What I'm reading this week: Confidentiality in mental health

Cordless, C. (Ed.). (2001). Confidentiality in mental health. London. Jessica Kingsley Publishers.

One thing of note when reviewing an edited volume is that each article is not equally good or equally relevant to one’s interests.  This book for example had some articles which related more to psychiatry or hospital based care than to the community based work I’m involved in. 

An ongoing theme throughout the book is the shift from a psychiatry/hospital oriented model of mental health care to a community based one and it’s implications confidentiality.  While in the past, patients may have engaged in individual psychoanalysis with one professional, many clients today are involved with interdisciplinary or interagency teams and their personal information may be shared with all members of the team.  Also, in the modern context we place emphasis on supervision, debriefing and consultation with colleagues.  While most of us as professionals would not perceive this as a breach of confidentiality, clients might. 

Another theme in the book is client expectations of confidentiality, informed consent, and whether clients really know what they are getting into.  While a client may be informed that their social worker works as part of a team, do they understand that this may mean common record keeping, or in the case of Assertive Community Treatment, a daily review of their file by the entire team. 

Finally, the book discusses the legal aspects of confidentiality and what constitutes a breach.  When does the threat of harm to others outweigh a clinician’s responsibility to keep confidentiality?  For many, it can be a “damned if you do, damned if you don’t” scenario as they face threat of litigation from both sides. 

I actually liked this book.  I didn’t read all of the legal chapters, but the chapter about social work was particularly good (or perhaps particularly relevant). The only draw back to the book was that it was British not Canadian and so all laws sighted were British.  I’d love to see Canadian authors pull together something similar.