Background
With the advancement of digital technologies in recent decades, health institutions in Israel have established information systems for managing the care and services provided to patients in the health care system, and in the area of mental health in particular. These information systems make the data accessible to treatment providers, thus helping to improve medical treatment and promote continuity of care. However, clinical information is considered sensitive, and in setting policies regarding its sharing, it is necessary to find the appropriate balance between continuity of care and quality of treatment on the one hand and protecting the patient’s right to privacy and information security on the other. This is especially the case when dealing with clinical areas considered particularly sensitive, such as mental health.
At the time of conducting this study, according to the Ministry of Health’s Information Classification Procedure A-8.2, identifiable information in the area of mental health (hereinafter referred to as mental health information) was classified as “strictly confidential”, unlike identifiable information in any other clinical area, which was classified as “confidential”, and there were strict guidelines to ensure that it is shared only with authorized treatment providers.
The Ministry of Health intends to change the classification of mental health information from strictly confidential to confidential, thereby expanding the sharing of information among treatment providers. Before implementing the change in policy, the ministry approached the Myers-JDC-Brookdale Institute to conduct a study examining the attitudes of the Israeli public regarding the possibility of expanding the sharing of mental health information among treatment providers.
Objective
To identify and characterize the attitudes of the Israeli public regarding the possibility of expanding the sharing of mental health information among treatment providers, with the goal of bringing those attitudes to the attention of decision-makers and having them taken into account when formulating policy on this issue.
Method
To assist in developing the research tool, six interviews were conducted with ten professionals: relevant position holders within the Ministry of Health (Digital Health Department and Legal Department) and treatment providers in the mental health field (a psychologist, a psychiatrist, a head nurse in mental health at a health fund and a director for mental health at an NGO). As part of the study, a qualitative thematic analysis was carried out of five interviews with individuals who are coping with mental disabilities (hereinafter also referred to as mental health patients) and six focus groups with participants from various populations: non-ultra-Orthodox Jews (two groups); ultra-Orthodox Jews; Arabs from the North; Bedouins from the Negev; and family members of mental health patients. The interviews with the mental health patients and the focus groups were conducted between December 2022 and April 2023, with a total of 52 participants.
Main Findings
The research findings indicate that the prevailing attitude among participants is in favor of sharing information—primarily with family physicians—provided that the patient gives his consent. The willingness to share information is nonetheless accompanied by certain concerns, such as stigmatizing attitudes among the treatment providers towards the patients. Participants emphasized the importance of maintaining the patient’s autonomy by enabling them to make personal decisions regarding the sharing of their mental health information. They also stressed the importance of maintaining patient privacy, for example by limiting the sharing of in-depth documentation (such as psychotherapy records).
Differences in attitudes were found across groups according to background characteristics. Participants from traditional societies (the ultra-Orthodox, Arabs and Bedouins) preferred to share information with a physician outside their community, were very concerned about the stigma (negative labeling) towards the mental health patient and his/her family and showed less trust in treatment providers’ ability to maintain medical confidentiality. Those with experience in using mental health services (mental health patients and family members of mental health patients) were worried that expanding the sharing of information would harm the quality of care as a result of stigmatizing attitudes among treatment providers. Given these concerns, they stressed the need to educate treatment providers—both those who work in mental health and those who do not—regarding the rules of information sharing and the importance of maintaining flexibility in the information sharing policy, according to the patient’s wishes.
Summary
The study examined the attitudes of the Israeli public regarding the possibility of expanding the sharing of mental health information among treatment providers. The research findings were presented to the director of the Digital Health Department at the Ministry of Health, prior to the publication of the Director General’s Circular (No. 8/2023) that changed the classification of mental health information from “strictly confidential” to “confidential”, and subsequently also to the director of the Mental Health Department. The study helped to refine the regulations regarding the sharing of mental health information between treatment providers, with the aim of improving the quality and continuity of care while minimizing the infringement on patient privacy. Additionally, the research can assist in creating a clear and logical rationale for the regulations that is easily understood by the public.
Recommendations
- Involve the patients in the sharing of their information. It is advisable for a treatment provider who is providing medical service to a mental health patient to inform them about the information they are entering into the system and to whom this information may be exposed.
- Shortly after receiving a diagnosis of mental illness, it is recommended that the guidelines of information sharing among treatment providers be explained to the mental health patient and his/her family, including the rationale behind it and the options to limit it.
- Shortly after receiving a mental health diagnosis, it is recommended that information about conditions that may undermine the patient’s mental health be documented in his/her medical records (such as anxiety about being in an enclosed space) or that may complicate his/her interaction with the health system (such as social anxiety). Information requiring special attention from treatment providers should automatically and prominently appear in his/her medical records and should be accessible to any treatment provider who interacts with him/her.
- Exclude psychotherapy records (in-depth documentation) from information sharing.
- Using professional medical tools, examine the relevance of past diagnoses and the possibility of transferring some of them to the medical records’ “archive”.
- Automatically lengthen the duration of a mental health patient’s visit with his/her family physician in order to establish trust, which will encourage sharing by the patient and enable the family physician to serve as the orchestrating agent for the patient.
- Develop training courses and seminars that will be attended periodically by family physicians, specialists, treatment staff, and especially mental health staff with regard to:
- Holistic and sensitive treatment of mental health patients.
- Reducing the stigma towards mental health patients.
- The importance of maintaining patient privacy and medical confidentiality in general, and particularly in the context of mental health.
- Promote standardization in the reporting of psychotherapy records by means of systemic and digital structuring of “text templates” for writing up diagnoses, treatment summaries, hospitalization summaries, and in particular text-dense documentation. This is in order to minimize exposure and the infringement of privacy on the one hand, and to improve efficiency in reading the summaries on the other hand.
Citing suggestion: Laron, M., Sobol-Sarag, D., Milshtein, E., & Penn, N. (2024). Expanding the Sharing of Mental Health Information among Treatment Providers – Public Attitudes. RR-991-24. Myers-JDC-Brookdale Institute. (Hebrew)