Friendship and Mandatory Reporting by Professionals

Reader’s Question

I am trying to deal with something that has made my severe depression even worse, and I was wondering if you might have any information about the official guidelines on being a “mandatory
reporter”. I am dealing with deep depression, and finally reached out to a friend, who I knew had dealt with mental health issues many years ago. Due to my depression, I had not been in touch with her in many years, and upon calling her, I found out she is in the process of getting her Master’s in counseling. We talked a long time, and she cried with me and said she wanted to do whatever possible to help me. She gave me hope and wanted to make sure that I kept in close touch, so that I wasn’t alone in this. It was a wonderful call, and for the first time I felt like someone understood.

The next day I got an email from her referring to the fact that she was a mandatory reporter, and that she had called the mental health agency in my county, who would be calling me. Her note went on to say that I was never to contact her again, and that she could do nothing more to help me. I was absolutely devastated by the email — it was the opposite of everything she had told me during our call, when she said she wanted to be there for me and help me make it through. It was a cold, unemotional email, void of any trace of friendship or concern. It has definitely affected me emotionally.

I later found out that she also called my husband (we are separated), whom she said she would not call. She told him that I called her, as well as the details about the call. She also told him that she called the mental health agency because she was a mandatory reporter, and that she emailed me to tell me I could not contact her again because, given she was a ‘counselor’ and had to call to report the issue, she was not allowed to remain my friend, or remain in contact with me, or help me in any capacity — not even as a friend. She told my husband that she had talked with either her own counselor, or a superior in her Master’s training, and they were the one who instructed her to do the mandatory reporting. She also seemed to be saying that the rule is that since she now has this “official” capacity, she can no longer maintain contact with me or continue her friendship with me. She essentially said that since she is a counselor, and she knows about my depression, etc., she is not allowed, under the guidelines, to remain friends with me. All contact is to be discontinued between us.

I completely understand that to abide by the law, she felt she had to abide by the mandatory reporting rule, as I am dealing with some (not-yet-threatening) feelings of suicide. But I don’t understand all of the rest. Is it true that she is also mandated to no longer have any contact with me as a friend because she is now a counselor and/or now has this official capacity? None of this makes any sense to me, and has been heartbreaking. I would just appreciate it so much, if you might know what the official guidelines are (relating to the counselor-friend portion of the situation), if you might be able to share them with me.

Another question I have is, if she was acting in an official capacity by contacting the mental health agency in my county, wasn’t she misusing her official capacity in calling my husband and telling him all about our phone call? If she says she cannot be both a mandatory reporter and my friend, then how was she able to call my husband under the “friend” capacity? If she says she can only act under the official capacity of being a mandatory reporter, isn’t she abusing that official capacity by divulging the contents of our conversation to him? Isn’t there even something in the HIPAA regulations that prevent this? ESPECIALLY if she claims that she can only operate as an official counselor-in-training with mandatory reporting responsibility, and no longer as a friend? My husband is a very loving person, and it is not that I don’t want him to know things, because I want him to know everything, but I feel such an utter breech of trust in what she did — especially now, when I feel so vulnerable in this world, and have had such a hard time trusting anyone.

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Thank you so much for your time, and for any thoughts you might have. It means more to me than I can say.

Psychologist’s Reply

This is a very heartbreaking, confusing, and difficult situation. Overall, I think you are experiencing an overreaction and confused response from a counselor-in-training. Graduate students and new counselors/therapists are often confused about this situation. Yes, mandatory reporting is involved but so is friendship, graduate student supervision, ethics, and the law…not to mention tossing in HIPAA (USA only). Some general thoughts:

• A lot of issues such as HIPAA probably don’t apply here because a phone call to a friend — even when counseling is involved — does not create a professional relationship. That call contained no “informed consent”, insurance papers, release of information, office signatures, etc. Millions of such counseling sessions occur each day all over the world…it’s called “talking to a friend”.
• In a moral sense, all friends are “reporters”. If you expressed suicidal thoughts, as a friend she might have called your family or husband. That’s what friends do if they feel it’s necessary.
• Mandatory reporting is a set of ethical and legal guidelines that formally requires a breech of normal confidentiality in specific circumstances. Typical situations that activate mandatory reporting are 1) danger to self or others such as suicide threats/thoughts, 2) duty to warn of possible harm to person or property, 3) child/elder abuse, 4) danger to community or national security, 5) suspicion of incompetence, etc. In your conversation with your friend, the mention of suicidal thoughts may have triggered her need to warn others and notify the mental health professionals in your area.
• For a licensed professional, “mandatory reporting” is always active. If two adults witness child abuse in a mall parking lot, one adult has the option of reporting it but the professional must report it.
• There is also the issue of “dual relationships”. Most ethical guidelines address having “dual relationships” with others although importantly, it implies that one of those dual relationships is a professional treatment relationship. In her desire to practice ethically, she may have misinterpreted your phone call as a “professional relationship” rather than a call from an old friend.

As your experience with your friend shows, she’s much better with the actual counseling and support than with the laws, ethics, and guidelines of practice in the community. From your side, you’ve called an old friend because you felt she could help you understand your depression…and she did help. From her side however, the unexpected call came with not only memories of the old friendship, but comments about suicidal thoughts. Her response to you was emotional, honest, and supportive. However, after the call she began processing the experience, trying to fit the call into her counseling training policies. She then contacted supervisors who emphasized the suicide risk and legal/ethical issues, demanding that she engage in a set of specific actions such as 1) notifying people, 2) sending you the email about terminating the friendship, 3) staffing the call with her supervisors, etc. If she had not been in a graduate counseling program, those issues would have never surfaced, although as a friend, she would probably have called your husband — she was worried about you.

I’d learn from what she said rather than the confusion that followed. She’s learning as well as every new counselor/therapist must learn how to handle these calls from friends, neighbors, co-workers, etc. Professionally, it’s her responsibility to set boundaries and she didn’t during that call. Attempting to set boundaries after the incident is very confusing to everyone. Remember that everyone with special knowledge receives these calls — mechanics, physicians, plumbers, bankers, etc.

I would recommend seeing a counselor/therapist in a professional relationship. If your depression involves suicidal thoughts you would also benefit from an antidepressant medication. You can find information on depression and treatment on this website. I’ve written a handout on depression as well that’s available on my website at www.drjoecarver.com. I’d also forgive your friend for being a graduate student and forgetting that friends provide counseling to other friends…they always have and always will.