Recovery includes having a good social support system – family members and friends who believe in the patient’s recovery. The health care system fiercely guards the patient’s personal information. How do we as mental health providers best communicate with the patient’s family?
There are differing attitudes about talking with families. In a study by Phyllis Solomon, Ph.D., most providers interpreted confidentiality policies conservatively, and 54 percent were confused about the types of information that are confidential (Psychiatric Serv. 2003;54:1622-8).
The need to ensure that communication is optimal is further demonstrated by the findings of a recently devised instrument called the Confidentiality Issues Test, or CIT. The CIT, as outlined by Tina Marshall, Ph.D., and Dr. Solomon, contains scenarios, descriptions, and questions about confidentiality issues and family members (Am J. Psychiatric Rehab. 2012;15:97-115). The following two questions come from the CIT, and the answer in bold is the correct one.
First Situation
A woman calls you about a patient on your caseload and identifies herself as your patient’s mother. You have no release, but the patient has mentioned that he visits his mother frequently, and you have no reason to believe that the caller is a danger to the patient. The caller says she wants to make sure that her son’s case manager gets certain very important information about his financial and legal situation –information that he often does not mention to staff.
Which answer is correct?
1a. All you can say is that you cannot give out any information about patients without a release, including whether any particular person receives services at your agency.
1b. You are only allowed to take the caller’s name and contact information and tell her that if any information can be released, someone will get back to her.
1c. While stating that you cannot give out any information, you are allowed to ask the caller about the information she is concerned about conveying and say that if it turns out that her son is a patient there, you will make sure the information gets to the right person.
1d. Since the caller is an immediate family member and has important information, you are allowed to confirm that the son is a patient at your agency, but not to release any other information.
Second Situation
A patient has told you (or someone at your agency) that she plans to take an overdose tonight, and has a large number of pills saved up at her apartment. You know that she has a roommate, and you have the roommate’s contact information, but you have no signed release to talk to the roommate.
Which answer is correct?
5a. Even in this situation, you must get a signed release from the patient to be able to call and talk to the roommate about the patient’s safety.
5b. You do not need to have a release to talk to the roommate if there is a question of imminent death or serious injury to the patient, as long as the information you share is restricted to the issue of the consumer’s safety.
5c. Neither of the above choices is correct.
5d. Not sure
Almost 50% of behavioral health providers who completed this test believed that even without revealing any information about a client, they could not listen to a family member or a significant support person without a release from the patient, or were unsure whether they could, according to Dr. Marshall and Dr. Solomon. Staff also indicated that they would attempt to avoid being in a situation where they had to implement a policy that seemed too fraught with difficulties.
Most patients, and especially those with chronic mental illness, need assistance in monitoring and managing symptoms as an important part of recovery. Families are the first to notice symptoms; families bring the patients to the emergency room; and families are most affected by their relative’s disability. Family conflict can arise when the family member does not understand the illness or the symptoms – and does not understand how best to respond to an ill relative. Families want to offer support but need some information about their relative’s illness and treatment. What can you divulge to families?
First, the patient needs to understand the role of the family in managing the illness. When patients understand that their family/friends can be helpful and agree to give the family members ways to be helpful, they usually are willing to have their family members come for a visit. A family consultation clarifies where the boundaries are between the patient, the mental health providers, and the family members. The family member does not need to know "specifics," but does need to know how to respond when difficulties arise so that the family member does not get overly anxious and then does things that are unhelpful.