The issue of health and social care confidentiality cannot be entirely divorced from its wider context. It is a fact of 21st century life that information relating to all aspects of our lives is routinely collected every day mostly without our knowing anything about it. We are all heavily monitored and observed by countless public and private organisations ranging from the DVLC to Safeways. Health and Social services are no exception and increasingly operate in a culture where statistical proof of the organisations "performance" is linked to future funding.

Confidentiality is a complicated issue for mental health services with a number of conflicting priorities outlined below.

While all health and social care staff have a basic duty (written in their employment contract) to keep what you say to them confidential, they must also operate within the law and protect the safety of the community generally. Thus, in the process of inducting you to their service, all health and social care agencies will caution that there are some specific instances where absolute confidentiality cannot be guaranteed. These instances include receipt of information about offences against children, serious risk posed to self or others.

Team work

A guarantee of absolute confidentiality does not sit easily within the framework in which mental health services are now delivered. Community Mental Health Teams
bring together mental health workers from different agencies in one base with the aim of improving co- ordination of care and the pooling of information needed to deliver it.
CMHTs hold weekly "clinical" meetings in which workers will discuss with team colleagues some of the people they have on their caseload. This means that unless you specifically request it you can expect at least one other person to hear in some detail about what you have said and possibly several others.
If you are concerned, check with your Care Coordinator about who will hear what.

Supervision

The nature of mental health work means that it is important for workers to share some of their experiences with clients and to access the support of colleagues. Supervision (a regular meeting with a supervisor) is the formal process through which workers monitor their own work, and deal with some of their own feelings about it safely. For this reason it is very much in your interest as a service user that the person you see for help receives some form of supervision themselves even though this means they will be talking about you to a third party. Supervisors are also bound by strict rules on confidentiality.

Records

All health and social care professionals are required to keep written records of the work they do with service users. Any contact with a CMHT will result in your details being recorded, both manually and electronically. This information is defined as "confidential", but there will be a number of other people, including secretarial and other admin staff who routinely have access to both written and computer held social and health care records. All these people are obliged as part of their contract to keep this personal information confidential. You have the right under the Data Protection Act 1998 to see all your health and social care records.

Management

Managers in Health and Social Services are required to provide information centrally about the services for which they are responsible. The government wants to know in ever increasing detail what is being delivered, by and to whom and whether it is effective. Much of this data is supplied in anonymised format, but it means that the staff with whom you are in contact have no choice about collecting information about you and feeding it into Information systems unless you specifically request otherwise.

Data Protection Act 1998

The Data Protection Act 1998, enshrines the rights of an individual to have their records held securely and to see the information held in those records. However it also allows for various exceptions under which personal data can be "processed" . Processing is defined in the Act as including "the concepts of obtaining, storing and disclosing data".

The Act allows that "Medical purposes" defined as "the provision of care and treatment, and the management of health care services" are one of the circumstances in which this "processing" of data is allowed. This effectively gives health and social care services the right to share information about you in a wide range of circumstances.

If you are worried about the confidentiality of what you divulge in the course of your contact with mental health services you should discuss it with your care coordinator, or staff on the ward and agree some rules about it in your case. In practice most people are comfortable with the idea that their basic details may be available to those working within the immediate team, but want more personal material kept between them and the person confided in.