Colleges and universities often offer mental health counseling as a free service, but school counselors aren’t always required to keep your information private. Here are your options, and what to know, if you want to seek help confidentially.
School Counselors
Services provided by a mental health center are often free, and may be your most easily accessible option. If somebody on campus refers you to the center, that fact may become part of your educational record. So even if you haven’t told the therapist anything, there may still be documentation that somebody was concerned about you.
Educational records are usually protected by a law called FERPA, the Family Educational Rights and Privacy Act. As the Jed Foundation reports, FERPA allows school personnel to share information about you as needed.
Information that you tell to a therapist isn’t automatically shared, so you do have some confidentiality. But as soon as you ask for accommodations for a mental health disability, or talk about a leave of absence, or if your therapist sees a safety concern and reaches out to somebody else on campus, that information is legal for school officials to share and it’s covered by the rules of FERPA.
FERPA states that information may be shared with your parents, if you are considered their dependent for tax purposes. If you aren’t—which includes the case where your parents don’t live in the US and don’t pay US taxes—then the school may share information with your parents in an emergency. They can also tell your parents about violations of an alcohol or drug policy.
Search for your school at U Lifeline to find out what resources are available to students, and what policy the school has on confidentiality. If your school isn’t listed, check out your student handbook.
Off-Campus Medical Providers
Mental health is considered part of health care, and once you’re off campus, your records are considered to be covered under HIPAA, the Health Insurance Portability and Accountability Act. This provides more confidentiality, and you get more control over your records.
Under HIPAA, you decide who may see your medical records. As long as you’re over 18, your parents won’t have automatic access. If you’re under 18, state laws can come into play, but if you are the one who consented to treatment (rather than your parent consenting for you), then you are the one who can control who sees your records.
If you’re on your parents’ insurance plan, they could end up getting a bill for your treatment. But in many states, you can call up your insurance company and ask them to send your “EOB”—your itemized bill, also known as your explanation of benefits—to your own address rather than to your parents. Whether they’re able to do that, or must do that upon request, depends upon state law. Ask as many clarifying questions as you need so that you can understand whether the company will be sending any information to your parents.
Bedsider, the sexual health resource, has scripts for this conversation, and tips on making sure you get all your questions answered. After all, you may want to keep your sexual health services confidential as well.
Emergencies and Mandated Reporting
No matter what law applies, your therapist can notify others about your mental health if they believe you are a threat to yourself or others. This could include your parents, if they think notifying your parents will help keep you safe. And it could include law enforcement.
If you tell your therapist about ongoing child abuse, domestic violence, or abuse of people who are elderly or disabled, they will probably have to report that.
Other Options
You have more options than just on-campus and off-campus therapists. You can video call a therapist with telehealth services like Teladoc and Amwell, just like you could call for a consultation about your sore throat.
You can also find help through various apps, chatbots, and mental health subscription services, which each have their own privacy policy. Some of them may not be bound by HIPAA rules and may not even be required to report abuse. That can be a pro or a con, since it can mean you won’t get help in an emergency. So make sure to think about how you feel about your chosen service’s rules.
There are also other groups that may not be affiliated with your school but that can provide free or affordable counseling. For example, you may be able to find a support group, or seek counseling through a church. And you can check out the various hotlines and groups that are available to help you through a crisis or help you find your way to a more permanent solution. These include the National Suicide Prevention Lifeline, and the Trevor Project for LGBTQ+ young people (ages 13 to 24).