3) Keep confidences. Share confidential information only when necessary to prevent injury or death. Take care when telling stories about other consumers that neither the details nor the context of the story identifies that person. Ask permission from your own family and friends before sharing information about them.

Maintaining confidentiality is an essential requirement of human service work. Yet one of the primary concerns that professionals voice about consumers in program and policy roles is their ability to understand the nature and importance of confidentiality. Consumers, just like their professional colleagues, must be vigilant about the privacy of all those with whom they interact.

All of us are exposed to a great deal of sensitive information. Not only do we have access to sensitive information about clients, we may also have access to confidential financial and personnel records of the organizations we work with. Because of their personal histories, consumers are also likely to be sought out as trusted confidantes by other consumers. Sometimes the lines of friendship and work can become blurred and it is easy to forget "who knows what about whom." Learning to keep confidences — to keep information private — is a skill and it must be practiced daily.

For Example...
Carla works in a community-based HIV treatment program as the Family Specialist. She provides one-on-one support to individuals affected by HIV and facilitates a support network for women in the community who are HIV positive. Carla lives in the neighborhood near the clinic and occasionally encounters her clients on the street, at the grocery store, or even in the elevator in her apartment building. Carla is always careful to respect the privacy of the women and families she works with. She never greets them publicly (unless they have an existing social relationship). Sometimes this is very hard to do, but Carla realizes that as a paid community-based worker she has some rules that her employer insists all employees follow. Carla also feels that if she were in the same situation as others in her community, she would want her information kept private and would expect the community worker to do that. She also knows that she must maintain the highest possible standard of confidentiality if she is to be accepted as a full member of the health care team and trusted by the women in the program.

At a support group meeting Carla learns that two women in the group are not following their prescribed regimen of antiretroviral medications. The women dislike the side effects of the medication and are overwhelmed by the number of pills they are required to take. They have not told their physician, however, because they do not want to disappoint her. Carla knows that the women have the right to refuse the treatment, but she is concerned that the medical team does not know about their decision. She is especially concerned about what it might mean for the women's health status.

At the weekly team meeting, Carla asks the physician to give an update on antiretroviral medications. She asks about the treatment choices available to patients who do not want to take antiretrovirals and also asks about the health consequences of taking fewer than the prescribed number of pills. She informs the team that a growing number of women at the clinic dislike the therapy, (she does not identify specific patients) and suggests that the physician come to her support group to do a presentation on treatment options.

Carla's goal is to increase the patients' knowledge about their treatment and to increase the staff's sensitivity to the difficulties of the antiretroviral treatment regimen. By enhancing understanding on both sides, she is working to create an environment where more honest and open communication can occur. By deepening her own understanding of HIV disease and medications, she increases her ability to be an informed resource to other women and families.

In this example Carla takes advantage of her unique position to address a complex problem, and she does so while maintaining the confidentiality of the women in her support group. Any one of us may encounter a rare instance when confidential information must be shared — when we believe that someone is a threat to themselves or to others. And when that happens, we must act quickly to alert a mental health professional. Keeping confidences, and knowing how and when to keep them is a serious responsibility. Living up to this responsibility makes consumers effective in their work.