Mental health care: Are our rights to privacy being eroded?

An opinion piece published in today's edition of The Chronicle Herald:

By Aileen McGinty

One in five Canadians are likely to experience mental illness within their lifetime. Statistically, this means that about 80,000 people in the Halifax area could be affected by new guidelines on disclosure of information being developed by Capital District Health Authority’s Mental Health Program.

The Mental Health Program was advised, rightly or wrongly, last year during a visit by the Meriden Programme from England that collaborative mental health care in Nova Scotia is restricted more than in most other places in the world by the emphasis on confidentiality.

Capital Health’s response to this is to develop new disclosure guidelines together with "champions of disclosure" in their various teams. What the Mental Health Program does not appear to appreciate is that you cannot get around existing legislation simply by introducing new policy. If legislation is required to be changed, there is an appropriate process to be followed. The danger with the direction taken by Capital Health is that the new policies may not be in compliance with legislation, leaving the organization open to challenge.

The draft disclosure guidelines prioritize the rights of family members of those with mental illness over the rights of the individuals living with mental illness. ("Family" is defined as those whom the patient identifies as supportive.) Families play an extremely important role in the lives of many of those with mental illness; however, the rights, dignity and respect owed to the individuals concerned must take priority.

These rights cannot be ignored as they are enshrined in the UN Convention of the Rights of Persons with Disabilities. On a provincial level, the Freedom of Information and Protection of Privacy Act provides that all public bodies are obliged to ensure the protection of an individual’s personal information.

In essence, the draft guidelines as written advocate manipulation and obfuscation of people who are vulnerable and likely to be in distress. In any discussion, clarity is paramount, but especially so when that discussion involves someone who may be distressed, confused or anxious.

These draft guidelines advise professionals not to ask someone whether they want their personal information kept confidential, but rather assume consent and ask only which information can be disclosed and to whom. Many people with mental illness as well as human rights professionals, both in Nova Scotia and other provinces, are finding this extremely disturbing. It is essential to inform someone that they have a right to keep their personal information confidential.

It is unlikely that any other health-care information would be treated with such a cavalier attitude and it may be possible that CHDA Mental Health Program could be setting itself up for complaints of discrimination on this basis.

Collaborative care is an important factor in the treatment of any illness. I am a great supporter of collaborative care generally, and am presenting on this very topic at the 12th Canadian Collaborative Mental Health Care Conference to be held in Halifax in June this year. However, research on collaborative care is quite specific about which particular circumstances lead to improved patient outcomes. It is simplistic to state (as in the draft guidelines) that "research shows that good supports improve patient outcomes," especially without referencing that statement.

My aim in highlighting this issue is not to be dismissive of collaborative care. My concern is to ensure that the individual’s right to privacy of personal information is not eroded.

The consultation period for this document was very short and the deadline for comments has passed. However, given the importance of this matter to so many people, I am sure that CDHA Mental Health Program would still be open to listening to the views of the public and other relevant bodies before completing the final document.

Aileen McGinty is a member of the Mental Health and Law Advisory Committee of the Mental Health Commission of Canada.

Also see:

Personal Directives in Nova Scotia

Personal Directives Act

Personal Directives Regulations

Personal Health Information Act (not proclaimed in force)

Carers and confidentiality in mental health - The Royal College of Psychiatrists (2010)

Rethink Policy Statement 27: Confidentiality and information sharing

SDO briefing paper – Information Sharing

Confidentiality and Information Sharing Reference List

The SSNS's 22nd Annual Conference - Mental Illness: Why Me?

The Schizophrenia Society of Nova Scotia’s

22nd Annual Conference

Mental Illness: Why Me?

Held on Friday, November 26th, 2010

Joan Greenwood (left) receives the 2010 Janine Williams Memorial Bursary from Cecilia McRae, president of the SSNS.


Ashley Smith, Founder and Executive Director, Embracing My Mind, Inc.


Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, Department of Psychiatry, Dalhousie University


Patrick Burke, QC, member of the SSNS Board of Directors, with Dr. Kutcher.


Aileen McGinty, Dip. Psych. (Open), M.T.A., Post-Graduate Diploma in Music Therapy, Certificate of Teaching, Dip.L.P., LL.B., M.A.








Phil Rogers, treasurer of the SSNS (left), with Dr. Tomas Hajek, Associate Professor & Dalhousie Clinical Research Scholar, Departments of Psychiatry and Anatomy & Neurobiology, Dalhousie University


Phil Rogers with Dr. Sherry Stewart, Killam Research Professor, Departments of Psychiatry, Psychology, and Community Health & Epidemiology, Dalhousie University


Left to right: Debby Gladstone, secretary of the SSNS, Ms. Laura Burke, MA Student in Creative Arts Therapies, Drama Therapy Option, Department of Creative Arts Therapies, Concordia University and Margaret Smith


Elainie Garland, vice president of the SSNS (left), with Andy Cox, Mental Health Advocate, IWK Health Centre and Member, Board of Directors, Mental Health Commission of Canada


Please click on any photography to enlarge it.

Photographs by Stephen Ayer.

Stick to facts on mental illness

A letter to the editor published in today's edition of The Chronicle Herald:

By Aileen McGinty [pictured]

Although I have only lived in this country for nine weeks, I cannot let the March 28 letter by Elizabeth Azuya go without response. I hope the views expressed do not reflect those of the wider Canadian community.

While the incident referred to — the stabbing to death of eight children in China — is indeed a tragedy, some of the statements in the letter are inaccurate and are particularly disappointing, following on as they do from the recent focus on mental health in The Chronicle Herald.

Ms. Azuya states, "The fact that people suffering from mental illnesses are mostly the ones blamed for such offences should change the ways in which such people are treated anywhere they go." Fact: The majority of people who are violent do not suffer from a mental illness. People with mental illnesses have the same basic human rights as anyone else and they should not be treated any differently. I wonder how Ms. Azuya thinks they should be treated.

"Leaving them to wander around could turn into a huge social problem." If I presume that "them" are individuals with a mental illness, the idea that "they" all wander around causing social problems is farcical. Fact: People with mental illness are 2.5 times more likely to be victims of violence than to be perpetrators of violence.

Does Ms. Azuya realize the large numbers of "them" who are wandering around anyway? Fact: In Canada, one in five people will experience a mental illness at some time in their life. Does this mean that 20 per cent of the people in this land should somehow be seen as posing such a risk to society that the streets are unsafe to walk on, as the letter suggests?

Ms. Azuya might like to know that statistically, the incidence of mental illness is actually less in China, at 17.5 per cent, although she may be relieved she does not live in Scotland where it is 25 per cent!

The fact that the suspect in the incident in China was once a "medical worker" is irrelevant. Given the incidence of mental illness, health service providers will undoubtedly have people working for them who have experienced mental illness at some point, and quite rightly so. Is it any wonder that while some people still hold outdated ideas about mental illness, individuals may not feel comfortable sharing that information, especially within the workplace?

I did wonder if this letter was a joke, but sadly, I fear it is not. And yes, Ms. Azuya, I am one of "them," but I am also a qualified lawyer (Scottish), psychologist (U.K.), teacher (U.K.) and music therapist (Canadian). I have spent many years working in the health care sector, have a very successful career and three thriving children, so please do not be afraid that I am "coming to stab (you) to death."

Aileen McGinty lives in Hammonds Plains.

Photo credit