|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 3 | Page : 217-218
When they Reveal their Secrets – An Australian Perspective
Soumitra Das1, Lokesh Sekharan2
1 Sunshine Hospital, Melbourne, Australia
2 Psychiatrist, Northern Health, Melbourne, Australia
|Date of Submission||15-May-2022|
|Date of Decision||13-Jul-2022|
|Date of Acceptance||27-Jul-2022|
|Date of Web Publication||21-Dec-2022|
Dr. Soumitra Das
Sunshine Hospital, Melbourne 3021
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das S, Sekharan L. When they Reveal their Secrets – An Australian Perspective. World Soc Psychiatry 2022;4:217-8
It is not so common when our patients reveal their acts of sexual crimes on minors as they fear the consequences of it. There was an instance where an elderly patient suffering from late-life depression disclosed a few incidents of past sexual abuse committed on vulnerable children. On most of the occasions, the victims might have deceased or have never come forward to report it. When victims share their stories, we encourage them to take support from legal institutions. However, the revelation of sexual crime by the perpetrator can create a significant ethical dilemma.
From a moral ground, we need to report any form of crime inflicted on children irrespective of the time of occurrence. In Victoria, a state of Australia, we follow both state and federal laws depending on the situations. The state law mandates the reporting of any sexual crime toward children irrespective of the time, either recent or historical. However, there are many practical challenges we need to consider before making any decision.
| Duty towards the Victim|| |
The perpetrator in question might pose a significant risk in near future to other children. Risk toward their children or children living in the vicinity should be considered. What if the risk appears to be low during a clinical presentation but escalates in the future? – whether not reporting the crime that happened in the past would create a significant legal issue for the clinician. On the other side, the victim might be an adult during the time of disclosure and does not want to press charges. Reporting such crime and related information might create a significant impact on the victim's ongoing stable life. It can breach the privacy of a person, even destabilize the personal, family, and social life. It might be a good practice that psychiatrists discuss with the victim first and enquire about their views. Establishing anonymity from any of the sides will be impossible when the legal system gets involved.
| Duty towards Perpetrator|| |
The perpetrator might be going through a significant level of guilt or even depression for which they will need professional help from psychiatrists. At the same time, discussing the requirement of mandatory reporting might significantly escalate the crisis. Hence, the treating team would need to choose a setting and timing for such a mandatory requirement. The treating team should develop a crisis plan for potential deterioration such as inpatient admission or support from the family. It is pertinent to discuss if the perpetrator wants to disclose this information to his/her family. In such a case, what might be the expected reactions from family members, especially if dependents share the same house?
As psychiatrists have a duty to protect the confidentiality, reporting historical information might significantly harm the therapeutic relationship. The person might lose the trust and potentially putting the psychiatrist at the risk of violence. There is also a possibility of the perpetrator changing the version of the information previously disclosed to the therapist.
| Legal Binding in the State of Victoria, Australia|| |
Protecting children from sexual abuse is the responsibility of the whole community. Victoria police encourages everyone to report any sexual offense irrespective of their time of occurring. Aligned with the Tarassof case, RANZCP code of ethics 4.4 dictates that “A breach of confidentiality may be justified where there are public-interest considerations, in order to protect the safety of the patient or of other people.” So, any disclosure related to future risk of child sexual abuse can be shared with the third person or relevant authority to prevent any harm to the child. Before reporting, we must have a reasonable belief that an adult sexually abused a child under 16 years of age. One can be exempted from reporting under certain circumstances such as fear of safety, or the information already are being reported. One can also be exempted if the victim was 16 or older and requests confidentiality. Regarding the historical incident, psychiatrists must report if the alleged victim was still aged under 16 years as on October 27, 2014.
| Conclusion|| |
It is still a matter of debate whether we should report every disclosure of historical sexual crime when the perpetrator reveals during clinical interaction. On the one hand, we have the moral and legal responsibility to protect society from any potential crime toward children, on the other hand, we must protect the confidentiality and well-being of our clients. The historical event even though does not bear any significance can create many ethical dilemmas when legal guidelines mandate us to report to the authority. Hence, it is always a wise step to discuss with different stakeholders before making any decision.
Clinicians, BRIEF Team, hume community team.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Walfish S, Barnett JE, Marlyere K, Zielke R. “Doc, there's something I have to tell you”: Patient disclosure to their psychotherapist of unprosecuted murder and other violence. Ethics Behav 2010;20:311-23.