What is patient confidentiality in Ontario's Mental Health Landscape?

Rachel Deshpande

Confidentiality is essential for most people when navigating mental health in Ontario. For many reasons, including stigma, privacy, harm reduction, protection, and many more, patient confidentiality with their doctors and the healthcare system is vital for many patients willing to seek therapy or medical help for mental health. Due to this, there is an extensive process outlined in the Ontario Mental Health Act for the privacy and protection of patients, as well as the Regulated Professions Actthe Health Care Consent Act, the PHIPA (Personal Health Information Protection Act) and PIPEDA (Personal Information Protection and Electronic Documents Act).

The Ontario Mental Health Act states that when there is a conflict between the provisions of the Personal Health Information Protection Act, the requirements outlined in the Mental Health Act apply. This is the case for most of the other acts that are implanted in the Mental Health Act. Indicating its importance in mental health treatment [1]. A patient’s health record is maintained confidential, except under a few legal and ethical circumstances outlined in the Act. Officers in charge at the psychiatric facility can collect patient information without the patient’s consent to comply with the Criminal Code of Canada or to examine the patient under a legal order [1]. Also, the Board that is in charge of reviewing Certificates of Renewal and Certificates of voluntary or involuntary admission is permitted to access a patient’s health information for certification by request of the attending physician for legal or personal safety reasons [1]. It has to do with healthcare ethics: although doctor-patient confidentiality is a significant relationship in the healthcare system, if the doctor believes that the patient is at risk of harming themselves or other people, it is needed for court or board review or under the Substitute Decisions Act, the decision maker of the patient is also permitted to the patient’s health record.

           Even in legal circumstances, there are still ethical considerations. During any legal proceeding, confidential information related to a patient’s evaluation, therapy, and admission to a psychiatric facility can only be disclosed if the individual has provided consent, the substitute decision-maker has provided support, or if revealing such information is deemed necessary for the greater public interest [1]. In general, protecting personal information is extremely important in Ontario, and it is only under certain circumstances that involve the physical, emotional, and mental safety of the patient and the public that personal information be revealed.

           PHIPA, the Personal Health Information Protection Act, defines the rules for collecting and sharing personal health information in Ontario [2]. PIPEDA also governs the sharing and distribution of personal data at the federal level while including all organizations and individuals under its umbrella of protection of personal information. These acts and the Health Care Consent Act work together to maintain the principles of healthcare ethics. The Health Care Consent Act focuses on the capacity to make decisions and provisions to ensure consent is obtained by the patient as much as possible. According to PHIPA, only a Health Information Custodian is privileged with private health care information regarding a patient. Health Information Custodians include health care practitioners, health service providers, people who operate long-term care homes, psychiatric facilities, retirement homes, pharmacies, and ambulance services, as well as medical officers of the Board, the Minister of Health, and others who require this information for providing care [2]. Exceptions to this include:

           Another Act that may be familiar to many is HIPAA, the U.S. Health Insurance Portability and Accountability Act. HIPAA has to do with privacy and information protection across the United States of America and does not have much impact on our regulations towards personal health care in Canada. Some people would consider PHIPA the Canadian version of HIPAA in Canada, and each Canadian province has its own privacy legislation regarding personal and health information [3].

           Consent is the most important part of doctor-patient confidentiality and maintaining your privacy rights within mental health services. Healthcare professionals must tell you all the rules regarding privacy, who is permitted to access your health information, and under what legal circumstances will your personal information be shared. In certain situations, healthcare providers may implicitly consent to exchange personal health data with other professionals. Nevertheless, if you explicitly express to the healthcare provider that you prefer not to disclose information to specific individuals, they must honor your choice. [4].

           Suppose you believe your rights under PHIPA have been violated or a healthcare professional has committed professional misconduct. In that case, you can file a complaint to the Information and Privacy Commissioner or the select organization’s contact person. You also have the right to access your healthcare information, instruct that your information is not shared amongst other healthcare professionals, change your personal health information, and give and withdraw consent to using and sharing your personal data [5].


[1] https://tinyurl.com/3d9dtpzn

[2] https://tinyurl.com/5n73s7z8

[3] Inc., I. (2019, December 2). Practical approaches for the personal health information protection act (PHIPA). Approaches to Personal Health Information Protection Act. https://tinyurl.com/mr3bytx6