HUNDREDS of lives would be saved from suicide if doctors were allowed to breach patient confidentiality to contact families of those threatening to kill themselves, leading mental health experts have claimed.

Psychiatrists argued that a “harmful and ingrained” culture of fear over the threat of legal action prevents some medical professionals from sharing information about at-risk patients.

Scotland has seen the number of annual suicides fall by a fifth in the past 15 years but it remains the highest rate in the UK.

Last night, Professor Louis Appleby and Dr Andrew Hill-Smith told a conference in Edinburgh that the default position to withhold information from the families of high risk mental health patients should be overhauled with doctors allowed to share concerns with other authorities.

Their call was echoed by Hamish Elvidge, whose 23-year-old son Matthew committed suicide after a short period of depression in 2009.

Speaking at the Royal College of Psychiatrists International Congress, he said: “Before my son took his own life, he had only just been discharged as a low risk patient, despite coming in as a high risk patient that very same day after a suicide attempt. At no point were his family involved in any part of the process. 

“There is a chance that had the hospital decided to share information with his family, our son would still be here today. 

“Confidentiality is far too embedded within the medical profession. The default position has to be one where you have to explain why you haven’t involved the family.”

General Medical Council guidelines insist that doctors “should usually” ask for consent before disclosing personal information and “as a principle, if an adult patient has capacity they are entitled to make decisions in their own interests”.

According to the latest available statistics, there were 672 probable suicides registered in Scotland in 2015, down from 696 the previous year. 

Over the previous decade there has been an almost 20 per cent reduction in suicides which has been partially credited to the pioneering Choose Life scheme.

Professor Louis Appleby said: “Psychiatrists should feel able to use their clinical judgement on where the balance of patient safety and confidentiality lies. Families are devastated when they discover too late that their loved ones had been talking to professionals about suicide.”

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said: “In my experience, if doctors make well-justified, well-recorded decisions to share information in the best interest of a patient who is in suicidal crisis, consistent with their professional codes of practice, this will be understood, respected and upheld in courts of law.”

Chair of BMA Scotland Dr Peter Bennie said doctors are obliged to comply with guidelines on patient confidentiality “that set out the limited circumstances in which it can be breached”.

Most often doctors violate the conditions if they are compelled to legally or to prevent a serious crime.

“Decisions to do this are always made on a case by case basis and can be an extremely difficult judgement call for doctors to make,” said Dr Bennie.

“It is essential that decisions around confidentiality get the balance right between ensuring the trust of patients in their doctor is not undermined and also acting in the best interests of our patients.

“Even in situations where the doctor is complying with a patient’s wishes, and not sharing clinical information with family members, it is important to give the family the opportunity to provide information to the doctor. This can often have a significant impact on the treatment plan.”

ANALYSIS - Breaking patient confidentiality is always a last resort – but never an easy decision

by Dr John Crichton

WHEN you meet any healthcare professional you expect your conversation to be confidential, but sometimes that confidentiality has to be broken to keep someone safe. Patient confidentiality is at the heart of the Hippocratic Oath.

But as a recent tragic case of a young girl’s suicide in Scotland has shown, there are times when some call this promise into question.

When it comes to breaking patient confidentiality, we are guided by the GMC but there is no “one policy fits all”. 

The circumstances of each case are unique and what is in the patient’s best interests must come first. Doctors have to navigate the reaction from the patient, family and friends and the medico-legal consequences for themselves as clinicians.

It is complex territory and not a decision that doctors take lightly. Let me be clear – any clinician considering breaking patient confidentiality to prevent patient suicide has found themselves in a very serious situation.

One of the privileges of being a psychiatrist is working with vulnerable people who share things they have never told anyone before. Together, you and the patient are a team, working to get better.

When we see people we think are at risk of suicide, we always encourage them to speak to their family or friends. 

It is hard to bring up suicide with people that are close to you and often patients express unease at doing this.

Trusted friends and family provide support to a patient in crisis and also be a source of information to help a medical professional make better decisions about treatment.

But doctors can’t force patients to share anything with anyone. If a patient does not want to involve their family, the doctor is then left with a choice. 

Respect their wishes or break patient confidentiality. In some circumstances, this is a choice between life and death.

We will always hear about more instances where a decision not to share information might have played a part in the worst possible outcome for a patient than when a doctor’s actions prevented this.

Breaking patient confidentiality is always a last resort – but it is never an easy decision.

The Herald: Dr John Crichton, is chairman of the Royal College of Psychiatrists Scotland and consultant forensic psychiatrist at the Royal Edinburgh Hospital.