Families, Privacy and Hospital Suicides

By Marvin Ross

One of the constant themes in my writing of mental illness is the need to involve the family. And so, when I read a lengthy account of the suicide of a young 20 year old girl that appeared in my local paper, what jumped out at me was that she had requested that her family not be involved with her illness or treatment. She wanted to spare the family grief and, it seems that the doctors went along with her.

The young girl had a number of suicide attempts while in hospital and the family was told none of it. Dr Peter Cook, one of the psychiatrists, told the newspaper that “We were obligated to protect the privacy of Nicole. She was an adult.” The other shrink said that confidentiality between patient and doctor is “sacrosanct.” Nicole did not want to share her medical information with her family.

Sadly, this young lady is not the only suicide in the past little while at this hospital. There have been 9 – 3 in hospital, 2 of patients on leave and 4 outpatients. To its credit, the hospital did commission an external review to see if things could be improved. One of the recommendations was for “closer collaboration with families.”

Now, maybe the outcome would not have been different if the family was involved but we don’t know that. And, the privacy legislation is pretty confining but there are ways to get around them if the medical staff really care. The hospital recently established a family resource centre as the result of a donation from a philanthropist friend of mine. It was difficult to get them to accept the gift but they did and it is being used and it is being well publicized to families.

At the time we were negotiating for a family resource centre at the hospital, I wrote an op ed for the local paper on the need that families have for inclusion with staff when their loved ones are being treated. Aside from pointing out the anger that families have towards being ignored, I mentioned the very sensible guidelines that were produced by the Mental Health Commission of Canada for family caregiver inclusion. And I mentioned this:

“Very few, if any, mental health facilities have adopted these recommendations despite the fact that about 70 per cent of those with serious mental illness live with their families according to the Mood Disorders study. And family caregivers spend 27 hours a week caring for their ill relative according to the EUFAMI survey. That is five hours longer than the average in other countries surveyed by EUFAMI.”

I don’t know if St Joes ever did adopt these recommendations and I do know that the Privacy Act is very restrictive. But, with a little effort, it can be sidestepped as I pointed out in a Huffington Post Blog.

I was basing what I had to say on an excellent paper on the topic that had recently been published by Dr. Richard O’Reilly, a professor of psychiatry, Dr. John Gray, an adjunct professor of psychiatry along with J. Jung, a student in the Faculty of Health Science at Western University.

I said this in my post:

They point out that clinicians often don’t even bother to ask their patients if they have permission to involve family.

If they do and the patient refuses, then they should take the time to explore the reasons for this refusal. Many patients don’t understand why it is important and do agree to allow their families information once it is explained to them. In some cases, there is some information they do not want shared (like sexual activity and/or drug use) and the staff can ensure that this information is not shared. Staff can also inform families of pertinent facts in meetings with the patient present. This often allays patient fears and is similar to the approach recommended in the UK and by the Mental Health Commission of Canada.

In those cases where no consent is given, the staff can give general information to the families and receive vital information from the family. The family can tell the doctors about new emerging symptoms, worsening of symptoms and medication side effects, all of which should be crucial information.

Until such time as political jurisdictions reform the privacy legislation, mental health staff can do far more to open the channels of communication with families for the betterment of their patients. It is time they do so.

I was pleasantly surprised that at a meeting with St Joes staff just after this was published, one of them told me that this blog was being read by staff and was being circulated within the hospital.

It seems that not sufficient attention may have been paid to that. I hope that more attention is paid to involving families so that these tragic events can be minimized going forward.

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6 thoughts on “Families, Privacy and Hospital Suicides

  1. Yes there are a a few families who do not measure up, but in my experience most do and they are the ones that hang in there when the system fails. they are there for the long haul. They need to be included in a sensitive manner. it is common sense. As for patients being vulnerable on day leave, all I can say that there are so few beds , the pressure to accelerate and inflate the progress is likely intense. It is time for a review of how many beds are needed and how many professional staff are needed. i could be wrong but I doubt it.

    pateients should not be treated like widgets passing along a conveyer belt. Treatment and stabilization for serious mental illness takes time and there must be a safe well funded place to do this. A fancy building will not cut it. it is staff and enough beds that might.

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  2. As an internist and gerontologist I have often been placed in difficult situations where a patient, clearly in the throes of dementia, has come to my office asking for my assistance. Often they specifically request that the family not be involved. In this setting I use my best judgement and more often then not get the family involved. I have never regretted doing so, and though privacy is critical life is sacrosanct. When faced with someone who clearly is not capable of making sound decisions the treating physician needs to use judgement. For the last several years I have expanded my practice to include patients with psychotic illnesses. Like senile dementia these too are neurological diseases and judgement is impaired,
    so once again I use my judgement always first considering the safety of the patient. Families are critical, as it often takes a village to provide the optimal care that all of these patients need and deserve.

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  3. My experience with a doctor for St. Joe’s (Hamilton, Ontario) outpatients was that his nurse told me they couldn’t talk to me, even though my brother signed a form stating that he wanted them to involve me.

    Another time, I called them to share important information with them. Again they said they couldn’t talk with me, even though I wasn’t asking for information — I was offering it.

    After dealing with that psychiatric hospital for 20 years with my older brother as an in-patient, and 20 years dealing with them and their Homes for Special Care (a Long Term Cate facility) community housing program with my brother as an out-patient, I would give them a failing grade. A handful of the doctors and social workers were great, but most of them did not care to comply with their own policies and guidelines.

    The ones that I would give a failing grade to are the CEO, the President, and the Executive Vice-President at that time. It is senior management that sets the tone of an organization, and let’s just say that things could have been better for the patients with little extra cost or effort during the period that I was involved: 1968 to 2008.

    He spent the last two years of his life at a nursing home (another Long Term Care facility — Burlington, Ontario). I was surprised by the difference between the two systems. The doctors and staff at the nursing home had no issue with communicating with our family. Staff was friendly with my brother, which was new to him. Meal menus were posted, there was a choice between two dishes at each meal, and meals were served at 5:00 PM — not 3:30 like at the Home for Special Care.

    Thanks for allowing me to vent.

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  4. Honouring patients’s privacy isn’t lack
    Of common sense but sometimes some health care professionals mix these two concepts. I’m still upset with one GP who denied talking to me when my family member was experiencing acute psychotic episode and literally refused to help hiding behind privacy. Luckily the help of police officers and ER staff was there and my family member is alive. I prefer that then dealing with death!!!

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  5. Families and family volunteers were and still could be( if there were enough around) the canaries of the coal mine. CAMH with 34,,380 patients in their 2016/2017 fiscal years only had 604 vollunteers, . Could it be the same at St.Joe’s ?

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