Confidentiality Barrier

I hear many families complain that, when their relative is admitted to a psychiatric hospital ward, they can’t get basic information about him or her when they call the hospital. They are told that the information is confidential and protected by statute. What a frustrating situation for the family and what an obstacle to good patient care this must be! Common sense and common courtesy, at least, should tell the hospital staff that each patient, upon admission, should be asked if he or she would be willing to sign a release of information form allowing staff to communicate with specific family members. New patients are asked to sign plenty of forms. This could easily be one of them. This is rarely done, however, in US hospitals and clinics. Why is this so? Is it laziness, because talking to families takes time? Or is it a reflection of the often unrecognized stigma that even mental health professionals harbor inside?

We have to recognize an important element in this situation. In the US, hospital administrators and their lawyers are running scared since the introduction, in 1996, of the federal HIPAA Privacy Rule that prevents service providers (with heavy fines) from releasing confidential health-related information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. A simple release of information form signed by the patient, or the existence of an emergency situation that over-rides confidentiality, can satisfy the needs of the family, the service providers, hospital administrators and lawyers alike.

Whatever the underlying motivation, if you run into this situation, you need to know that, even without a signed permission to release information or the existence of an emergency situation, communication is still possible. You can always give information to the staff that they should have if they are to be able to understand their patient and to treat him or her properly. You can tell them, for example, about your relative’s behavior prior to the hospital admission that they may not know about because he or she is too guarded to mention it. You can tell them about your fears, your concerns, or what a wonderful person your relative is when not afflicted by illness.

Here is what the well-known American psychiatrist Robert Liberman has to say about this issue in his 2008 book, “Recovery from Disability”:

“Too many practitioners pay obeisance to a misguided conception of privacy and confidentiality. There is no violation of confidentiality when a clinician solicits information from family members. Can anyone picture an internist or surgeon failing to invite a close family member to provide confirming and converging information regarding the patient as a key element in diagnosis and choice of treatment? Relatives are lucky if they get in to see the professional responsible for the patient’s treatment, much less hear of the patient’s diagnosis and prognosis. Plainly speaking, relatives are ignored by mental health professionals.”

What can you do if you find yourself in this situation?

Number one: Be assertive. It is your right to know what is happening with your loved one. Take a stand!

Two: Ask the staff to ask your relative to sign a release of information allowing them to talk to you. Failing that, ask your relative to ask the staff to give him the same form to sign. If your relative declines to do this on Day One, ask again on Day Six or Seven.

Three: Remember, there is no law that prevents you from giving information to anyone on the hospital staff if you think it would be useful.

Four: Expect to be included in post-hospital discharge planning unless your relative specifically objects to your inclusion.

Let’s bring some sanity back to the mental health treatment system.
Dick Warner