Hi Gerasimos,

You're right, this a very real barrier for families who want to be involved in the treatment of family members. What I know is that sometimes the barriers are real organisational/policy/ethical barriers, sometimes there are barriers for the client, and sometimes there are barriers for the clinician. Confidentiality has a little bit of everything. While we can't change ethical standards, there are still ways to involve families in treatment. In my experience as a family therapist in a mental health facility one way is to help colleagues become more comfortable. First, providing education about ethics and standards of practice can help. Giving them practice dilemmas to work through can provide them with tools for different challenging situations. Providing ongoing support/supervision to colleagues is also important. Finally, having one or more individuals advocating for family involvement in mental health and addictions also helps people to start thinking about one person's difficulties with a broader lens. Having family support in recovery is vital. The more services are created for family members, the more clinicians will slowly start becoming more comfortable with situations that may not seem simple, but offer enormous benefits to the individual with the mental health concerns or addiction, as well as the family. Hope that helps.

Toula

Sometimes a resource in plain language can get a conversation started around these issues. The SANE Australia Factsheet series are helpful. There is a very useful one pitched to families that can be a resource to distribute but can also help clinicians have conversations togethe re being inclusive of families and friends - benefits, challenges, how to go about it:

http://www.sane.org/information/factsheets-podcasts/206-families

Hope this helps.

Hi Toula,

Thank you very much for your response. It is really nice to see colleagues from other areas to also experience similar issues in their practice.

It seems that health professionals are indeed of need to become more educated on what is and what is not confidential. No-one wants health professionals to be struck off due to malpractice, it is an increasing concern of mine however that the more they employ confidentiality as a method of avoiding relatives, the more likely they are to actually work outside the ethical framework. Either way we have of duty of care towards relatives as well.

Thanks for the food of thought

cheers

g.

Hi Melissa,

Thanks for the response and the great SANE Australia link. Much appreciated.

cheers

g.

There's also one practical way around confidentiality: Ask patients to sign releases stipulating what client clinical information can be shared by the provider with one or more family members or others during a set time frame. Without releases psychiatric hospitals in the US cannot even say that a specific individual is or is not a patient. With that baseline clarifying what is and is not "confidential" won't help much. Of course, releases require patient cooperation which may not be forthcoming. Family members do get extremely frustrated and upset when they know their relative is an inpatient (maybe because the patient called them) and they get "stonewalled" when they ask staff simple questions. It sometimes helps to remind US patients at least that confidentiality is a widespread feature in health care and cite HIPPA (Health Insurance Portability and Accountability Act of 1996) as an example. It also might help to spell out confidentiality policies in patient/family handbooks and on provider web sites.

Hi Tony,

Thanks for sharing your experience from the US, and for the practical hints. Unfortunately, your comment about relatives feeling "stonewalled" is so accurate.

Thanks again

Gerasimos