The article discusses a number of issues associated with medical privacy in psychiatry, including forensic psychiatric evaluation. Current Law of the Russian Federation “On Psychiatric Care and Guarantees of Citizens’ Rights in Its Provision” requires taking into account the mental state of a person with a mental disorder when informing him about his mental health condition. However this rule misses new realities of digital health and is not included into the legislation on protection of citizens’ health. It is hardly possible to realize in practice and it needs an additional and established by law mechanism of access to medical records, considering specific properties of psychiatric patients. Problems also arise with a mentally disordered person's access to his forensic psychiatric medical record. On the one hand, the report of forensic psychiatric evaluation is an evidence in the court case, and the procedure for its disclosure is regulated by procedural legislation and legislation on state forensic expert activities. On the other hand, the Constitutional Court of the Russian Federation considers such a report as a medical document, for which the rules of legislation on protection of citizens’ health apply. In this paper the authors propose the solution to this dilemma that requires corrections in the position of the Constitutional Court of the Russian Federation. The authors analyze the history of legislation on medical privacy and draw attention to obvious long-term trend that shows in continuing expansion of the range of persons who have right to access such information without consent of the citizen concerned. The authors conclude that medical privacy is gradually losing the nature of the right guaranteed by federal law. Especially worrying are the attempts of a number of state bodies and officials to obtain information about mental health of unspecified groups of people. Too many third parties already have access to medical information for various reasons, and the number is growing with introduction of digital health information systems. The authors come to conclusion that such a development can lead to serious negative consequences for the legally guaranteed rights of citizens and stress the importance of special attention to protection of medical information, including measures against unlawful access and possible leaks.