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Confidentiality issues for patients at risk of harming others | Signal

Reference number
1140 B
Issue date27 November 2009

This Signal relates to lack of clarity among mental health staff on when to share information with external agencies without service user’s consent.


The National Reporting and Learning Service (NRLS) was notified of an investigation following a serious incident, where a patient with bi-polar disorder was responsible for the death of one man, permanent brain injury to another and harm to six other people. The patient was under the care of an assertive outreach team and in regular touch with mental health services.


The investigation highlighted a number of learning opportunities for others working in mental health.


A main concern was that the assertive outreach team had not notified other agencies that the patient had changed his name by deed poll. The team did not notify other agencies as they believed there was no significant risk, and they were concerned client confidentiality would be breached.


The Department of Health (DH) issued guidance on information sharing and mental health in August 2009. It is clear that when information needs to be shared with others (such as police or probation services), staff should try to obtain the consent of the service user.


However, where the service user refuses, or this is not possible, the healthcare team must consider the risk to the service user and the wider public of not sharing the information. If in doubt, they should contact the trust’s Caldicott Guardian, the vulnerable person’s officer or police liaison officer.


Staff should be aware of the overriding safety concerns for the public and take into account the vulnerability of the patient. It is important to note that data protection legislation does not prevent sharing information in these circumstances.


Some of these issues (with particular concern about risks to children) were raised in the Rapid Response Report on preventing harm to children from parents with mental health needs. The deadline for implementing these actions is the end of November 2009. The actions include considering potential risks to children at the point of assessing the patient on admission and discharge. 


Organisations may wish to remind staff of current DH guidance and other useful resources:



Relevant to: mental health, confidentiality.






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