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Maintain patient privacy or save a life?

Doctora at English universities are to be issued with guidance advising them to contact parents if they have serious concerns about the mental health of students.

Currently, most universities and college doctors refuse to alert parents, due to concerns that it would be a breach of the student’s right to confidentiality as an adult. Legally, students are still adolescents rather than adults up to the age of 25.

This move follows the death of Andrew Kirkman, aged 20, a Physics and Philosophy student at Balliol College, who took his own life in December 2013. Earlier that week he had been told by his tutor to take two terms of medical leave and had seen his college doctor, who prescribed him antidepressants. His parents were unaware he was suffering from depression.

The guidance, issued by Dr Geoff Payne, medical director for NHS England in the Thames Valley, reminds GPs that under-25s should be monitored in the first few weeks after starting a course of anti–depressants due to suicide risks.

Dr Payne told The Times, “Students who go to elite universities are used to being successful. Coping with any degree of failure becomes difficult, especially if they are socially isolated.

“It is hard to argue that, knowing young people might be at risk and knowing their parents might actually protect them, one should not take that step to let them know.” Wendy Kirkman, mother of Andrew Kirkman, said she hoped the advice would save the lives of other students.

She told Cherwell, “I’m not entirely sure that Geoff’s comments about disclosure are changing anything, apart from making the situation clearer and giving GPs more explicit guidelines.

“People seem to be frozen into inaction by the fear of disclosing information to the parents of students who are over 18, when they have always had the legal right and perhaps obligation to do so anyway. Who an ‘appropriate person’ would be is always open to discussion, but if there is any concern that the parents should not be informed, this decision could be taken at a later juncture once the immediate risk of self harm has been addressed.

“There is a lot more to these guidelines than just the question of whether parents should be informed if their student children are suicidal. Closer monitoring of such cases and intensive talking therapies is also recommended,” she added.

But Dr Payne’s new guidance protocols have not been met with acclaim in all quarters.

Alasdair Lennon, OUSU Vice-President of Welfare & Equal Opportunities cited students’ “right to privacy,” telling Cherwell, “I find these developments deeply concerning and I will be taking measures to oppose them. I have requested an urgent meeting with Dr Geoff Payne, the individual responsible for the guidance. I will also be writing to the Association of College Doctors to express my concern over these developments. I find it immensely worrying that, without consultation, this guidance has been approved, and that our right to privacy has been degraded.”

Charles Foster, a medical law tutor, spoke to the legality of broaching doctor-patient confidentiality. Foster explained to Cherwell that, “The law is clear enough, but its application is sometimes not. Doctors owe a duty of confidentiality to their patients. But that does not mean that there is an absolute duty to keep all secrets. Doctors can disclose information if the public interest in disclosure outweighs the interest in maintaining confidentiality.

“Where non-disclosure could result in death or serious injury, the secret can be disclosed. “In the case of a depressed young adult the doctor would have to make a judgment about disclosing the diagnosis to a parent. In some cases disclosure might well help to avert a risk of a serious danger. There, the law would support disclosure. Doctors should in every case seek to obtain the patient’s consent to disclosure to a third party.”

Marco Narajos, Co-Chair of Oxford mental health campaign Mind Your Head, questioned whether the guidelines would even be effective, telling Cherwell, “The problem with this policy is that it places the blame on the individual. It assumes that if only the individual were able to talk about their feelings to their family, their mental health problem would be resolved. “The problem here isn’t non-disclosure. The problem is the lack of support systems in place, such as long waiting lists to receive psychological therapies, such as CBT and psychodynamic therapy.”

Narajos also noted that, “As the General Medical Council outlines in its confi dentiality guidance in ‘Good Medical Practice’, doctors should keep matters confi dential, otherwise patients may be less likely to seek medical attention. The key is to find out from students what they would like to share with whom and in what circumstances. Disclosures are fine if the student consents to it.

“Trust is key in the patient-clinician relationship. I would still urge anyone who are having mental health difficulties to seek help – the Counselling Service, peer supporters, welfare officers, college chaplains, Nightline, the Student Advisory Service, the Samaritans, and yes, even GPs.”

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