STATE OF MICHIGAN

FRANK J. KELLEY, ATTORNEY GENERAL

Opinion No. 5709

May 20, 1980

MENTAL HEALTH:

Community mental health boards

Patient rights

A county community mental health board may obtain information concerning specific recipients of mental health services from private or public agencies with which it has contracted to provide mental health services to such recipients without necessity for securing the recipient's approval. Such information may be shared within the units of the community mental health program.

Honorable Claude A. Trim

State Representative

The Capitol

Lansing, Michigan 48909

You have requested my opinion on the following questions:

1974 PA 258; MCLA 330.1001 et seq; MSA 14.800(1) et seq, 1974 PA 258, supra, MCLA 330.1200 et seq, is known as the Mental Health Code. 1974 PA 258, supra, ch 2, Sec. 200, et seq provides for county community mental health programs. 1974 PA 258, supra, Sec. 206 states that '[t]he purpose of a county community mental health program shall be to provide a range of mental health services for persons who are located within that county.' 1974 PA 258, supra, Sec. 208, as last amended by 1978 PA 166, requires that a minimum level of services be furnished through the county program. Upon establishment of a county mental health program, a twelve (12) member county community health board is established pursuant to 1974 PA 258, supra, Secs. 212 and 222.

1974 PA 258, supra, Sec. 226 sets forth the powers and duties of the county community mental health board and under subsection (g), the county community mental health board is empowered to approve and authorize all contracts for the providing of mental health services. Consideration must also be given to 1974 PA 258, supra, Sec. 226(h), which directs the county community health board to review and evaluate the quality, effectiveness and efficiency of services provided through the county program. Further, 1974 PA 258, supra, Sec. 226(j) permits the board to establish general policy guidelines within which the county program shall be executed by the director of the program. Also pertinent is 1974 PA 258, supra, Sec. 228, which states

1974 PA 258, supra, ch 7, Sec. 700, et seq, sets forth the rights of recipients of mental health services. OAG, 1979-1980, No 5502, p ___ (July 2, 1979). 1974 PA 258, supra, Sec. 702(a) specifies that the receipt of mental health services '[s]hall not operate to deprive any person of his rights, benefits, or privileges.'

1974 PA 258, supra, Sec. 746, which concerns the records of recipients, states:

In 1974 PA 258, supra, Sec. 748, the legislature has provided:

Further, 1974 PA 258, supra, Sec. 750, specifies that communications between a mental health recipient and a psychiatrist or psychologist are privileged. See also RJA, 1961, Sec. 2157; MCLA 600.2157; MSA 27A.2157; People v Lapsley, 26 Mich App 424; 182 NW2d 601 (1970), lv app den 384 Mich 825 (1971); the freedom of information act, 1976 PA 442, as amended; Sec. 13(1)(i); MCLA 15.243(1)(i); MSA 4.1801(13)(1)(i).

(1) May a county community mental health board, which is legally defined as the 'Governing Body' and 'the Provider' of mental health services--require information about specific clients from the service provider agencies with which it contracts without the express agreement of the client?

1974 PA 258, Sec. 748(1), supra, provides that information concerning a recipient may be disclosed 'outside' the county community mental health program only as provided in section 748. This provision is designed to protect against the dissemination of information to facilities or persons outside the community mental health program. Where a recipient receives mental health services pursuant to a county community health program, the county program is the 'holder' of the record under 1974 PA 258, Sec. 748(1), supra. Thus, information concerning recipients may be circulated within units of the community mental health program, which includes those private or public agencies with which the county mental health board has contracted for mental health services, pursuant to 1974 PA 258, Sec. 228, supra.

A review of mental health recipients' privacy rights prior to the enactment of 1974 PA 258, Sec. 748, supra, is instructive.

Community mental health service programs were initially established pursuant to 1963 PA 54. ⁽²⁾ Thereafter, 1973 PA 85 added Sec. 15 to 1963 PA 54, supra, to provide:

1974 PA 107 ⁽⁴⁾ was enacted to provide for the licensing and regulation of mental hospitals, psychiatric hospitals and psychiatric units. 1974 PA 107, supra, Sec. 9, stated:

Thus, under the former provisions of 1963 PA 54, Sec. 15, supra, the privacy of patients who received community mental health services was to be held inviolate, and patient data may not be maintained in any manner whereby a patient may be identified by name. Further, under 1974 PA 107, Sec. 9, supra, patients' privacy rights were further safeguarded as patient records were to be held confidential by the department of mental health, and neither the contents of a record nor the name of a patient may be disclosed without court order. However, no provision of 1963 PA 53, supra, or 1974 PA 107, supra, in safeguarding the privacy rights of recipients of mental health services prohibited the dissemination of a patient's record information within the framework of the mental health system, in furtherance of the furnishing of mental health services.

When enacting a comprehensive statute, such as 1974 PA 258, supra, the legislature is presumed to have knowledge of existing statutes. Skidmore v Czapiga, 82 Mich App 689; 267 NW2d 150, lv den 403 Mich 810 (1978). Therefore, it must be presumed the legislature in enacting 1974 PA 258, Sec. 748, supra, was cognizant of the provisions of 1963 PA 54, Sec. 15, supra, and 1974 PA 107, Sec. 9, supra.

Thus, information concerning a recipient which is circulated within the community mental health program must be held as confidential information and not open to public inspection; 1974 PA 258, Sec. 748(1), supra. Further, 1974 PA 258, Sec. 748(5)(a), supra, provides that information may be disclosed to others who provide mental health services to the recipient, where the holder of the record and the recipient (or the minor recipient's parents, or guardian) consent; this provision is applicable to dissemination of information to a facility which is not part of the community mental health program. However, it must be emphasized that information concerning a recipient which is utilized within the framework of the county mental health program must not disclose the identity of the recipient, unless germane to the authorized purpose for which the information was sought, and no other information shall be disclosed unless germane to such authorized purpose. 1974 PA 258, Sec. 748(2), supra. The mode of proceding mental health services must 'protect and promote the basic human dignity to which a recipient of services is entitled.' 1974 PA 258, supra, Sec. 704(3).

Therefore, it is my opinion that a county community mental health board may obtain information concerning specific recipients from private or public agencies with which it has contracted to provide mental health services to recipients, where such information is sought for a purpose germane to the county mental health program, without procuring the consent of the recipient.

(2) May such a county community mental health board require its contracting service providers to share, information about clients with each other, inasmuch as they are both of the same single county mental health system?

In accordance with my response to your first question, and in light of the powers and duties of county community mental health boards set out in 1974 PA 258, Sec. 226, supra, it is also my opinion that a county community mental health board may require the service providers with which it contracts to share information concerning recipients, so long as such information is germane to the provision of mental health services, subject to the provisions of 1974 PA 258, Sec. 748, supra, provided that such information is not disseminated outside the county mental health program.

Frank J. Kelley