Navigating the Student Healthcare Framework

The decision to share confidential student health information among clinicians in the campus health center and counseling center also deserves consideration. Over the past ten years, the US federal government has established integration between primary care and mental health services as a significant priority (learn more here). There are widely varying models for this integration (learn more here).

On college campuses (as in other primary care settings) many students presenting for medical care are experiencing concomitant mental health problems and in many case their mental health difficulties may be their primary presenting problem-whether explicitly or implicitly. On many campuses, some or all of the prescribing of psychiatric medications is done at the health service. As a result, in order to ensure continuity and quality of care, it is helpful for the counseling and health centers to establish a system of carefully bounded communication/collaboration. For some, this occurs through a shared electronic health record and for others it is through a regularly scheduled meeting between health and counseling center staff to discuss shared cases. On a few campuses, the students’ electronic health record is integrated while for others there may be firewalls in place allowing access only to specific information. Often this takes the form of a firewall that prevents health center clinicians from accessing counseling center clinical/therapy notes. Another approach is to keep therapy/counseling notes separate from the electronic health record. In any case, the ability for treating clinicians to be aware of diagnosis and prescribed medications should be carefully considered in informing treatment approaches.

As in the case of sharing information in the event of an emergency, policies for sharing information between health and counseling centers also need to be clear and transparent to students. Some institutions address this in the confidentiality/consent for treatment agreement that the student receives when they present for treatment at the health or counseling centers, while others obtain a release of information from students at the time when information needs to be shared.

JED encourages colleges and universities to develop systems for sharing appropriate clinical information when legally permitted and clinically indicated, whether it be in the case of significant risk or in the service of providing holistic and integrated health care. In both cases, policies for sharing information need to be clear and transparent and easily accessible to students. In all cases, the guiding principle that drives the decision on sharing confidential student health information needs to be what is in the students’ best interest as well as the safety and health of the campus community.

As Ralph Slovenko stated many years ago: “Trust—not absolute confidentiality—is the cornerstone of psychotherapy. Talking about a patient or writing about him without his knowledge or consent would be a breach of trust. But imposing control where self-control breaks down is not a breach of trust when it is not deceptive. And it is not necessary to be deceptive” (Ralph Slovenko, Psychotherapy and Confidentiality, 24 CLEVE. ST. L. REV. 375, 395 (1975))

For further reading on Confidentiality in Campus Counseling Services: Bower, K., Schwartz, V., Legal and Ethical Issues in College Mental Health, in, Kay, J., and Schwartz, V., Mental Health Care in the College Community, Wiley (2010). Pg. 115-23

Read more on integrated care.

JED is grateful to the following individuals who generously took the time to share their insights and experience in reviewing and contributing to this document:

• Louise Douce, Ph.D., Assistant Vice President for Student Life and Director Counseling and Consultation Service, retired; Adjunct Assistant Professor, Department of Psychology, The Ohio State University.

• Greg Eells, Ph.D., Director of Counseling and Psychological Services, Cornell University.

• Peter F. Lake, J.D., Charles A. Dana Chair and Director, Center for Excellence in Higher Education Law and Policy, Stetson University School of Law.