Confidentiality and Mental Health

Confidentiality and Mental Health

Confidentiality and Mental Health

Confidentiality and Mental Health


Confidentiality and Mental Health explores the theoretical and practical implications of confidentiality and disclosure for professionals working with people who have mental health problems.


Bill (K.W.M.) Fulford

Keep a diary and one day it will keep you. (Mae West, Hollywood, 1937)

Our culture, as Christopher Cordess writes in the opening chapter of this book, is a 'culture of disclosure' (p.27). But it is also a culture of confidentiality. Health professionals thus find themselves caught in a double bind. On the one hand, as Cordess describes, they are subject to growing pressures to reduce the threshold of disclosure. Yet at the same time they are the target of increasingly stringent ethical and legal controls aimed at protecting the confidentiality of their clients and patients.

This double bind on healthcare practice – to disclose and to keep secret, to expose and to hide – is the first of the paradoxes of confidentiality revealed by this book. It is a paradox, moreover, which is nowhere more evident than in the area of healthcare with which this book is particularly concerned, namely mental health. There are many reasons for this: the recent historical shift from closed institutions to the open framework of modern community care (Chapter 3); the organisation of community mental health into multi-agency teams (extending beyond healthcare to social services and other non-clinical agencies, Chapter 8); the growing importance of issues of dangerousness (e.g. in situations of dual responsibility, Chapter 6; and in relation to child abuse, Chapter 5); the self-revelatory nature of many forms of psychotherapy (Chapter 7); and a host of other factors, have all combined to make deep dilemmas of disclosure and confidentiality a fact of daily life for everyone concerned with mental health, professionals and users alike.

Small wonder, then, that in the conference from which this book sprang, as Julian Stern describes in his report on the break-out groups (Chapter 13), the call was for clarification. More detailed professional codes were urgently needed, many felt, and tighter legal rules; or perhaps a specialised ethics committee, a statutory body on the lines of the Human Fertilization and Embryology Authority (HFEA) with responsibility for the regulation of practice in this difficult area.

1 This is of course not a strict or linguistic paradox like the classical paradox of the liar ('this statement is
a lie' is true if false and is false if true).

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