Family Caregivers and Confidentiality

To the Editor: The concerns about confidentiality expressed by Louise Leazenby, R.N., (1) in her letter in the November 1997 issue are justified; some mental health professionals do "hide behind" confidentiality statutes to avoid including in the treatment process family members who are also caregivers for their mentally ill relative. Experiences such as those described by Ms. Leazenby have motivated family caregivers in such states as New Hampshire and Maine to seek legislative remedies that address the informational needs of family caregivers.

I am the only family member-professional in the state of California employed full-time by a county department of mental health as a family advocate. I am familiar with the difficulties and frustrations encountered by family caregivers who seek basic medical information to assist them in their caregiving role. However, I do not believe mental health practitioners' unwillingness to work with family members is the primary impediment to information sharing. Petrila and Sadoff (2) claim that mental health practitioners tend to be overly rigid in their interpretation and practice of confidentiality. I agree. However, I believe this attitude stems from a combination of inconsistency in practitioners' interpretation of confidentiality statutes and a lack of clear procedures governing their interactions with clients and family caregivers.

In an attempt to address this issue, the Riverside (Calif.) County Department of Mental Health recently revised its confidentiality policy to protect the statutory privacy rights of clients while being sensitive to family caregivers' needs for basic medical information. The underlying assumption is that mental health practitioners will better be able to meet the informational needs of family caregivers if they have clear guidelines they can integrate into their day-to-day practice.

The revised guidelines were developed by various members of the county mental health department, including the family advocate and patients' rights advocate, and were reviewed by legal counsel to ensure compliance with state confidentiality statutes. They cover identification of family caregivers, exploration of the client's reasons for refusal to share information, and negotiations with clients to permit limited information sharing. Most important, they clearly state that confidentiality statutes do not prohibit staff from receiving information from family caregivers. Ms. Leazenby's attempt to provide staff with information about her son's treatment would have been welcomed in Riverside County.

To ensure that family caregivers in Riverside County are aware of the department's revised confidentiality policy and guidelines, they are explained in a brochure that has been widely distributed throughout the county mental health system and also has been sent to all Alliance for the Mentally Ill affiliates in California. In an effort to share this information with other mental health professionals, I presented a workshop at the American Psychiatric Association's 1997 annual meeting in San Diego.

Balancing clients' statutory rights to privacy and family caregivers' needs for basic medical information is an important issue for mental health practitioners. I believe the policy and guidelines developed by the Riverside County Department of Mental Health are a step in the right direction, one that benefits both clients and family caregivers.