By Ian Slayter (pictured)
Often, care is shouldered by families — people, whether relatives or friends, who provide the emotional and practical support that is so critical to someone living with mental illness. They are one of our greatest resources because they provide timely, insightful information about a person who is becoming more ill or not responding well to treatments.
Providing families with general information about treatment and care improves their understanding of what their loved one may be experiencing. If we encourage patients to consent to share basic clinical information about their illness, treatment and needs, families are better able to help them. We know from research that working with families improves patient outcomes.
We have a duty of care not only to the patient but also secondarily to the family, as defined above, both to help them support the patient, and to help them cope with the challenges of living with, and caring for, someone with mental illness.
We have drafted disclosure guidelines, with insight from individuals living with mental illness, families and care providers to guide how and what information can be shared when the patient consents, and what is withheld when the patient is not prepared to do so.
This is all in accordance with the Personal Health Information Act and other applicable laws of Nova Scotia. We are now finalizing the guidelines in response to the extensive feedback received from stakeholders.
In an April 28 opinion piece titled "Mental health care: Are our rights to privacy being eroded?" Aileen McGinty stated that our policies, meaning the draft disclosure guidelines, "may not be in compliance with legislation." However, we have taken steps to ensure that the guidelines do follow legislation and the UN Convention on the Rights of Persons with Disabilities.
She suggested the guidelines prioritize the rights of family members over the rights of patients. We respect the rights of the individuals living with mental illness and work with them to arrive at the level of consent they are comfortable with, first and foremost. There are certain situations, allowed by law, where limited disclosure may be necessary to prevent danger.
Patients’ personal health information is private and confidential. The central message of our guidelines is that care providers should explain to patients that sharing of some of their clinical information about their illness, treatment and related needs can improve the level of their support. The care providers are advised to ask if the patient wishes to consent to share particular information with designated persons.
Ms. McGinty’s feedback is helpful; we need to make certain elements clearer. We have received a lot of helpful feedback from many people. The disclosure guidelines will be available on our website, OurHealthyMinds.com, along with other supporting material.
Collaboration is a major step in improving our services. The insight we gain from individuals and families based on their experiences in our system is invaluable. The disclosure guidelines provide a process to open communication among individuals, families and care providers, while protecting and respecting the rights of individuals living with mental illness.
Dr. Ian Slayter is clinical director, Adult General Psychiatry Services, Capital Health Mental Health Program; and assistant professor, Dalhousie University, department of psychiarty.
CDHA Mental Health Program Disclosure Guidelines - DRAFT - 30 March 2011