Mary Lou McDonald (Dublin Central, Sinn Fein)
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96. To ask the Minister for Health his plans to improve communication between mental health professionals and services with the families of persons under their care in order to better treat their illness and improve recovery chances while respecting the principle of privacy and confidentiality [4635/17]

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 recommendation that such involvement should be made compulsory against the wishes of the patient.

There may be potentially serious downsides to 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.

I am also referring this question to the HSE for response.