Negotiating confidentiality in correctional mental health services: ethical challenges and practice implications in a small island prison system

Purpose This study aims to explore how confidentiality is experienced and negotiated within prison mental healthcare in the Maldives and examine the implications of these experiences for correctional practice, institutional trust and service delivery within a small-island prison system. Design/methodology/approach This study used an exploratory qualitative design and semistructured interviews with 37 participants, including incarcerated individuals (n = 30) and mental health professionals (n = 7) within the Maldives Correctional Service. Data were analyzed using reflexive thematic analysis. Findings Confidentiality was experienced as a negotiated, context-dependent process shaped by institutional surveillance, custodial responsibilities and social interconnectedness. Four themes emerged: confidentiality under conditions of institutional surveillance; negotiating ethical practice under dual loyalty obligations; social proximity and relational vulnerability in a small-island context; and strengthening ethical confidentiality practices. These dynamics may influence perceptions of privacy, therapeutic willingness and systemic trust. Research limitations/implications Although the findings are drawn from a single correctional system, they offer insights relevant to other socially interconnected correctional settings and highlight the need for clearer confidentiality policies, ethical guidance and professional support to strengthen institutional trust and service engagement. Practical implications This study develops clear institutional policies outlining confidentiality boundaries, documentation practices and circumstances under which information may be shared within correctional settings; strengthens ethical supervision, training and professional support for correctional mental health personnel to address dual-loyalty conflicts and ethical decision-making; establishes dedicated private spaces for mental health consultations to enhance privacy, trust and therapeutic engagement; implements context-specific guidelines addressing overlapping relationships, post-release interactions and digital professionalism in socially interconnected communities; and promotes transparent communication and voluntary participation in mental health services, which may contribute to institutional trust and support open disclosure and engagement with rehabilitation and reintegration. Originality/value To the best of the authors’ knowledge, this is the first study to examine confidentiality within correctional mental health services in the Maldives. This study contributes to the limited literature on correctional mental healthcare in the prison systems of small-island developing states.