Despite strong evidence for the clinical and cost effectiveness of family interventions in mental health, NICE Guideline recommendations for involving relatives, and relatives repeatedly asking to be involved, this still does not happen in far too many cases. The recent report by the Schizophrenia Commission (2012) identified better involvement of relatives in partners in care, as a key recommendation to improve practice.
So why does it not happen? The most common reason relatives are given is “confidentiality”. As an example, I have a good friend who is currently very depressed. He can’t face talking to anyone and most days struggles to get out of bed. He was sent an appointment for psychological therapy but is too ill to attend. When his wife tried to call the service, just to explain the situation and ask what she should do, they refused to speak to her and said they could only talk with him directly. He is too ill to call them. Clearly confidentiality is an excuse. She is not asking for any personal or sensitive information. She wants only to help but the service offers her no information, no coping strategies, and wouldn’t even advise her of any other options to access help.
The concept of confidentiality dates back to the Hippocratic Oath in the 5th Century BC and is clearly important to protect the legal and ethical rights of an individual to talk openly to a doctor and trust that personal and sensitive information will be kept private. However, all too often it is used as a way of staff avoiding engaging with relatives. Relatives can be distressed, frustrated and terrified – all of which are challenging to manage and require clinical time. However relatives also know the person they care for better than anyone else, are motivated and available to support them, and also have the right to receive support. If relatives stopped providing care, then mental health services would no longer be in crisis – they would simply collapse.
By supporting staff to engage more effectively with relatives, to understand what they can share within the confines of confidentiality, and to recognise the huge value to be gained for working in partnership with relatives; and by providing information and coping strategies to relatives, and training them to understand their rights and how to get what they need from mental health services, we can go some way to reducing the need for so many people to be admitted to hospital. By moving away from an individualistic model of mental health, to a more systemic approach which engages relatives we may be able to keep more people at home in their own beds and avert the crisis in England’s mental health services.
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