5Confidentiality and consent
93.As we stated in our interim report, we heard evidence from those bereaved by suicide that there is an issue with confidentiality and sharing information with families. We explained this issue:
Patients have a legal right to confidentiality, but encouraging the option to involve trusted family or friends can improve support and aid recovery. However, we heard that too often, misunderstanding about confidentiality, lack of confidence, or even simply time constraints can lead professionals to adopt a ‘tick box’ approach to seeking consent. Professionals may err on the side of not involving families, rather than taking the time to explore fully with the patient whether there would be benefit in contacting a trusted family member or friend.80
94.Hamish Elvidge helped us to understand the difference between the ‘tick box’ approach to seeking consent, and the difference that explaining the benefits of sharing information when seeking consent can make:
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?”81
95.We recommended that stronger action needed to be taken to increase awareness of the Consensus Statement on information sharing and suicide prevention, to train staff, and to “engender a culture shift away from the current presumption that suicidal patients will not want their family or friends to be involved in their recovery”.82 We were disappointed that the Government, in the third progress report on the strategy, took upon itself no responsibility for this action. Instead, the report notes that
The National Suicide Prevention Strategy Advisory Group (NSPSAG) is working with the Royal Colleges to explore ways in which we can improve the awareness of the Consensus Statement with their members.83
96.We commend the work of the NSPSAG in this area, and we do not wish to suggest that they should be in any way less involved in this work. However, it is disappointing that, despite the Government acknowledging in its report that it had heard from stakeholders and from us that it “should do more to promote the Consensus Statement”,84 there are no proposals for action to be taken. Furthermore, our recommendations went further than just raising awareness, and there is no recognition in the Government’s progress report on the strategy that any action on training staff is required.
97.Hamish Elvidge, who was involved in the development of the Consensus Statement and is also involved in the NSPSAG’s work in raising awareness of it, told us in November that
In September 2016, the advisory group invited the royal colleges to update them on the progress they had made. The truth is that they had not made any progress. I think one royal college had issued it with an email—a newsletter. No change had occurred.85
98.In our follow-up evidence session on 31 January, he gave us his views on the continued lack of progress:
I was very encouraged by what the Select Committee said about professionals needing better training on how to involve families in care and assessment. You recognised the fact that, if that is done, it is likely to result in support and better recovery, but it is disappointing that so little has been done about it. The sum total of the Government’s response was simply that we should do more to promote the consensus statement. That consensus statement has now had its third anniversary. No details were provided on how it is going to be achieved and when the statement might be embedded in best practice for GPs, nursing, A&E, psychiatry or whatever.86
99.We were pleased to hear that there have been positive discussions between members of the NSPSAG and at least one Royal College (the Royal College of Psychiatrists),87 which we understand was a step forward in generating agreement that the Consensus Statement should be embedded into the culture of those who will be involved with individuals who have suicidal thoughts.
100.We are disappointed that the Government has not included any proposals for action on the Consensus Statement in its report on the strategy. We recommend that there should be a named responsible individual within Government to support the NSPSAG in discussions with the Royal Colleges and to ensure progress in raising awareness of the Consensus Statement and training of staff in this area (including training on how to seek consent).
101.Writing a blog on ‘Confidentiality in the context of suicide prevention’,88 Professor Sir Simon Wessely, the President of the Royal College of Psychiatrists (RCPsych), has recognised the importance of improving practice in the area of information sharing. It is encouraging that he states that RCPsych will emphasise the approaches encouraged in the Consensus Statement as the College revises its guidance on suicide and self-harm. He states that “this will be an important contribution to changing culture and practice in this area”.89
102.Dr Peter Aitken recognised the concerns from a health professional’s point of view:
We at college council have had a good conversation about what we might need to do to set the direction of the College of Psychiatrists to make sure that happens. I wonder, however, when I meet colleagues in my practice how nervous they are of legal consequences that possibly are not there. Doctors are occasionally rather in awe of their legal colleagues. Some of us worry that something bad will happen if we are not very careful about confidentiality.90
103.This concern is understandable. However, Professor Sir Simon Wessely, after explaining in his blog that when a practitioner is satisfied that a suicidal patient lacks capacity to make decisions about information sharing, the practitioner should use their professional judgement to determine what is in the person’s best interest, counters some of these concerns:
I know what any professional reading this piece is thinking: what if I get this wrong, or, more accurately, what if someone thinks I have got it wrong? The spectre of the GMC, other regulatory bodies or the Courts looms large in their thinking, and I am not surprised. ‘Safety first’ becomes the agenda. Better not take any risks. But I think these concerns, although understandable, are overstated. 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.91
104.We commend this approach. We nevertheless also agree with Dr Aitken that it would be wise to include trust legal departments, legal authorities and defence unions in the discussions between the NSPSAG and the royal colleges. As Dr Aitken explained, it is crucial that
When doctors ask for advice from their trust’s legal departments or from their defence union they are offered support that is sympathetic to the consensus statement, because if as a doctor you have to make a decision on your own late at night and you phone the defence union which comes straight back with, “Be very careful about that,” you tend to be very careful about it.92
105.We recommend that further discussions between the NSPSAG and the Royal Colleges on the Consensus Statement should involve representatives from trust legal departments, legal authorities and defence unions, in order to ensure consistent guidance.
106.We were extremely concerned to hear that, in some situations, individuals who were suicidal did consent to information being shared with a trusted friend or family member but this was not acted upon. We heard this particularly powerfully from Steve Mallen, a bereaved father whose son Edward died by suicide in 2015: despite Edward giving consent for medical professionals to share information with his parents, they did not do so. Situations like these are clearly unacceptable.
107.Training for medical staff on the Consensus Statement and on how to seek consent should include educating medical professionals on the importance of action when a patient has given consent for information to be shared with a friend or family member.
108.We also note the importance of general practitioners being kept informed about their patients who are at risk of suicide.
80 Fourth Report of Session 2016–17, Suicide prevention: interim report, HC 300, paragraph 24
81 Q206 [Hamish Elvidge]
82 Fourth Report of Session 2016–17, Suicide prevention: interim report, HC 300, paragraph 26
83 Preventing suicide in England: Third progress report of the cross-government outcomes strategy to save lives, paragraph 38
84 Preventing suicide in England: Third progress report of the cross-government outcomes strategy to save lives, paragraph 37
85 Q206 [Hamish Elvidge]
86 Q433 [Hamish Elvidge]
87 Q433 [Hamish Elvidge]
88 The Huffington Post, Confidentiality in the Context of Suicide Prevention, 6 December 2016
89 The Huffington Post, Confidentiality in the Context of Suicide Prevention, 6 December 2016
90 Q434 [Dr Peter Aitken]
91 The Huffington Post, Confidentiality in the Context of Suicide Prevention, 6 December 2016
92 Q434 [Dr Peter Aitken]
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