Commonly, exceptions involve mandatory reporting requirements for child abuse or certain infectious diseases, or Tarasoff duties for patients who pose a danger to themselves or others. Incarceration may impose unique circumstances that require the clinician to interpret statutes in a way that considers the structured and secure nature of the environment. Most institutional regulations require correctional staff to respond to potential security breaches such as plans for escape or possession of contraband. State laws also control the use of treatment information in criminal and civil proceedings. These limits to confidentiality are particularly pertinent for pretrial detainees and parole violators with open charges, where information obtained during the course of treatment may be used as evidence of mens rea.
Many states allow for disclosure in civil proceedings such as malpractice actions.
In correctional facilities, a direct parallel would be the inmate grievance regarding medical or mental health care. Similarly, courts with jurisdiction in civil rights litigation may appoint masters who have the authority to review treatment information. Case law also establishes a legal groundwork for confidentiality. In Ruiz v. Estelle , the maintenance of confidential treatment records was one of the six minimum criteria established for adequate prison mental health services. The main difficulty for clinicians with regard to confidentiality arises in situations where there are no clear guidelines, or where existing regulations conflict with accepted clinical standards.