Could you clarify something for me? When you say 'sexual activity with minors is reportable', do you mean actual sexual activity or discussing the origins of thoughts and suchlike? I've always taken those first-meeting-explanations and signed wavers of understandin' to not be referring to the mental map, but instead to physical, concrete actions. Is that correct or is there wiggle room I was previously unawares of?
It's a good question.
I can answer this only for US laws which unfortunately vary between the 50 states and federal law.
First of all- something that everyone should be aware of: physician-patient privacy laws only pertain to physicians. If you tell a non-MD therapist, a nurse or anyone other than a physician, you have no guarantee of confidentiality beyond the minimal protections of HIPAA. HIPAA does not apply when there is the potential that a crime has been committed.
A HIPAA covered entity also may disclose PHI to law enforcement without the individual's signed HIPAA authorization in certain incidents, including: ...
To report PHI to a law enforcement official reasonably able to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public...
To report PHI to law enforcement when required by law to do so (such as reporting gunshots or stab wounds)...
To respond to a request for PHI about an adult victim of a crime when the victim agrees (or in limited circumstances if the individual is unable to agree). Child abuse or neglect may be reported, without a parent’s agreement, to any law enforcement official authorized by law to receive such reports.
For therapists, there's a lot of variability but in general, if a therapist is given information that a crime is committed, they may be required to report that crime to authorities. There are broad categories that are usually reportable. The categories include child exploitation.
The problem is that the term "child exploitation" varies between states. Some states do include possession of child pornography to be "child exploitation". In some extreme interpretations,
viewing child pornography is considered reportable child exploitation.
To give you an example of one of the more comprehensive laws- California's Child Abuse Reporting Law says that all health practitioners- including physicians- are required to report any conduct that may be categorized as 1) Physical abuse, 2) Sexual abuse, 3) Child exploitation, child pornography and child prostitution, 4) Severe or general neglect, 5) Extreme corporal punishment resulting in injury, 6) Willful cruelty or unjustifiable punishment, 7) Abuse or neglect in out-of-home care. If ANY of these is suspected, the health practitioner must call the State immediately.
Given these broad categories, it is very difficult to get treatment for pedophilic impulses because any mention of any behavior that could fall into these categories is reportable to the State of California. In practice, because of the risk of liability, when there is doubt the health practitioner is generally going to call the State.
