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.

Read the full article
Report a problem with this article

Related articles

  • More for Policy & Practice

    Armed Forces Covenant toolkit: Updated edition (2025)

    Abstract: One of the key achievements of Forces in Mind Trust’s (FiMT) Our Community - Our Covenant series of reports, beginning in 2016, has been to establish a toolkit for local authorities to help them develop support for their local Armed Forces Community (AFC). The 2016 report launched the idea of a “core infrastructure”, supported by self-assessment questions and some wider tips. Formal research and informal engagement show that the toolkit still provides an important contribution to successful local delivery of Covenant pledges and wider AFC support. It’s a baseline in the face of ever-present funding stresses and a point of reference when there are changes in member and officer responsibilities. This means it is important that the toolkit remains up to date. It was last reviewed in 2022 and presented as an Annex to FiMT’s research report A Decade of the Covenant. Since then, there has been further research into local support for the Armed Forces Community for the next iteration of the Our Community - Our Covenant series. This updated toolkit reflects these recent findings about local practice as well as developments following the introduction in the Armed Forces Act 2021 of the duty of due regard to the principles of the Covenant in the focus areas of housing, education and healthcare. As with the original document, the toolkit remains targeted at local authorities. It covers their own direct role in supporting the local AFC, but also the crucial activity of convening local partnerships and so enabling effective local collaborative action. The key changes to the core infrastructure and self-assessment cover: (1) More emphasis on embedding AFC support into the mainstream of local authority work. (2) An extended top tips section with more advice based on recent research. (3) We have dropped the descriptive scenarios of challenges that members of the AFC face. These have now been overtaken by analytical scenarios included in the freely available national training material and in the Ministry of Defence’s (MoD) Covenant Legal Duty toolkit, which helps to explain the legal duty aspect of the Covenant. (4) Some additional material about the individual roles, collaboration, communication and vision and commitment elements of the core infrastructure. This toolkit update is being made in spring 2025 at a time when further change in the Covenant environment is likely, with potential extension of the Covenant duty and expected re-organisation in English local government and creation of new combined or strategic authorities. Additional modules could be added to the toolkit to reflect these ongoing policy developments.