Seán Fleming (Laois, Fianna Fail)
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1412. To ask the Minister for Health if he will examine the patient confidentiality clause in respect of a person's mental illness in view of the fact many persons who are adults have health issues and, ultimately, can lead to serious mental health issues and possible suicide and due to patient confidentiality their parents or next of kin or other family members cannot be informed and if they were they possibly would be able to provide distance on the matter; and if he will make a statement on the matter. [26008/16]

Helen McEntee (Meath East, Fine Gael)
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There have been calls to involve family and carers to a greater degree in the development of care and treatment plans for those suffering with mental illness. In addition there has also been a call that family involvement in the care and treatment of such patients should be made compulsory.

The Expert Group which reviewed the Mental Health Act 2001 and published its report in 2015, looked at the former and recommended ‘proactive encouragement for the patient at all stages to involve his/her family/carer and/or chosen advocate in the admission process and in the development of the care and treatment plan with the patient’s consent’. Outcomes tend to be better when family are involved and the recommendation of the Expert Group in this regard is seen as important and is accepted by all key stakeholders. The vast bulk of patients are satisfied to allow families to be involved.

However, there are other considerations which must be taken into account where a patient reserves the right to withhold consent to share confidential information with his or her family.

Firstly, it should be clearly stated that the Medical Council’s Ethical Guide already specifically allows a doctor to ethically breach confidentiality if, for example, he/she believes that the patient is at risk of harming himself/herself or others. Doctors therefore have existing powers in exceptional circumstances and do use them where they consider it necessary. That is not to say, of course, that the prediction of risk is easy.

While encouraging family involvement in the care and treatment of mental health patients was recommended by the Expert Group, there was no such recommendation that such involvement should be made compulsory against the wishes of the patient.

There may be potentially serious downsides to such an absolute approach where those with mental illness may decide not to confide in their Doctor/medical team at all if they are strongly against involving family members involved for whatever reason. Last week the annual St Patrick’s Mental Health Services survey reported that 22% of people said they would not tell anyone if they were experiencing suicidal thoughts. The worry is that some patients, if told that any of their personal health issues could be discussed with family members without their consent, would not tell anyone about possible suicide ideation or seek appropriate medical advice in the first place. This is a legitimate concern that needs to be considered if any move was made to make family involvement compulsory.