Mental health policies on reporting child sexual abuse and physician‐patient sexual relationships

The reporting of child sexual abuse (CSA) and physician-patient sexualrelationships (PPSR) are currently the focus of professional, legal and mediaattention in several countries. This paper briefly reviews mental health policieson these issues and reports on a WPA survey of them. While the WPA MadridDeclaration permits breaching confidentiality for mandatory reporting of CSAand clearly prohibits PPSR, it is not known how or to what extent these policiesare implemented in WPA Member Societies’ countries. It is also not knownwhether policies or laws exist on these topics nationally or to what extentpsychiatrists and the public are aware of them. Representatives of WPA MemberSocieties were e-mailed a survey about issues pertaining to CSA and PPSR.Fifty-one percent of 109 countries replied. All reporting countries had lawsor policies regarding the reporting of CSA, but this was often voluntary (63%)and without protection for reporting psychiatrists either by law (29%) orby Member Societies (27%). A substantial number of psychiatric leaders didnot know the law (27%) or their Society’s policy (11%) on these matters.With respect to PPSR, some reporting countries lacked laws or policies aboutPPSR with current (17%) or past (56%) patients. Fewer than half of respondingrepresentatives believed that their Society’s members or the publicwere well informed about the laws and policies pertaining to CSA or PPSR.There is clearly a wide range of laws, policies and practices about CSA andPPSR in WPA Member Societies’ countries. There is a need in some countriesfor laws or supplemental policies to facilitate the protection of vulnerablechild and adult patients through clear, mandatory reporting policies for CSAand PPSR. Mechanisms to protect and support reporting psychiatrists shouldalso be developed where they do not already exist. There is also a need insome countries to develop strategies to improve the education of psychiatrists,trainees, and the public on these issues.