Policy on Confidentiality

Solihull Mind's policy on confidentiality is based on the view that any breach of confidentiality will be exceptional - in almost all cases confidentiality will be respected.

An organisation responding to people in distress - who may reveal highly personal information - must safeguard the confidentiality of that information in order to:

- ensure trust and safety for the individual

- respect their legal right (if any) to confidence

- develop a reputation as an organisation that people will feel confident to approach.

However, there may be rare occasions when for legal and/or ethical reasons the service might decide it has a duty to break confidentiality. (See section on risk to third party).

Occasionally, permission may be sought from service users to share minimum information to protect service provision. (See section on risks to services).

Risks to the service user her/himself

Policy Statement: Confidentiality will not be breached in the 'interests' of the service user, unless they give permission.

Solihull Mind believes that it would be paternalistic and contrary to our philosophy of the right to self-determination to break confidence in contradiction to what the person her/himself was saying. This policy might, therefore, mean that despite the efforts of a worker/volunteer to talk through the options for help, that suicides may occur and that staff/volunteers and other users of our services will need considerable support when these incidents arise.

Difficult and distressing though this is for staff and volunteers, it is strongly felt that this offers service users access to support in times of crisis; and that many more potential suicides are saved by being able to talk through issues without fearing a breach of confidentiality. Action will, however, be taken if a person actively attempts self harm on Mind's premises - this includes the communal areas of the housing schemes; or in any location if a service user involves a staff member/volunteer in their attempt to self harm. The worker then has an option of taking action e.g. disarming, first aid, or calling an ambulance. It is recognised that in some instances this action could not be discussed in advance with a senior officer.

This is necessary in order to protect staff/volunteers/other service users from possible serious emotional damage following the inclusion in the attempted self-harm of others.

The only other occasion where a worker may need to breach confidentiality is if a service user is being abused by another person, and Mind are required to comply with Vulnerable Adult Measures (see separate Policy on Adult/Child Protection).

Practical implications

Based on our previous experience it is expected that by far the majority of people who come to Mind and express their intent to take their own lives will be supported through their crisis/distress. The need to take action will therefore be very unusual. Where necessary, however, the following action should be taken:

- If a person is found unconscious action to save their life (i.e. first aid or calling an ambulance) should be taken. No contact with other services (e.g. police or psychiatric services) should be made.

- If a person says they have already taken tablets or that they intend to self-harm in this or some other way, they need to be informed that should they become unconscious action will be taken.

It also needs to be explained why this needs to be done - i.e. that they cannot include staff/volunteers/users in their actions - but reassured that confidentiality on their behalf will be maintained with regard to psychiatric services, the police, their family etc. unless they state otherwise.

This action allows the person to make a choice whether to stay on the premises (communal area) or leave. If the person leaves it needs to made clear that no follow up action will be taken without their permission.

Where Adult Protection Procedures are being considered, Mind must demonstrate that all possible attempts were made to discuss this in advance with the service user.

Risks to third parties

Policy Statement: Confidentiality may be breached when there are grounds for thinking there is a risk of serious harm to a third party.

Mind's primary responsibility is to the users of our services, but there are occasions when there are clear ethical grounds for balancing this against the interests of third parties. If there are grounds for thinking there is a risk of immediate and serious harm to someone - for instance, if a user of our service is stating that s/he intends to commit a murder or that s/he is sexually abusing a child - we have a moral duty to put the interests of the potential victim first. Mind's values as a mental health organisation add to the importance of adopting this ethical position as we understand the impact on mental health of major traumas such as child abuse or serious assault.

Reported risks to someone, from a third party

Policy Statement: Mind does not break confidentiality in relation to allegations against third parties.

Mind would not normally intervene in reporting hearsay to other agencies, but would encourage the person to contact the relevant agency themselves (eg social services or the police). However, there may be occasional situations where the person feels unable to raise the issue themselves - for instance,if a patient in a psychiatric hospital is afraid to complain about staff brutality. In such cases Mind may consider finding out more about the allegation with a view to perhaps complaining ourselves; or arranging support/advocacy to assist the person to complain.

Risks to staff/volunteers

Policy Statement: Mind must consider breaching confidentiality where there are grounds for thinking there is a risk of serious and immediate harm to staff.

As an employer of paid and unpaid staff, Mind has a duty towards their physical and emotional well-being.

Practical implications

It is likely to be extremely rare that either our counselling or advice/information services will have to consider breaking confidentiality. However for those occasions when the interests of the third party need to be considered, the following process illustrates how the policy may work in practice.

1. A person rings or calls in to ask for information/advice. At this point in law there is no 'confidential relationship' - because no confidential information is imparted.

2. The person begins talking about her life story and then the relationship does become 'confidential'. The worker/volunteer now has a duty of confidence (ie all information is now confidential to the service).

3. The person begins to talk about violent feelings. The worker/volunteer listens and suggests routes for help with this.

4. The person begins to talk about how s/he wants to act on these feelings. At this point the worker/volunteer can take the relationship out of the confidential realm by warning that s/he will no longer be able to keep this discussion confidential, because s/he may have a duty to the other person (the potential vicim), to try to avoid the risk of harm to them. This gives the person the opportunity to end the call, leave, or change track.

5. The person reaffirms intentions to commit an act of violence. The worker/volunteer at this point must consider whether to breach confidentiality. Wherever possible this must be discussed with the Local Director - or, in the absence of the Local Director, Mind's Chair or vice-chair, or a senior member of staff.

6. If it is decided that there are grounds for believing someone is at risk of immediate and serious harm, the person should (if possible) be informed that confidentiality will be broken. Once this decision is taken it does not mean everything the person said should be relaid to other parties; if for instance the police are contacted, they should be told only what they need to know. No information should be given to agencies (e.g. Social Services) not directly involved in protecting the third party.

7. If the person gives no information about their identity or whereabouts, it is almost always technically impossible to trace them. The only ways to do so are:

- in case of repeat calls (for instance, repeat threats to a staff member) to ask the police to put tracer equipment on the line. This is always short-term.

- for one-off calls, to call the police while the person on the line and ask for the call to be traced. This should never be done without a decision by the Local Director, Chair, or Vice-chair.

Risks to services

Policy statement: Consideration may be given to requests for information required by external agencies if funding for services depends upon it. This does not override an individual service user's right to refuse.

When working with other agencies and funders Mind will always initiate negotiations by defending and explaining the right to confidentiality for service users.

On some occasions, however, funding for a project may be unobtainable unless some information is made available. This is most likely to be in areas of work and training where information such as name, address, National Insurance Number etc are routinely collected and required for service monitoring. In this case a decision has to made as to whether we request this from service users in order to provide the service. We will always try and ensure all other funding avenues have been sought before using any funding that has a request for information attached. If we do use this source of funding we will seek reassurances that information held by them will be protected under the Data Protection Act and not passed on to other agencies - e.g. benefits related organisations.

Practical implications

1. Not enough service users may agree voluntarily to give over information to draw in the funding required for the project; and a decision will need to be made as to whether the service will be subsidised from other funds or withdrawn.

2. The aim in all our services is to give service users full information on which they can make an informed decision. Where this is difficult in the first contact - due to issues such as distress, agitation etc - the person will be given a leaflet with basic information, and the worker will seek further appropriate opportunities to give a fuller explanation.

Training and support

The policy must be consistently managed and staff have the support they need.

All staff should be offered training on implementing the policy.

All staff should have access to support and de-briefing following phonecalls, advice/counselling sessions of this nature.

This policy will be reviewed bi-annually unless new information requires an earlier review.