Harm through stigma: Commander notification of service members' mental health

Abstract: United States service members' personal mental health information lacks the protection afforded by Health Insurance Portability and Accountability Act (HIPAA), diverging from the legal safeguards granted to other citizens. The Public Welfare Law and the Department of Defense (DoD) reduces these protections through clauses, outlining nine conditions where service members' information can be disclosed to their commanders, who may lack formal HIPAA or medical confidentiality training. Once a commander is notified, the information may be shared with others without the Service Members consent, creating an unregulated spread of private health information. Additionally, the military environment, marked by a stigma surrounding mental health issues, compounds this vulnerability. Therefore, Service Members seeking mental health support may encounter adverse consequences upon returning to their command through the propagation of stigma, which may further foster a culture of reluctance to seek help. A fictional character within the military serves as a conduit for nonmilitary providers to understand the contextual intricacies while highlighting the ethical dilemma faced by providers adhering to Congressional law, American Psychological Association (APA) Ethics Code, and DoD standards while also serving their clients. Key ethical considerations include informed consent, disclosures, maintaining confidentiality, discussing the limits of confidentiality, avoiding harm, and conflicts between ethics and organizational demands.