Tutors and staff at universities struggle with the issue of confidentiality with regards to their students who are suffering with mental distress. While they are not trained counselors, they have the best interest of their students in mind. Yet, they are not allowed to take the parents of these students in confidence in the name of confidentiality.
Confidentiality is a foundational ethical standard for health professionals. It is the ethical duty to fulfill the promise that client information received during therapy will not be disclosed without authorization. It becomes a legal concern if broken, whether intentionally or not.
What if not breaking confidentiality leads to harm?
There are exceptions.
Confidentiality does not apply when disclosure is required to prevent clear and imminent danger to the client.
Protecting the client from harm must supercede the harm to the relationship that may happen due to a breach of confidentiality.
BACP (British Association for Counselling & Psychotherapy) Ethical Framework says:
“Situations in which clients pose a risk of causing serious harm to themselves or others are particularly challenging for the practitioner. These are situations in which the practitioner should be alert to the possibility of conflicting responsibilities between those concerning their client, other people who may be significantly affected, and society generally. Resolving conflicting responsibilities may require due consideration of the context in which the service is being provided. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. In all cases, the aim should be to ensure for the client a good quality of care that is as respectful of the client’s capacity for self-determination and their trust as circumstances permit.”
The GMC reiterates the importance of confidentiality in good medical practice but does not talk of suicide in particular.
Courts usually consider two fundamental issues:
- did the professional adequately assess the likelihood that a patient was suicidal?
- if an identifiable risk of harm was determined, did the professional take sufficient precautions to prevent suicide?
In general, the therapist is protected from liability if they have conscientiously performed and documented a thorough evaluation, followed by carefully considered, appropriate interventions.
Early diagnosis and treatment of mental illness is key for better outcomes. Hence the staff at schools and universities should be equipped with skills and knowledge to identify such illness in students. They should be empowered to get appropriate help for them at the earliest.
In case of disclosure of severe suicidal ideation, the safety of the ‘at risk’ person should be the only concern.