Key Takeaways

  • Client confidentiality is a core foundation of the therapeutic relationship. However, there are times when a therapist has a legal and ethical obligation to break confidentiality in order to keep someone safe.
  • Mandatory reporting laws require therapists to file a report whenever they suspect that a vulnerable person is being harmed or could be harmed.
  • If you’re unsure whether or not a report is warranted, seek consultation and remember that you don’t have to prove the report is valid. You’re simply required to report what you’ve been told, not investigate the validity of the claim.
Throughout the United States, mandatory reporting laws require certain professionals to report possible instances of abuse or neglect. While reporting requirements vary slightly from state to state, they are all designed to protect people categorized as “vulnerable,” which includes children, the elderly, and people living with a disability.  Of course, being a mandated reporter comes with great responsibility — and it’s not something therapists take lightly. No clinician enjoys making reports regarding potential abuse or neglect. In fact, it’s very common for therapists to experience anxiety when faced with these types of calls.  The whole process can be nerve-wracking: from deciding whether or not to make the report, ensuring that enough information can be provided to the reporting agency, then waiting for the follow-up. As a therapist, know that you are not alone in this feeling — and that there’s support available as you navigate these decisions. 

Situations that require mandated reporting

People identified as “vulnerable” cannot cognitively (and therefore legally) provide consent. As a mental health professional, there will be times when you need to advocate for the protection of a client or someone connected to your client. This includes filing a report whenever you have reason to believe that a child, elderly individual, or a person living with a disability may be the victim of:
  • Physical harm: Including slapping, punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting, burning, or any other means of causing bodily harm. In most states, this now includes spanking.  
  • Sexual harm: According to the Federal Child Abuse Prevention and Treatment Act involves “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of a caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or another form of sexual exploitation of children, or incest with children.” This also includes any report of minors engaging in sexual contact with one another. It can be important to explain this to adolescents and their parents at the beginning of your work together.  
  • Neglect: In the form of ignoring the life-sustaining needs of a vulnerable person. This can include emotional, educational, medical, or physical neglect. In most states, abandonment is also considered neglect.

What about emotional abuse? 

Hearing about verbal and emotional abuse can be difficult. Unfortunately, most states don’t have any specific protocol or take action when it comes to verbal and emotional abuse. If emotional abuse is evident, it can be useful to report it alongside any physical abuse, sexual abuse or neglect claims. This provides documented context that could be useful in establishing a pattern of harmful behavior.  Therapists should use their own discretion and get clinical consultation when deciding whether or not to report emotional abuse. 

What about self-harm?

If you have an independent, non-vulnerable adult client who is engaging in life-threatening self-harm, you are required to report the issue to an emergency contact or your local emergency services for a wellness check. If a minor you work with is engaging in self-harm, you should speak with their legal guardian and express your concerns. Then, if the legal guardian does not take appropriate action to prevent harmful behaviors (such as removing knives from the child’s access, etc.), you must report this to the appropriate authorities as neglect.

What if the abuse was already reported?

Sometimes when abuse is disclosed, the client may state that the abuse was already reported by another professional. In these cases, use your clinical judgment to determine if reporting the claim is necessary. In most cases, it is helpful to report the claim regardless of previous reports. This helps boost credibility in the claim and will ultimately lead to a more just outcome. 

What if I’m concerned my client could harm someone else?

Mandatory reporting laws allow a therapist to breach client confidentiality to protect the safety of vulnerable people. But there are also instances where therapists may break confidentiality to protect a third party from harm. This is collectively known as a therapist’s “duty to warn” and it has its roots in the California Supreme Court case of Tarasoff v. Regents of the University of California that took place in the 1970s. “Duty to warn” laws state that if a therapist comes to believe that there is an active threat or specific plan to cause life-threatening harm to someone, the therapist has an ethical responsibility to report it. As always, therapists should report any concern related to what a client has shared in their clinical documentation as well.  

Ethics of reporting: What to consider if you’re not sure

Like many other aspects of working in mental health, mandatory reporting isn’t always a straightforward process. Sometimes, there can be some confusion around whether or not it’s in your client’s best interest or if you’re legally required to make a report. No matter what, it is important to remember that you have a legal and ethical obligation to report abuse or neglect when it affects vulnerable clients. Consider the following when deciding what may warrant a report:
  • Mandatory reporting laws vary from state to state. So be sure to familiarize yourself with your state’s guidelines. Check your state’s website (look for the Department of Safety and Professional Services or your state’s equivalent) or contact your local licensing board for the most up-to-date information on mandated reporting within your state.
  • Take a step back and ask yourself: Has a vulnerable person told me that they are being harmed or that their needs are not being met? If so, a report is likely required.
  • Similarly, has my client shared information about a vulnerable person being harmed or having their needs unmet? If so, a report is likely required. 
  • If you suspect something harmful is going on but your client hasn’t clearly stated it, seek clinical consultation from a supervisor or professional peer. Only take this approach if your suspicions aren’t time-sensitive or related to imminent risk. If you believe that there is imminent risk present then file a report ASAP.
  • Consider the harm that could happen if you do (or don’t) file a report. While it’s true that reporting can sometimes hinder the therapeutic relationship, the harm caused by not reporting is often far greater. 
  • Remember that therapists and other mandated reporters are not required to investigate the validity of the report. You are a reporter, not an investigator. You don’t have to prove the abuse or neglect really occurred — that’s the role of the state agency that receives your report. Instead, trust your instinct, seek consultation whenever necessary, and when in doubt simply report what you are told.

Where do I report?

You can take some of the confusion out of making a report by preparing yourself ahead of time with the information you need. Take some time to familiarize yourself with your state’s Child Protective Services (CPS) organization. While the specific name of the agency may differ from state to state, this is the organization that mandated reporters must contact to make a report.  You should also locate the number for your state’s Adult Protective Services (APS) agency. Again, the actual name of the organization may differ by state, but this is the agency you’ll need to call to report the abuse or neglect of a vulnerable adult. Write down the contact information for your state’s CPS and APS and make sure you can access it easily.  In the case of imminent physical risk, call 911 or contact your local police department.

Support for mandated reporting with Rula

Mandatory reporting laws protect people who cannot protect themselves. But they also support early intervention, hold perpetrators accountable, and increase awareness of the signs and symptoms of abuse and neglect. As a licensed mental health professional, you have a duty to understand the reporting obligations associated with your role. These include knowing what constitutes abuse and neglect and which agency to contact to make a report.  At Rula, we also know that there are times when you might need some consultation or peer support to make the best decision for your clients. That’s why we offer clinical consultation hours and a dedicated private online community for therapists to get peer input on cases. 

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