Breaching patient confidentiality sometimes necessary to prevent suicide, say eminent psychiatrists

Press release
27 June 2017

Breaching patient confidentiality is sometimes necessary to prevent suicide, two eminent psychiatrists will argue today as they join forces with the families of those who have taken their own lives.

Professor Louis Appleby and Dr Andrew Hill-Smith will appear alongside Hamish Elvidge and Louise Robinson at the Royal College of Psychiatrists International Congress today at 11:30am, arguing against the current default position of health services to withhold information from the families of high risk mental health patients.

They will argue that there is a harmful and ingrained culture of fear of reprimand from legal bodies.

It comes at a time when suicide is the leading cause of death among men aged 15-49 in England and Wales.

The Five Year Forward View for Mental Health has set an ambition to reduce the numbers of people in England taking their own lives by 10 per cent by 2020/21.

When considering such strategies, families should be considered a potential source of information, advice and support. They should be seen as potential partners in suicide prevention.

Hamish Elvidge said, “Before my son took his own life, he had only just been discharged as a low risk patient, despite coming in as a high risk patient that very same day after a suicide attempt. At no point were his family involved in any part of the process.”

“There is a chance that had the hospital decided to share information with his family, our son would still be here today.”

“Confidentiality is far too embedded within the medical profession. The default position has to be one where you have to explain why you haven’t involved the family.”

In 2014, the National Suicide Prevention Strategy Advisory Group, of which Mr Elvidge is a member, developed the Consensus Statement.

The statement is 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 was signed up to by numerous health bodies.

However, Mr Elvidge says little has changed in practice.

Professor Louis Appleby, Chair of the National Suicide Prevention Strategy Advisory Group said, "Psychiatrists should feel able to use their clinical judgement on where the balance of patient safety and confidentiality lies. Families are devastated when they discover too late that their loved ones had been talking to professionals about suicide."

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said, “In my experience, if doctors make well-justified, well-recorded decisions to share information in the best interest of a patient who is in suicidal crisis, consistent with their professional codes of practice, this will be understood, respected and upheld in courts of law.”

“Courts are exceptionally reluctant to rule against doctors who have clearly acted in good faith in the interests of their patients.”

The Royal College of Psychiatrists believes that every area in England must develop a multi-agency suicide prevention plan showing how they will be working to reduce suicide in high-risk locations and amongst high-risk groups.

Related: Carers and confidentiality in mental health


Notes to editors
Royal College of Psychiatrists International Congress 2017

The Royal College of Psychiatrists International Congress 2017 runs 26 – 29 June in Edinburgh. You can join the conversation online using #RCPsychIC.

About the Royal College of Psychiatrists

We are the professional medical body responsible for supporting over 18,000 psychiatrists in the UK and internationally.

We set standards and promote excellence in psychiatry and mental healthcare.

We lead, represent and support psychiatrists nationally and internationally to governments and other agencies.

We aim to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities. We do this by working with patients, carers and other organisations interested in delivering high quality mental health services.

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