WHOM DOES CONFIDENTIALITY SERVE?

I am beginning to believe that laws protecting confidentiality
are used in the service of the management of community mental
health systems more than in the service of the system users.

I am not referring to confidentiality in the sense of privacy,
privilege, ethics, or common sense.

I am referring to the restriction of even the identification of
the person as a patient.  This is the position of the American
Psychiatric Association and seems to be the widespread
understanding of the rules and codes.

I know aggregate information is legally available.  Generally,
the data are collected to meet overseer reporting requirements. 
But it is difficult to get in user-useful form.  

     For instance, six months ago, I requested aggregate
     demographic information about local system users by
     electoral district.  I have been told that confidentiality
     precludes generating reports of this sort, and told that
     special software would need to be written and that our
     county has only one person capable of doing this.  Since I
     persisted, our deputy administrator hand counted the totals
     from a zip code sort.  As I expected, more than half of
     system users live in one electoral district.  This is
     adequate to begin lobbying for the next election, even
     though district lines of elected officials are not identical
     to zip code areas.  

Knowledge is power.  Controlling knowledge helps to control who
has the power.  Slowing the flow of information in this way helps
to maintain the existing power and control structure.

I would not want to breach the privacy of those who voluntarily
admit themselves to hospitals.  But under current practice, as
well, there is no way for local client networks to send mailings
say to all those psychiatrically detained without consent.

It seems to me that confidentiality has become secrecy, and that
people's capacity to control their own lives and better their lot
is limited by this shift in meaning.  Secrecy limits flexibility.

Secrecy limits participation.  Secrecy is smoke that sets others
to wondering what the shameful fire is.

It seems that the best way to test this would be legally.  Do you
have any suggestions?


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