New study published on Patients’ Access to Their Psychiatric Notes


Annika Bärkås is the first author of this publication exploring how patients are given access to their electronic health records from psychiatric care across Sweden. 

The phenomenon of sharing clinical notes or narrative visit reports with patients is often referred to as ‘open notes.’ Open notes in psychiatric care are considered particularly controversial. The few studies that have investigated the effects of open notes in psychiatric care (majority conducted in the USA) reports that patients experience increased understanding of their mental health, feeling in control of their care, and enhancing trust in their clinician. On the other hand, healthcare professionals remain concerned that mental health patients may become anxious, confused, or offended by what they read.

This study is the first overview of how Sweden’s regions and some of the largest cross-regional private care providers share psychiatric notes. The study aimed to explore Swedish national and local policy regulations regarding patients’ access to their psychiatric notes and describe to what extent patients are offered access to their psychiatric notes. Sweden has a decentralized healthcare system with 21 self-governing regions. All regions have endorsed the Swedish National Regulatory Framework, which stipulates that citizens should have direct access to all the digital health information available and the same opportunities regardless of where the citizen lives or receives care. The study reports regional differences concerning open notes in psychiatric care, where 17 of 21 regions share psychiatric notes with patients. Forensic psychiatric care was the most excluded psychiatric care setting (of adult psychiatry and pediatric and adolescent psychiatry). Our findings also show regional differences in how psychiatric notes are shared. For example, immediate access or delay, if both signed and unsigned notes are shared, and if notes are shared with both outpatients and inpatients. All private care providers reported that they mainly follow regions’ guidelines.

Bärkås A, Scandurra I, Rexhepi H, Blease C, Cajander Å, Hägglund M. Patients’ Access to Their Psychiatric Notes: Current Policies and Practices in Sweden. Int J Environ Res Public Health. 2021 Aug 30; 18(17):9140.