The following is the summary of “Duty of confidentiality during family involvement: ethical challenges and possible solutions in the treatment of persons with psychotic disorders” published in the December 2022 issue of Psychiatry by Hansson, et al.

The evidence-based suggestion of including family members in care during serious mental illness is still not being followed to a high enough degree. Mental health providers face enormous ethical, legal, and practical obstacles in maintaining patients’ privacy, which is one of the most significant roadblocks. However, there is a severe lack of studies addressing this obstacle. The purpose of this sub-study, which was embedded within a cluster-randomized trial aimed at implementing guidelines on family involvement for people with psychotic disorders in community mental health centers, was to investigate the ethical difficulties mental health professionals face when upholding their duty of confidentiality and to identify key measures that could help them better deal with such difficulties.

About  75  people participated in 21 semi-structured focus groups throughout the intervention period, including members of the implementation team at both the beginning and end of the period and physicians who were not part of the implementation teams. To learn about the experiences and transformations of their participants, researchers used purposive sampling and manifest content analysis. First, there is the difficulty of knowing how to apply the law; second, the conflict between patient autonomy and a looser interpretation of the duty of confidentiality; third, the conflict between patient alliance and beneficence and a looser interpretation of the duty of confidentiality; fourth, the difficulty of knowing how much family members know about the patient’s illness; and fifth, the conflict between the interests of family members and the duty of confidentiality. 

Training and practice in family engagement and standardizing family involvement methods were measures taken to improve the handling of the responsibility of secrecy. Health care providers’ ethical reasoning and clinical practices regarding the duty of secrecy saw substantial modifications once they acquired competency in and favorable experiences with family engagement. An important finding from the study was the need to inform patients adequately about how they can be involved in their care. Training on family involvement and confidentiality statutes, followed by practice, can help professionals handle confidentiality difficulties better. In addition, mental health services need to apply stricter confidentiality regulations and a more standardized approach to family engagement.

Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04461-6