit his mother a few days ago. He says he regularly feels anger welling up inside him and indicated that he is scared he might really hurt her. The patient did not turn up to his scheduled subsequent appointment and you have been unable to contact him despite repeated attempts.  

You are very concerned that he poses a serious risk of harm to his mother, but you wonder where your obligation lies – is your duty to maintain your patient’s privacy or to protect the mother’s safety by informing the police?  

What does the law say?

Privacy of health information of patients is not absolute. Circumstances may arise where it is necessary to balance maintaining privacy of health information against avoiding danger or harm to the community or individuals in the community.

Under the Australian Privacy Principles, health information can only be used and disclosed where there is consent or for a reasonable secondary purpose, including when there is a serious threat to the life, health or safety of the patient or someone else, or the public. Download our ‘Privacy Essentials’ factsheet for more information.

In addition to the Commonwealth's privacy legalisation, some states and territories have their own legislation governing privacy obligations with which doctors must also comply. Whilst there are some differences in the wording used, these provisions are similar to the Commonwealth legislation.

What should you do in this scenario?

In the scenario above, given your serious concerns and the patient’s failure to re-engage with treatment, you can notify the police on the basis that he has admitted to beating his mother and there is a serious and imminent threat to his mother’s life, health or safety. The patient may also pose the same risk to himself or others.

If he had re-attended, you may consider telling the patient that you have informed the police of your belief that he may pose a serious risk of harm. If this is disclosed, it is essential to document any discussion in the patient’s clinical records.

You should also document the communications with the police in the patient’s medical record. In making the disclosure, it is important to only disclose information as reasonable necessary for reporting the matter and not the patient’s complete clinical records. The patient may file a breach of privacy complaint, so your contemporaneous documentation will be important in responding to any such complaint.

In weighing up whether to call the police, it’s also important to bear in mind that the patient initially came to you seeking help and it is in his best interests to remain engaged with treatment so you may need to refer the patient to another psychiatrist.  

It is inherently difficult to make these sorts of decisions and will turn on the circumstances of each situation. As there is no mandatory obligation to make a report in relation to a patient (except, for example, where a child is at risk of harm), the decision will involve balancing the patient’s confidentiality against assessing the risk of harm to themselves or someone else.   

Key lessons

If the patient’s consent hasn’t been received, information should only be provided to the police in these types of situations:

  • a warrant or subpoena is provided (Read Chapter 1 of our handbook on responding to requests for medical records), or
  • it is authorised by a specific legislation provision (for example, mandatory reporting of child abuse), or 
  • there is a reasonable belief that there is a serious threat to the life, health or safety of the patient and/or public.

*This scenario has been created based on our cumulative experience of a number of similar cases.

Useful information

If you are faced with as similar dilemma it is unwise to make a decision to maintain privacy, or to provide information to an appropriate authority, without first obtaining advice. Visit our website or email, or if you require immediate advice, call 1800 128 268.

You may also be interested in our articles:

Patient safety and privacy: where do you draw the line? highlights a member case to clarify when exceptions to protect the health and safety of your patient or someone else, apply.

Are you ready? Mandatory data breach notification looks at what doctors and practices need to do in the wake of new laws which have made notification of serious data breaches mandatory.

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