Letters

Editor:

Obtaining collateral information is an integral component of the psychiatric assessment. Current American Psychiatric Association (APA) guidelines recommend acquiring such information, particularly in cases in which “patients have impaired insight, including when patients have substance use disorders.”¹ The Internet may serve as an important source of collateral information.² One readily available resource that can influence treatment planning is patients' criminal case records, which are publicly available online in many states and can be easily accessed by clinicians.

Accessing patients' criminal records via the Internet can provide clinically significant information. Such sites may provide details relevant to clinical concerns, ranging from prescribing controlled substances, to uncovering a history of drug-related crimes in patients with substance abuse disorders, to performing a more comprehensive risk of violence assessments on patients found to have histories of assaults or other violent crimes.

The ethics of using the Internet to search for patient information has been explored by other authors,³ and important questions remain, including the optimal manner in which such information ought to be integrated into the clinical encounter: should patients be told about the results of searches performed on them? Should the results of a search be documented in the clinical record? Furthermore, psychodynamic factors informing such searches, including voyeurism, should be considered, and clinicians should be mindful of countertransferential enactments—namely, assuming the role of detective as opposed to that of psychiatrist. The aforementioned complexities inherent in performing such searches should not, however, prevent psychiatrists from using potentially important data.

Historical information about patients has traditionally been obtained primarily through the psychiatric interview. However, patients, for various reasons, may be reluctant or unwilling to provide data about their criminal history that nonetheless may be of vital importance to treatment planning and risk assessment. Online state legal records provide an easily accessible and readily available adjunctive source of information that may prove useful in the management of such patients.