By Douglas Meyer
In light of recent personal events, I have been forced to reevaluate my views on mandated reporting. By mandated reporting, I am referring to the collection of laws and professional codes of conduct that force people to file a variety of reports for situations including, but not limited to, child and elder abuse, sexual assault and self-harm. While the specifics of the situations that must be reported vary widely, a general theme is that an adult must report any risky situation they observe in a professional capacity so that those involved can get necessary help. What follows should not be taken as a comprehensive argument against mandated reporting, but rather as a suggestion for why “getting someone the help they need” is not strong enough to warrant mandated reporting.
Imagine a sixteen year old, we’ll call him Sam, who was recently sexually assaulted. Sam is showing mild signs of depression and has night terrors almost every night as a result of the assault. He knows that some psychological help may prove beneficial, but is unwilling to forfeit his privacy, even if necessary to get the help he needs. I’m going to make a few assumptions for the purposes of analyzing Sam’s case:
1. Sam’s peers would be supportive, but lack sufficient training to help him.
2. Sam’s high school has guidance counselors who are well trained in helping sexual assault survivors.
3. Sam would not be able to afford a psychiatrist without financial assistance.
One of Sam’s options would be to seek the help of a Mental Health Professional (MHP). For the purposes of this discussion, I will define an MHP as a person who has received extensive training in offering psychological assistance and who maintains patient confidentiality. This would be Sam’s best chance of getting the help he would need for his depression and night terrors because the mental health professional would be able to help Sam work through his traumatic experience. In addition, this option would let Sam maintain his privacy, since the only person who would find out about his experiences would be the MHP. Unfortunately, Sam would likely need to explain why he was in need of an MHP to his parents in order to receive their financial assistance. Sam’s unwillingness to forfeit his privacy coupled with his inability to afford an MHP on his own means that this option is unavailable to him.
There are likely only two free options available to Sam. First, are anonymous helplines (AHs) which include services such as online support groups and hotlines Sam could use. AHs would be helpful to Sam, but they would only be beneficial as supplements to other forms of help. Most support groups are comprised of well-meaning peers who bond over shared tragedies, but without sufficiently trained professionals included, they just do not have the capacity to provide all the help Sam needs. Hotlines are very often staffed by volunteers who have minimal training to provide basic guidance and support to callers, but these volunteers would only be able to guide Sam in finding MHPs and another type of assistance, which will be discussed momentarily. As a result, AHs could provide Sam with a lot of support, but only supplementally.
The other possibility would be a cluster of psychological services, which I’ll call Nonconfidential Psychological Agents (NPAs.) As the name suggests, NPAs are services and people, including school guidance counselors and teachers, who cannot offer their clients confidentiality because of their mandated reporting obligations. NPAs can be assumed to have sufficient training to provide Sam with the help he is seeking, and I’ll assume that there are sufficient NPAs available at little to no cost such that cost would not be a barrier to Sam.
Unfortunately for Sam, these three options are insufficient to deal with his case. Option 2 (AHs) would only be able to provide supplementary assistance, but on its own, couldn’t provide Sam with the necessary assistance. Options 1 and 3 (MHPs and NPAs, respectively) would be able to provide the necessary assistance to Sam. However, option 1 would be inaccessible to Sam due to financial barriers.
Earlier, I mentioned that my interpretation of the purpose of mandated reporting was to get someone the help they need. However, this would seem to fall apart when applied to Sam’s case. Mandated reporting does nothing to alleviate the financial burden associated with psychological counseling, and so it would not make MHPs a valid option to Sam. Mandated reporting does have a very strong effect on Sam’s access to NPAs. By preventing NPAs from protecting client confidentiality, mandated reporting actually acts as a barrier to these services. Ironically, the program that was implemented to get people help actually prevents many people seeking counseling from accessing those services. Moving forward, programs that promote access to counseling, like financial assistance programs, should be considered as replacements for mandated reporting strategies.
Douglas Meyer recently completed his first year at UCLA studying microbiology and the intersection between advancements in biology and society. Next fall, he will serve as Co-president of UCLA's Undergraduate Bioethics Club.