Notes for
sensitive sessions

A GP consult produces findings: a blood pressure reading, a description of a joint, a medication change. A therapy session produces something harder to render as a note: affect, disclosure, the client's own words about a relationship or a childhood event, a pattern they're only starting to see. The clinical record still needs to exist. MBS funded sessions still need a contemporaneous, clinically relevant note, and AHPRA's expectations of accurate record keeping still apply. But the raw material of the hour is personal in a way a spirometry reading simply isn't.

That gap is where an ambient scribe either earns its keep or does real damage. Configured badly, it drafts a note stuffed with verbatim disclosure that never needed writing down, or a note so thin it fails the clinical purpose of a record at all. Configured well, the clinician spends the hour listening rather than typing, with a draft waiting afterward that reflects clinical content rather than a transcript of the conversation.

Most psychologists already work with two kinds of notes, and the distinction matters more once a scribe is drafting in the background. The client file is the formal clinical record: the presenting concern, the risk screen, the formulation, the agreed plan, and the progress from session to session, the material a colleague, a board, or the client themselves might reasonably need to see if care continued elsewhere. Process notes are the clinician's own working material: reflections, therapeutic hypotheses, and observations used for supervision or to track the therapeutic relationship itself. Whether something belongs in one, the other, or neither is a clinical judgement call, not a technical setting, and no scribe should collapse that distinction by default.

Practices that adopt ambient scribing well configure the tool to draft toward the clinical record only, the shorter clinically relevant summary, and leave process notes as a separate, deliberate act the clinician still does themselves. That keeps the automation where the value is highest and the sensitivity lowest.

• Clinical record: presenting concern, risk screen, formulation summary, agreed plan, session to session progress
• Process notes: the clinician's own reflections, therapeutic hypotheses, supervision material
• Neither should default to a verbatim transcript of the session

Consent for an ambient scribe in a mental health setting has to do more work than a tick box at intake. The client needs to understand, in plain terms, that a device in the room is listening to help draft a note, that a named clinician reviews and signs anything before it becomes part of the record, and that they can ask for it to be paused at any point in the session without needing to justify why. Health information is "sensitive information" under the Privacy Act 1988 (Cth) and the Australian Privacy Principles, so that consent needs to be genuine and informed, not implied by the client simply having shown up. Our piece on consent for AI scribes covers the mechanics of asking well; the point specific to therapy is that the request should be renewable, not a one time form signed months before a difficult disclosure ever comes up.

Some practices find it useful to reconfirm consent at the start of a new course of sessions, or whenever the content is likely to shift, for example moving from initial assessment into trauma focused work. That's a clinical decision, not a compliance one, and it sits with the clinician, not the software.

An ambient scribe transcribes what it hears and drafts toward a note. It does not, and should not, decide how a disclosure of risk gets framed, escalated, or acted on. When a client discloses something that changes the clinical picture mid session, the safety response is the clinician's, immediately, in the room. The record of that response, a risk assessment, a safety plan, a decision to contact a carer or an emergency service, is the clinician's professional output. The scribe can help draft the shell of that entry afterward, but the judgement inside it is not something a transcription tool should be trusted to originate.

This is the same principle that governs every Aurii draft in any setting, the scribe writes and the clinician decides, but it carries more weight here because the cost of a wrongly framed note in mental health work is higher than a wrongly framed note about a sprained ankle.

• Disclosures of suicidal ideation or self harm
• Disclosures of family violence or child safety concerns
• Anything that changes a risk level or triggers a mandatory reporting obligation

The value of a therapy session depends on the clinician's attention being on the client, not a keyboard. That's the practical case for ambient scribing in this setting more than in most others: the microphone sits in the room and the clinician keeps eye contact, keeps the pace of the conversation, and doesn't break the moment to type a quote down before it's lost. But it only works if the device stays unobtrusive and the client stops noticing it within a few minutes, which is a placement question as much as a software one. A visible, unfamiliar gadget the client keeps glancing at defeats the purpose as thoroughly as a clinician typing throughout.

It's worth being explicit with clients about what the scribe is not doing, too. It isn't analysing tone for hidden meaning, it isn't flagging the client to anyone, and it isn't listening for anything beyond drafting the note the clinician would otherwise write by hand afterward.

Mental health records tend to carry among the longest retention expectations of any clinical file, and AHPRA's record keeping expectations, alongside the relevant state health records legislation, both assume the file will still need to be produced years after the last session. Data captured, transcribed and stored in Australia, with Sydney as the primary location and a Melbourne backup, encrypted per record, under a seven year tamper evident audit trail, is the baseline a mental health practice should expect from any documentation tool, ambient or not. Full detail sits on our security and data handling page.

My Health Record is a separate question again. What a clinician chooses to upload to a client's My Health Record, operated by the Australian Digital Health Agency, is a clinical and consent decision the clinician makes deliberately. It isn't something a scribe pushes automatically, and many practices choose to keep detailed mental health content out of the shared record entirely, in line with the client's own preference.