A conversation with a patient about sharing information with family members might go something like this:
Doctor: "Suzi, if you have a side effect from your medication, what should your husband do? Is the side effect life-threatening, or can you call in the morning to get advice? We have talked about if you have a side effect you call me, and we can discuss it. If your husband gets too worried because your side effect is frightening, then there is conflict about how to manage the symptom. So, if your husband knows what we discuss about side effects, then things at home will be calm. What do you think?"
Patient: "Okay, I understand. That sounds good. The less worried he is, the more he will let me alone."
D: "Are there other situations where you think that if your husband had more information, he might be less anxious and therefore less on your back about things?"
P: "Maybe if he understood my depression more – that I get forgetful or too tired or feeling hopeless ..."
D: "How would it help if he had more information?"
P: "He would not start to talk to me in that angry voice, then get on the phone and complain to his mother."
D: "Do you think he would agree to come in so that we could talk about ways to manage your symptoms?"
P: "Yes, but you have to promise not to talk about other things."
D: "What other things do you not want me to talk to her about?"
P: "I don’t want you telling him that I feel suicidal."
D: "Do you think he knows?"
P: "Yes, but I don’t want him talking about it with me."
D: "Don’t you think he would be more settled if he knew you could successfully use your safety plan? Your plan is for you to do something to distract your thoughts and to counteract the feelings, then to call me or the emergency number if you are needing further help. Remember the plan you have? You have used it a couple of times."
P: "Maybe, yes, perhaps."
D: "Put yourself in his shoes. Wouldn’t you be more comfortable knowing that there is a good safety plan in place?"
P: "I guess so."
D: "Okay, think about it, talk to him, and let’s schedule a meeting. Also, if you want, you can both go to the family support group we have."
P: "Okay, I’ll talk to him."
Staff also can offer nonconfidential information to family members and friends. We make it clear that we are not authorized to acknowledge whether the person is receiving treatment at the agency but can still answer general questions such as those dealing with diagnosis and treatment. We can provide written educational material and information about community resources. We can say that family involvement is important and that with the patient’s agreement, family members and friends can be involved in treatment; and we can listen to whatever they want to tell us.
Here is a quick summary of points to remember when it comes to confidentiality issues:
1. Discuss goals of family involvement with patients.
2. Educate staff about the benefits of involving family.
3. Provide guidance to staff on what to discuss with families and how to talk to families.
4. Ensure that your staff understands what is and what is not confidential information.
5. Remember that you can always listen to what a family member or friend has to say.
6. Keep in mind that serious risk trumps the need for a release of information to family or friends.
Confidentiality is vital. It safeguards patients’ trust and allows patients to work toward their own recovery. There are consent procedures for releasing confidential information, and some agencies have forms specifically designed for families. These forms specify the types of information to be released to a designated family member or significant person, and have a longer time frame of 1 year. These forms allow information to be communicated verbally rather than in writing.
When staff members understand the rationale and goals of involving family and friends, and if they receive training in how to approach patients and their families, willingness will be greater to implement a family-friendly approach to recovery.
Dr. Heru is with the department of psychiatry at the University of Colorado Medical School. She has been a member of the Association of Family Psychiatrists since 2002 and currently serves as the organization’s treasurer. In addition, she is the coauthor of two books on working with families and is the author of numerous articles on this topic.