Federal law states that patients or their authorized representatives may have access to their medical records. In most cases, if the request is made in writing by an authorized person and the patient pays the cost of copying, obtaining medical records is not difficult, although it may take some time. Psychiatric medical records, however, may not be so easy to get.

The Health Information Portability and Accountability Act (HIPAA) contains an exception for psychiatric records that, in the view of the provider, may be withheld if disclosure of the information would be harmful or detrimental to the patient, provided that the patient receives an explanation. Whether or not the record would be harmful to the patient is up to the psychiatrist or therapist.

Psychotherapy notes that a treating mental health provider keeps separate from the medical chart are also exempt. These psychotherapy notes are defined by the law as, "notes recorded in any medium by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session."

The reasoning behind this exemption is that session notes are personal notes that belong to the treating professional rather than to the client. If these notes are kept separate from the medical chart, then they are not part of the medical record and the patient has no right to have copies.

So ultimately, unless the information would be harmful to the patient, the law requires that a psychiatrist provide a copy of the medical chart containing the usual medical information: medical history, symptoms, diagnoses, laboratory results, testing and treatment information and any psychiatric notes actually contained in the medical record. All other notes kept separately may be withheld even if they would not be "harmful."

If your psychiatrist or mental health facility declines to give you a copy of your or your parent's psychiatric medical record, that decision will be difficult to combat because of the "harmful/detrimental" exemption. However, it is often possible to have the records sent for review to another mental health professional who is or will be treating you for the same condition, such as a physician, licensed clinical psychologist or licensed clinical social worker. Whether that professional will make the same determination about "harm" is, of course, hard to know in advance.