When a beloved actor recently ended his life, a number of people on social media opened up about their mental health struggles. For a country that has always held mental health at an arm’s length from public discourse, this was a welcome change. With a pandemic underway, the effects on the populace’s mental health is one that can have a lasting impact.
While these conversations and growing awareness are both a step in the right direction, certain incidents have also brought to light the pertinent question around ethics and patient-doctor confidentiality.
The Better India, in conversation with experts from across the country sheds light on the matter outlining its utmost importance and course of action in case of a breach.
Confidentiality in the Field of Mental Health
Dr Laxmi Narayan Rathore a Gwalior-based Clinical Psychologist with 15 years of experience, shares that client or patient confidentiality is of utmost importance in the field of mental health.
“Unlike in case of any physical ailment, mental health issues are extremely stigmatised by the society. A lot of times, patients do not even want to disclose that they are getting mental health help, owing to this stigma. There is a sense of shame associated with it for no reason and that works as a deterrent for many to even come to terms with their mental health issues. In such a situation, trust is extremely important and confidentiality is the thread that binds that trust between a patient and a therapist, counsellor, psychiatrist or psychologist, together,” he mentions.
Prof Sukanya Ray, a Clinical Psychologist with 14 years experience, who also teaches as an assistant professor at the Tata Institute of Social Sciences, speaks how patient confidentiality also goes beyond the stigma.
“As mental health professionals, it is a part of our code of conduct to be non-judgemental, ethical and create a space of absolute trust. And the basis of this is a promise of confidentiality. One needs to remember that, it is not the professional’s narrative or story to share, but the patient’s. We hold no ownership of their narrative, without their consent. So more than stigma, what makes confidentiality even more important is the simple aspect of ethics,” she says.
“Divulging such sensitive information without the consent of the patient is a great dishonour to the person as human as well,” adds Soumya Srikumar, a Bengaluru-based medical social worker with over 20 years of experience as a counsellor.
Limitations to Confidentiality clause
The Mental Health Care Act 2017 safeguards the rights of the patients in its Section 23 (1), declaring that, ‘A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare.’
While all health professionals are bound to keep the patient’s information obtained during care or treatment confidential, it also outlines certain exceptions like the need for involvement of other health professionals for improvement in treatment, or to ensure safety of the patient from themselves or for public safety and security.
“Even in case of the sub-clauses that provide an exception, the concerned health professional has to be wary about what information is being shared. They cannot share personal details like name, address or phone number of the patient with their colleague or another medical expert. Protecting a patient’s identity is important in this case,” says Dr Rathore.
He adds that the law also outlines an exception to release of information upon the order of a central authority, High Court or the Supreme Court, or any such statutory authority. “If an investigation is underway and information about the patient is relevant to it and the authorities have asked for it, then as mental health professionals, we have to divulge it,” he says.
In this scenario, Sukanya points out that informed consent comes into play.
Consent is Key
“At the onset of the treatment procedure, we make sure that the patient is aware of these clauses of confidentiality. Some professionals even make their patients sign a consent form for this. Without their consent we cannot even speak about who our patients are. Making them aware of their rights and building of trust on it is a crucial part of this process,” says Sukanya.
But what happens when the patient involved is not alive to give consent?
Dr Rathore says, “If any legal authority is not directly asking for information about the patient from the mental health professional, then it is not their place to share. Until and unless a statutory body approaches the professional with questions about the case, no information should be revealed either in the media or any other platform.”
He adds that breach of these clauses can amount to various financial penalties as well as criminal offences, leading up to loss or suspension of license. “In case of breach without consent patients can sue the mental health professional, be it for a criminal or defamation offence. Owing to the lawsuit, the professional having caused a breach may not just have to bear financial penalties but also may lose their practice license,” he says.
“Such breach of confidentiality is a complete antithesis of therapy. In a society which is already so sceptical about mental health, this situation does not do any good but instead harms the carefully earned credibility of hundreds of other mental health professionals,” says Sukanya.
Soumya fears that beyond this, such circumstances can contribute to the negative perception around mental health and deter many more in need from seeking help.
“Awareness about these issues has become even more important now owing to the current situation. People need to be aware of their rights and exercise it responsibly,” she says.
(Edited by Gayatri Mishra)