The scene

A GP received an email from the criminal justice mental health liaison team at the magistrate’s court. It said a patient she had seen recently was remanded in custody awaiting trial later that day, and asked for information about any history of mental health problems or medication prescribed.

The GP noted that the request came from a community psychiatric nurse (CPN) with an NHS email account, but was unsure about disclosing information without consent from the patient. She told the MDU adviser that she was not sure about the role and remit of a CPN working for the criminal justice mental health liaison team, and so had decided to seek MDU advice.

MDU advice

The MDU adviser agreed that the starting point was to understand the role of the CPN, and explained that criminal justice mental health liaison teams are more simply known as ‘Liaison and Diversion’ (L&D) services in many areas of the UK.

L&D service professionals can be psychiatrists, CPNs or social care professionals and are found in police stations and magistrates courts. Their role is to help people with mental health problems, learning disabilities or substance misuse problems at their first contact with the criminal justice system.

L&D services aim to improve overall health outcomes (often by referring people on for appropriate health or social care support) and support people in the reduction of re-offending. L&D professionals can share information with the judiciary, probation service and the police, with the person’s consent. This can inform decisions about case management and sentencing.

The adviser and the GP discussed the GMC’s guidance on confidentiality, which would support the GP in relying on implied consent to share information with those providing direct care to the patient. Implied consent might be relied upon if, for example, a GP were contacted by a CPN after an admission to a hospital or a referral to community mental health services.

While the L&D professionals might use the information to provide (or support the provision of) direct care to the patient, the adviser reiterated that they might also use the information for other purposes (to inform the decisions of the court). In this situation, explicit consent from the patient would be required.

The outcome

After discussing the role of the L&D service with the MDU adviser, the GP contacted the CPN to clarify how any information shared would be used, and to request explicit written consent from the patient if the information was to be used for anything other than providing direct clinical care.

The CPN replied saying they were making a referral for the patient to have ongoing support with his mental health, but also that information from the GP could additionally be shared with the magistrates. After this discussion, the CPN provided written consent from the patient allowing the GP to share the information requested.

A request from the magistrate's court

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