Running a practice
When can a therapist break confidentiality, as mandated reporters?
While therapists have an essential responsibility as mandated reporters, it’s challenging to navigate. Learn when a therapist can and must break confidentiality.
August 19, 2024 • Updated on May 14, 2026
4 min read
Confidentiality is one of the core values that creates a safe, trusting therapeutic relationship. When your clients feel confident that what they share stays between the two of you, they’ll be more likely to share their thoughts and feelings authentically, leading to more productive therapy. That said: In rare and serious cases, you may have an ethical and legal obligation to break client confidentiality.
Mandatory reporting laws, or mandated reporting, require therapists to report to authorities when a person is being harmed or is in danger of being harmed. While you as a therapist have an essential responsibility as a mandated reporter, the process can be challenging to navigate.
Key insights
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Confidentiality is a key tenet of the therapeutic relationship — but there are rare times when safety trumps confidentiality. Therapists must report certain situations, such as threats of serious physical harm and neglect or abuse of children and elders.
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Clients should be aware from the beginning of your therapeutic relationship that you may need to break confidentiality if these rare but serious situations arise.
Situations that require mandated reporting and breaking confidentiality
In general, mandated reporting laws exist to protect individuals — and specifically vulnerable persons including elderly people, children, or those living with disabilities, for example — who often cannot protect themselves from harm. Each state in the U.S. has its own mandated reporting requirements for therapists, with guidance about which situations are mandatory to report and how they should be reported.
The most common mandated reporting situations include:
- Threats of serious physical harm, such as a credible chance that the client plans to take their own life or someone else’s.
- Neglect, which entails ignoring a vulnerable person’s emotional, educational, medical, or physical needs.
- Abuse, including physical, sexual, or emotional abuse of a child or elder. Abuse may not necessarily fall under mandatory reporting laws if it does not involve these vulnerable groups or occurred in the past.
Some mandated reporting situations can be murky, and a therapist’s duties vary by state. That’s why it’s so important to be aware of your state’s individual laws, and your responsibilities within them.
What is the “duty to warn” for mental health providers?
The “duty to warn,” also known as the “duty to protect,” refers to a therapist’s responsibility to prevent future harms when possible—for example, intervening if there’s a credible threat to someone’s life. Again, the specifics that trigger the duty to warn vary by state. But, generally, if there is a specific person (or group of people) in imminent danger, a therapist is obligated to break confidentiality and warn the potential target and/or appropriate authorities. In some cases, duty to warn requirements extend to a client at high risk of self-harm. Relatedly, even if a client has signed an ROI, or release of information form, a therapist wouldn’t necessarily share this information unless it was needed for client safety.
What is a providers’ responsibility as a mandatory reporter?
Mandatory reporting is not a subject to take lightly. There can be serious consequences for providers who wilfully break mandatory reporting laws, potentially including criminal charges.
Beyond making a report (which usually can be anonymous), a mental health provider may also be expected to cooperate with investigations or court proceedings. To be sure you’ve done all that’s required, stay up-to-date with your state’s laws and consult an attorney, licensing board, or professional organization, if necessary. State laws regarding mandatory reporting are constantly changing — and it’s your responsibility to track any changes.
Who is covered under mandatory reporting?
In some cases, therapists may be bound by mandatory reporting laws even if the threat or information comes from, or pertains to, someone who is not a regular client. It’s best to brush up on your state’s specific laws to know how this provision may apply to you.
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How to report
In order to report, you need specific information. For example, you typically would not report if a client tells you they’re having intrusive thoughts about harming a child. However, if the client admits they harmed a child in some way, or if they reveal a plan and intent, you would be mandated to file a report.
Where you report depends on the information you’ve received. If a child is being harmed, then you’d contact your area’s Child Protective Services. If an elderly individual is being harmed, then you’d contact Adult Protective Services. Call the police if someone is homicidal, and the suicide hotline (988 or your state’s designated number) if someone is considering self-harm or suicide. In any case, always defer to your state’s laws when it comes to mandated reporting.
Please always consult your state licensing and reporting laws for understanding your client’s specific situation and any obligations that may arise.
What happens after you report?
The nature of a report determines what happens next. A call to Child Protective Services about suspected child abuse will likely follow a different path than a call to the police about a potential homicide.
Regardless of the specifics, a therapist is not generally expected to personally investigate a case or prove that harm occurred. They may, however, be asked to cooperate with the authorities’ investigation or to provide additional information as necessary.
How to discuss this with your clients
Discussing mandated reporting requirements with your clients may feel awkward, but it’s essential to do so proactively. For many people, it takes a great deal of trust and vulnerability to confide in a therapist. If therapeutic conversations do not stay private, clients may feel betrayed or blindsided — particularly if they were not previously aware of your responsibilities as a mandatory reporter.
The American Psychological Association’s code of conduct says that psychologists should discuss the limits of confidentiality at the beginning of a new therapeutic relationship. Providers should inform their clients directly, as well as their clients’ legal guardians or representatives, if necessary.
Your informed consent paperwork, which a client receives at the start of therapy, should also include all the information they need to know about their confidentiality rights and your responsibility as a mandated reporter.
Also be aware that some states require therapists to notify clients and/or their families when they file a report. These conversations are never easy, but they will likely go a bit more smoothly if clients and their families already know about your legal requirements to report.
Confidentiality is complex — your systems shouldn’t be
Mental health providers have to make difficult choices every day, whether it’s deciding on the right diagnosis, figuring out what to say in a challenging appointment, or determining whether a client’s admission meets the bar for mandatory reporting. Doing this work is never easy — but Headway aims to make it a little easier.
Headway supports all elements of your practice, from marketing and scheduling to credentialing and billing. We make it simple to accept insurance and guarantee that providers will be paid bi-weekly. Plus, our free, comprehensive platform streamlines the administrative work of providing mental health care, making processes like documentation and claim submission far more efficient. That gives therapists and prescribers the time and energy to do what they do best: care for patients.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.
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