Cardinal Pell at his press conference last Wednesday stuck to his insistence that the confessional was always inviolable. A seal so tight that all manner of sin can be absolved in absolute secrecy.
If trained medical practitioners hear similar confessions during a consultation (for example, someone is at risk, or a crime has been committed), they may be legally obliged to report it. The exact requirements vary from state to state, but include physical and emotional abuse, neglect and risk of harm.
The Australian Medical Association (AMA) Code of Ethics says: ‘Exceptions to [patient confidentiality] . . . may include where there is a serious risk to the patient or another person, where required by law, or where there are overwhelming societal interests.’
This produces an absurd situation where the clinicians who actually have the professional skills to help a troubled person must report. Yet someone trained only in theology and with no clinical background does not. People with the skills to help may have to report their patients; the ones without, don’t.
Intentionally or not, this can divert someone who is troubled or who has committed a crime away from seeking help from medicine and into the confessional, where there is not a scintilla of evidence that religious doctrine or methods can assist them. It follows that the person may continue abusing, because their prayers do not help them to stop, nor do they help the ones they are harming.
The role of faith is very important to some, and this should work hand in glove with civil society, including the laws of the land. But surely subverting the law is another matter entirely .
In Australia, clinicians are required to comply with national law that legislates mandatory reporting and also with state law which mandates reporting for issues like the risk of child abuse, actual abuse, or criminal activity. A list of mandatory reporting requirements is here.
One of the first ports of call for someone troubled is often a clinical psychologist who has been trained and registered to deal with mental frailties. Instead of issuing a certain number of ‘hail marys’ to a client, psychologists use proven clinical practices to help them to solve their problems. If they just sent patients off to pray, they could be sanctioned or deregistered.
Psychologists have additional obligations under the Australian Psychological Society’s Code of Ethics with which they must comply to keep their registration.
The Stirrer spoke with Dr Rebecca Mathews of the APS, who outlined the Code’s requirements.
On record keeping and note taking:
Psychologists maintain accurate, current, and complete records of psychological services. Client psychological records include information that identifies the client and documents the nature, delivery, progress, results, or recommendations of psychological services, and includes appointment diary entries, working notes, assessment material, information stored in a computer.
On mandatory requirements for psychologists:
Psychologists are required to communicate to clients the limits to confidentiality at the outset of providing a psychological service. This means that psychologists inform their clients, that if they become aware that “there is an immediate and specified risk of harm to an identifiable person or persons that can be averted only by disclosing information”, then the psychologist may disclose that information to avert risk. There is a duty of care for psychologists to protect the client and others from harm.
Dr Mathew explains “Psychologists inform their clients that information given to them in confidence by clients is not privileged information, and that the psychologist may be compelled at some point in the future by a court of law to reveal that information”
So a client’s records must be kept and those records could be used for prosecution later, even if there is a not a notifiable event. So it is a brave patient, greatly committed to their healing, who seeks treatment knowing all of this. These laws and Codes of Ethics are designed to protect the vulnerable and the abused.
If the Royal Commission on institutional child abuse does anything – it must put an end to this ridiculous situation, where the ones who can’t help because they don’t use evidence based techniques have a legal right to silence, while the one who can, has to take detailed notes that could open the door to future prosecution of their patient.
Bringing Catholic clergy in line with the medical fraternity seems the absolute minimum we should expect. And even that would overvalue a priest’s role in the healing process, given their lack of training in the medicine of the mind.