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The Royal College of Psychiatrists Improving the lives of people with mental illness

Chair's Blog

January 2018

Guest Blogger Dr May McCann (Central Carers' Forum member and Chair of CAUSE) reflects on "Confidentiality and Communicating with Families or Carers" following her attendance at the joint RCPsych in NI & RQIA event at Belfast Castle on 19 January

 

RCPsychNI and RQIA

 

It was interesting to attend the recent ‘Working towards Improvement’ RQIA and RCPsych workshop during January (despite the falling snow!); the final presentation motivated me to explore a little the current environment in relation to ‘confidentiality’ and reflect on its College history.

 

 

It was a privilege to hear the dignified, measured, ‘personal perspective’ of Hamish Elvidge (pictured third from right below) recounting the health service’s ‘tick-box’ risk assessment, devoid of family involvement, that preceded his son Matthew taking his own life. ‘And they didn’t look into Matthew’s eyes…’ The response of the family, on the other hand, has been impressive.  ‘As is so common, we (the family) were not fully aware of the depth of his depression and how to help.  We therefore do as much as we can to help others who are, or may be, in a similar situation, by increasing the awareness of depression and other mental health issues and, we hope, preventing other young people from taking their own lives.

 

Joint event with RQIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In 2010 they established, covering all running costs, the Matthew Elvidge Trust, funded by events organised by supporters - they are currently Fleet M&S charity of the year. In a five-year period, the trust raised over £300,000, supporting selected projects and activities including bereavement support.  It works in partnership with related charities and sits on government advisory bodies in the Departments of Health and Education.  In 2014, the National Suicide Prevention Strategy Advisory Group, of which Mr Elvidge is a member, developed the ‘Consensus Statement’ (Information Sharing and Suicide Prevention: Consensus Statement, 2014), which makes it clear that the duty of confidentiality is no justification for not listening to the views of family members and friends, who may offer insight into the individual’s state of mind. It is about allowing for greater disclosure to families at times of risk and has been signed up to by the Department and Professional bodies. The document is, for good reason, somewhat legalistic in tone, devoid of the human touch which is the ‘touchstone’ of effective practice. In his presentation, Hamish Elvidge suggested a different way of communicating the consent question….a conversation…...

 

 ‘One way is to say “Do we have your consent to share information with a family member, friend or colleague?” The chances are that the answer will be, “No.” Or you could say, “In our experience, it is always much better to involve a family member, friend or colleague whom you trust in your treatment and recovery, and we know the triangle of care is likely to result in a greater chance of successful recovery. This will result in you recovering much quicker. Would you like us to make contact with someone and would you like us to do this with you now?

 

Concern about the increasing suicide rate is a driver in the current iteration of the consent discussion, which includes an awareness that families should be viewed as potential partners in suicide prevention. Some examples are: ‘Sharing Information to save lives’ (the title of Hamish Elvidge’s presentation), Simon Wessely’s Blog, ‘Confidentiality In The Context Of Suicide Prevention’ (2016), ‘Breaching patient confidentiality sometimes necessary to prevent suicide, say eminent psychiatrists’, a press statement from the International Congress (2017). 

 

I was glad to see the latter reference the ‘Carers and Confidentiality’ booklet, part of a raft of excellent materials, including leaflets and a training resource, emanating from the 2004, ‘Partners in Care’ campaign, (RCPsych and Princess Royal Trust for Carers). The then ex-President, Mike Shooter, was significantly involved, as were some great women from the Carers’ Forum. Confidentiality, a number one issue for carers then as now, was part of the section on Communication, one aspect of ‘working together to make a real difference’. There was no specific suicide focus.  I’ve used Partners in Care materials as teaching aids in many contexts, including MRCPsych and, with permission, the confidentiality booklet and another Partners in Care leaflet are available on the CAUSE website.

 

‘Carers and Confidentiality’ provides a useful explanation, for carers, of the ethical and legal issues faced by professionals in relation to consent - a list of barriers to sharing information and examples of good practice.  These include discussing confidentiality with patients at an early stage when they are not acutely unwell, encouraging patients to understand the benefits of sharing appropriate information with carers, recording discussions/views on confidentiality in patient’s notes to allow for continuity, revisiting the issue, encouraging the use of advanced directives. It reminds professionals that even when the patient continues to withhold consent, carers should be given sufficient knowledge to enable them to provide effective care, the opportunity to discuss any difficulties they are experiencing in their caring role, help to try and resolve these and general information about mental illness and about emotional and practical support for carers.  None of this involves a breach in confidentiality.

 

Despite the tragic reasons behind the current interest in confidentiality, it is important that the issue is now aired so publicly. However, already the House of Commons Health Committee is concerned at the lack of movement on ‘the Consensus Statement’ after three years.  There is commitment from the College to take it forward, hence, I suppose, among other things, the selection of guest speaker at the recent RQIA/RCPsych workshop.  But it is concerning to reflect on how long it is since the Partners in Care campaign which, at the time, gained widespread interest ‘with requests from all over the UK, the USA, Canada and Australia.

 

If communication with families/carers remains a problem, it is difficult to see how our forthcoming Mental Capacity Act will work as intended.  The rights of the ‘nearest relative’ will be gone, which, regarding the role of ‘applicant for assessment’, could be very detrimental to family/friend relationships. Carers, as well as professionals, face problems with information sharing. While they can be the first to notice worrying changes, their contacting professionals can be interpreted as a breach of trust and confidentiality.  In the new Act there are more positive potential roles for ‘carer’ involvement - in supporting decision making, in determining best interest, as possible ‘nominated person’ - and, if one has not been appointed, ‘carer’ is first on the default list, preceding specified family roles. I look forward to participating in the College’s forthcoming event on Mental Capacity legislation in the Waterfront in March.

 

Next month I attend my first session at the newly structured Carers’ Forum in London. In preparation, I need to write a brief report on the last meeting of the Special Committee on Human Rights (SCHR), to which I was recently appointed. It is strange to be sitting on a Committee with people whose work so informed discussions during the Bamford Review - Genervra Richardson and George Szmukler, who is Chair. As requested, I prepared a brief paper on the background to our Mental Capacity legislation. Discussion of the review of mental health legislation was obviously on the agenda and we have just finished responding to the draft position paper on the human rights case for significant reform of the Mental Health Act which George Szmukler is preparing. It should be available very soon.

 

Authored by Dr May McCann

 

 

 

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Dr Gerry Lynch

 

Dr Gerry Lynch, Chair RCPsychNI

 

RCPsych NI & RQIA - 19 January 2018

Joint Meeting

Belfast Castle

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