As a government inquiry into mental health and addiction concludes later this month, we thought it was an opportune moment to discuss some of the common concerns that can arise about disclosing mental health information.

The focus of the mental health and addiction inquiry will include whether or not to share information with families, crisis assessment teams, accommodation providers and other associated support services.

It is incumbent on clinicians to do the best for their patients. Where that involves getting other people including family members engaged in treatment, they should do what they can to obtain the patient’s authorisation to share the information necessary with those family members. This is a good starting point.

But it is important to differentiate between patients voluntarily engaging with mental health professionals, and situations involving a compulsory assessment and treatment process as legislated by the Mental Health (Compulsory Assessment and Treatment) Act 1992.

Diminished capacity

A compulsory assessment and treatment process is reserved for those patients who have a “mental disorder”, meaning a mental illness which poses a serious danger to the health or safety of that person or of others; or seriously diminishes the capacity of that person to take care of themselves.

Section 7A of the Act has a mandatory "consult whanau" requirement. That means patients under that Act will have their information presumptively shared with family unless doing so would compromise their care. This doesn’t apply if a doctor has reasonable grounds for deciding consultation with family is not practicable or not in the best interests of the patient. But in deciding whether or not to consult with family members, the doctor must consult the proposed patient or patient.

There is no such provision in the Act in relation to voluntary patients. This is not insignificant. Why should people accessing mental health care expect a lower level of privacy than those accessing sexual or reproductive health, or anything else?

Maintaining confidentiality

The Privacy Act and the Health Information Privacy Code (HIPC) enable the sharing of personal information in appropriate circumstances. Health practitioners are generally under an obligation not to share personal health information about their patients, both as a requirement of the HIPC and under general ethical obligations to maintain confidentiality.

But the Privacy Act, HIPC and the Health Act 1956 all provide authority for practitioners to make prudent disclosures necessary for providing of the proper care of the individual in accordance with sound clincial practice. This is usually, but not always, with the authorisation of the patient concerned.

We’re aware that the judgements necessary about the the nature and extent of families involvement in a patients care, and the information they need to be involved in care, can be difficult.

This article was first published in NZ Doctor magazine on 8 November 2018.

Image credit: Poster - National Institute of Mental Health (US)

health, Health Information Privacy Code, IPP11 - disclosure