The scene

A GP member called the MDU's advice line to query their duty of confidentiality, after the Fixated Threat Assessment Centre (FTAC) contacted her about a patient who was exhibiting potentially threatening behaviour towards a public figure.

The FTAC forwarded the GP letters that the patient has been sending to the individual on a regular, almost weekly basis. They were not threatening in nature, but did suggest the patient had an unnatural fixation, and the GP could understand why there was concern about the content.

The GP knew that the patient had some mental health issues but did not believe they were a physical danger to anyone, but the FTAC asked the GP for information about the patient's mental health. In view of the nature of the letters and the public status of the recipient, the GP wanted to know if she was obliged to disclose information without the patient's consent.

MDU advice

The FTAC is a joint NHS and police unit based in London. Its role is to assess and manage risks that may be posed to prominent individuals, such as members of the royal family and politicians, by people who suffer from serious mental health conditions. Some of these people may not be known to medical services, and therefore one aim of the organisation is to help people get the care they need and in doing so, reduce the risk to others.

The trust between a doctor and patient is extremely important in order to establish an appropriate therapeutic relationship, however, there may be times when you have to consider breaching a patient's confidentiality. One of those times may be when it is in the public interest to do so. This may be to protect individuals or society from harm, such as serious crime.

The adviser told the GP that she did not have an obligation to disclose sensitive information to the FTAC, and would need to be able to justify breaching the patient's confidentiality, if she did not have their consent. Unless it would put her or others at risk, she could arrange a consultation with the patient to discuss the contact she'd had from the FTAC and explain their concerns while assessing the patient's clinical status and needs.

If the patient agreed, the GP could then let the FTAC know about this consultation and what action was taken as a result. If the patient refused to consent to the GP disclosing their information, she could simply reassure the FTAC that matters are in hand.

The adviser said that if, on the other hand, the GP did believe the patient posed a threat to any prominent individuals or the public in general, and she could justify disclosure in the public interest, she would not need to ask for the patient's consent. However, unless there is a risk associated with doing so, she should let the patient know that she intends to disclose personal information about them and to whom. As always, it would be important to carefully document the discussion and any decisions made.

Fixated threat assessment centre

Related articles

Membership in your pocket