Abstract
To the Editor
Timely treatment of mental health problems is an issue of concern in Australia. Recently, Bassilios et al. (2016) reported on the success of the Access to Allied Psychological Services (ATAPS) program in increasing service provision during childhood, focusing on vulnerable socio-economic or demographic groups. However, the range of issues that delay service access among young people is extensive, and there is a need for programs that address general psychological barriers in addition to the needs of specific populations.
Concerns about confidentiality are a major barrier to help seeking for mental health problems during adolescence. However, many adolescents have a limited understanding of professional confidentiality obligations (Carlisle et al., 2006). While requirements regarding confidentiality differ between professions and discussion of these is beyond the scope of this letter, a better understanding of Australian adolescents’ beliefs regarding confidentiality will aid interventions that facilitate appropriate help-seeking.
Year 9 students (n = 2447; mean age = 14.93 years; standard deviation [SD] = 0.45) were recruited from schools in Victoria, Australia, as part of a school-based help-seeking intervention (MAKINGtheLINK; Lubman et al., 2016). Participants read a vignette describing a same-age peer experiencing depressive symptoms (‘Sarah’) and indicated their agreement to statements regarding confidentiality. In addition, they were presented with a list of nine help sources and asked which they believed were bound by professional confidentiality obligations.
Approximately half the sample believed that family and friends are legally required to keep their secrets (Table 1). A similar percentage agreed that health professionals must keep a client’s information private even if they were concerned that they were going to hurt themselves, suggesting that many adolescents lack an understanding of health professionals’ duty of care toward underage clients. Approximately 40% believed that parents were able to break confidentiality simply to remain informed. Indeed, with the exception of mental health professionals and school counselors, most participants were unable to identify help sources that are bound by professional confidentiality (Table 2).
Adolescents’ agreement to statements regarding confidentiality.
Adolescents’ beliefs regarding the confidentiality obligations of help-sources.
These results suggest that Australian adolescents have a limited understanding of confidentiality, including the sources to which it applies and the circumstances in which it can be breached. Improving understanding of these issues is critical given that willingness to disclose personal information is likely to be limited when confidentiality is not assured (Carlisle et al., 2006). Programs that improve understanding of these issues are necessary to complement existing programs focusing primarily on increasing accessibility and affordability (e.g. Bassilios et al., 2016).
Footnotes
Acknowledgements
We are grateful to the schools, parents and students who have agreed to take part in the trial. We would also like to thank the following individuals for their assistance with running the program in schools: Emma Sandral, Anna Guthrie, Alissa Walsh, Laura Abbey, Nyssa Ferguson, Michael Turner, Shera Blaise, Margaret Chigros and Erica Gurner.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
Financial support was provided by the National Health and Medical Research Council (NHMRC Grant APP1047492).