The Double-Edged Sword of Mandatory Reporting

Mandatory reporting is an excellent example of how tone-deaf and confusing mental health policy can be. Mandatory reporting laws require health professionals, including therapists and psychologists, to report certain things to higher authorities, even if they were revealed during an otherwise confidential session. Depending on were you live different things are reportable, but “danger to self” is virtually universal.

Most people see this as a way to intervene during crisis, and they may be right. There really aren’t numbers about the efficacy of this policy. Like most things in mental health, it just “feels right” to the legislators who passed it. Therapists and other health providers may support mandatory reporting, since it gets them off the hook for difficult patients.

But no one ever asks the clients what’s up.

I was explaining mandatory reporting to my mom the other evening. Here in Texas, if you are involuntarily hospitalized (a common result of mandatory reporting) you are taken to a private psychiatric hospital. There are special courts that hear your case, but it is nearly impossible to get released quickly. Going to a place like that is a worst nightmare for many of us.

Something clicked for my mom. “Well, how do you talk to your therapist when you feel suicidal?”

I immediately answered, “I don’t.”

I dance around it. I felt suicidal in the past, but don’t worry, not now. I don’t have a plan or anything. I lie and lie to keep myself safe. The open relationship I’m supposed to have with my therapist is a farce, and I must always guard the most painful parts of my disease. The therapist can’t really help me completely because she will never have the whole story. Sometimes I worry about putting her in the position of deciding whether to call MHMR.

I’m sure some people have a good enough relationship with their therapists that they don’t worry about this. They are lucky people. Most of us are constantly dodging and weaving, terrified of what happens if we get sucked into the system.

One day, when I was going through an especially rough patch, a police officer showed up at my apartment. I am a tall woman, but he was a giant man, at least a foot taller than me. He had a bullet proof vest, mirrored sunglasses, and two guns.

"I'm here to help with your emotional issues."

Anyone who shows up to a mental health emergency with guns is probably emotionally illiterate, and this guy was no exception. I got him to leave through a combination of sweet talking and oversharing, which eventually made him visibly uncomfortable. My secret super power is psychic distress. That, and being a white lady in my thirties.

You think I ever went back to that therapist? Not a chance in hell.

There’s another layer here, too. When we talk about mental health background checks for guns, we’re talking about involuntary hospitalization records. Currently, that’s the only data available.

Now, it’s not that I want to own a gun. But. The current gun control argument goes something like this: the second amendment is an inalienable right to own guns. However, if a person is mentally ill (has been involuntarily hospitalized) it is OK to deny them of this “inalienable” right.

What’s stopping people from extrapolating this out to other rights? If you get your name on the “mentally ill” list, what else will they eventually keep you from doing? Even the progressives aren’t seeing the major problems with this policy. Staying off the radar seems to be the safest option.

Of course, staying off the radar also prevents us from getting assistance that might help us. It makes us feel even more ashamed of how we feel, because it’s a damn thought crime. It separates us from our therapists, psychologists, teachers, and doctors.

Sometimes I think I might be better off hiring a lawyer to listen to me talk; they don’t usually have any of these requirements.

What do we do?

First, every intake appointment for every therapist, psychologist, and physician should include a discussion of mandatory reporting. People need to know when they are exposing themselves, and what happens if they do.

Second, mental health professionals can practice resistance. Don’t knee-jerk report people. Understand that you may ruin someone’s life at a time when they are trying to find a reason to live. Tell your clients where your boundaries are, how free they should feel talking about suicide. Assure them that if you ever really do feel that hospitalization is right for them, it will always be their choice. You will stay with them while the arrangements are made. Promise never to put someone in a situation where they must deal with Officer Cartman.

Third, as non-mental health professionals, we can be allies to our friends in therapy. If they don’t feel comfortable talking about suicide in session, let them know they can talk to you. Therapy is still a good idea for depression, anxiety, and all the nasty coping mechanisms we tend to build up around ourselves. Assure them they have an outlet for suicidal thoughts too.

Finally, we all need to advocate for better intervention resources. Crappy public/private inpatient mental hospitals are just neo-asylums. We throw everyone in together, then wonder why they aren’t getting better. There should and could be better suicide-specific intervention programs that aren’t as dehumanizing, demeaning, and dangerous as what we have now.

Mandatory reporting was created with the best intentions, but a crucial part of program design is evaluation. Given that it severely cripples the client-therapist relationship, maybe we should go back to the drawing board.