The Potential Risks of Immediate Access to Psychiatric Records & The Cycle of Hospitalization
The increasing movement towards “open notes” – granting patients immediate access to their medical records – presents a complex challenge, particularly within the field of mental healthcare. While openness is a valuable goal, emerging evidence suggests that immediate access to psychiatric records can, in some cases, be detrimental, possibly even contributing to a cycle of repeated hospitalizations.This is a concern highlighted by personal experience and supported by recent research.
One individual’s journey illustrates this danger. After years of navigating repeated psychiatric hospitalizations, a turning point came with access to their past records after significant improvement and a period of stability. Discovering the language used to describe their condition and trajectory was deeply unsettling, and the individual believes that had they encountered this labeling during active struggle, it could have reinforced a self-perception as a ”professional patient,” potentially prolonging the cycle of care. This experience underscores the potential for records to become self-fulfilling prophecies.
This concern isn’t isolated. A study revealed that a significant proportion of healthcare providers (HCPs) report negative consequences when patients access their records. 55% of HCPs surveyed noted clients experiencing significant distress after reading their notes, while 29% reported clients terminating treatment and 21% observed instances of negative or self-destructive behaviour following record access.
Though, the implementation of open notes isn’t without potential benefits. Research suggests clinicians are adapting their documentation practices to be more patient-amiable,potentially strengthening the therapeutic relationship. one study found that HCPs generally strive to create notes that are easier for patients to understand.
The core of this debate lies in the shifting power dynamic between clinician and client. Some clinicians view open notes as a means of fostering partnership, while others fear it could undermine the therapeutic process. Clinicians often feel discomfort with the practice, acknowledging it could both improve and diminish care. Research indicates open notes are empowering clients, impacting how clinicians build rapport, and prompting adjustments in practice to mitigate potential adverse consequences.
As an LCSW, a commitment to objective documentation is paramount. Notes should accurately reflect what a client states, for example, “The client stated she felt sad upon the loss of her cat,” rather than interpretations of internal states, such as “The client was feeling anxious because she had a physics final the next day.” This approach minimizes the risk of inadvertently influencing a client’s self-perception through potentially stigmatizing or inaccurate labeling.
Ultimately, open notes are becoming increasingly prevalent.Recognizing both the potential benefits and risks is crucial. Judicious use and careful consideration of the timing and context of record access are essential, particularly in the sensitive realm of mental healthcare, to avoid inadvertently contributing to a cycle of hospitalization and hindering a client’s path to recovery.
