When Should a Social Worker Break Client Confidentiality?

Following the social work Code of Ethics, HIPAA guidelines and state and federal laws is central to effective and responsible practice. But what if a client exhibits alarming or potentially violent behavior? As social workers, you should always respect client confidentiality and follow good practices, but once a client discloses information that could put themselves or others at risk, you must immediately assess the credibility of the information and take appropriate reporting actions.

What Are Common Situations That Require Breaching Client Confidentiality?

When a client is a danger to themselves.

One of the most common – and serious – situations requiring a breach of that confidentiality is when a client is suicidal or otherwise poses a danger to themselves. When a client exhibits clear signs of suicidal ideation or self-harm, you have an ethical, legal and professional responsibility to ensure their safety.

Before breaking client confidentiality, your first step is to conduct a suicide risk assessment to evaluate the severity and immediacy of the risk. For instance, if a client shows signs of despair and consistently says things like “I have nothing to live for” or “I don’t want to be here anymore,” you should inquire further by asking them how often they feel that way and whether they have recently thought about suicide or self-harm to assess whether the person is a danger to themselves.

Once risk is identified, you must actively work to mitigate it; failure to do so may constitute a breach of the standard of care. Do not just end the session once time runs out. You need to do the clinical work to ensure the client is safe to leave the session.

Identify safety plans for wherever your client is going next. Will they be safe going home? Is there someone else at home? Can there be arrangements to have the client go somewhere other than home? Can you speak to the person they live with? Or someone who would agree to stay with them? What is the safety plan for the client once they leave your office? These are all things you need to consider before letting a high-risk client exit a clinical session.

If you determine that the client requires urgent intervention, you must take immediate action. This may include, but not be limited to, encouraging the person to voluntarily agree to receive a psychological evaluation or admission to a psychiatric treatment facility. If the client does not agree to collaborate with you voluntarily, then you must consider breaching confidentiality and contacting 911 so they can be transported to a facility. You can also file a petition to conduct a psychiatric evaluation or initiate a petition for involuntary hospitalization.

All these distinct options depend on your clinical assessment and the level of safety you determine is needed based on the facts and circumstances that confront you.

When a Client Is a Danger to Others.

Another situation that requires breaching client confidentiality is when a client poses a credible threat or imminent danger to others. Under certain circumstances, social workers operate under “duty to warn” obligations. Generally, the duty to warn arises when a client is planning to intentionally cause harm to themselves or a specifically identified person. In these specific cases you are legally required to discharge your duty by contacting law enforcement, initiating commitment proceedings or warning the potential victims.

Additionally, in many jurisdictions, if a client has a firearm, you can contact the state agency that authorizes gun permits and let them know that you are a social worker and have determined a client to be a clear and present danger to others. The state agency will then follow up with the client and revoke their permit. You can also file an Extreme Risk Protection Order (ERPO) to temporarily restrict firearm access.

Instances of child or elder abuse.

If you have reason to suspect a child that is known to you in your professional capacity is being abused or neglected, you are legally required to report it. You also have an obligation to report elder abuse or the abuse of a person over the age of eighteen who has a disability. A direct disclosure from a client, a child, a caregiver or an elder; observed bruises or injuries; or signs of malnutrition all require you to immediately notify Child Protective Services if the person is under the age of 18, or Adult Protective Services if the person is 18 or older and has a disability or is over the age of 55.

Consequences of Failing to Break Confidentiality When Required by Law

Failure to report abuse or a client that poses a risk to themselves or others can result in civil liability, criminal penalties, lawsuits, fines and loss of licensure. Threats and warning signs need to be taken extremely seriously. Without intervention, they can lead to unfortunate, preventable harm or loss of life

Social workers may fear that reporting something that turns out to be false or unneeded will damage their professional reputation or anger clients. However, it is always safer and ethically sound to err on the side of disclosure. It is also important to remember these statutes are “reporting” statutes, not investigating statutes. If you have a reasonable suspicion that a person in your professional capacity may be being abused or neglected, you have the duty to report the suspected abuse or neglect.

At the same time, it is critical to establish clear boundaries at the start of a therapeutic relationship. Clients should be informed, both verbally and in writing, that certain disclosures or behaviors they report require mandatory reporting under ethical and legal obligations. For example, if a client tells you they abused their child last night, they need to know that it triggers a legal obligation for you to report that abuse to the appropriate state or county authorities. It is not discretionary; it is mandatory.

Document Everything

Thorough documentation is essential. Record the client’s exact statements and behaviors, your clinical assessment and the rationale for every decision you made. After you file a report, you will be asked to explain why you breached confidentiality, and you need to have the proper documentation that proves that what you did was reasonable and clinically sound.

How Professional Liability Insurance Protects You

Alongside documenting everything, professional liability insurance provides critical protection. If a client files a complaint or lawsuit, your insurance will cover legal costs and provide representation. You will also have access to a helpline that can answer any questions or doubts regarding confidentiality breaches.

Social workers should always exercise clinical judgment. When a client says or does something that raises serious concern, it is your responsibility to ask questions, assess risk and intervene when necessary. Timely action can, and does, save lives.