July 6 juillet 10:15 – 12:15
Room CMEL-102
Chair: Michael
Bay , Ontario Consent and Capacity Board
Best practice guidelines for the treatment of mental illness
recommend sharing information and involving families in the treatment process.
However, research indicates that provider-consumer-family collaboration is not
currently a part of routine clinical practice. One barrier that is frequently
cited by providers and families is unclear confidentiality policies.
Many mental health systems do not have clear procedures and consent forms for releasing information to families. Without formalized procedures, mental health providers base their decisions regarding releasing confidential information on their own individual interpretation of their legal and ethical obligations to their client. These decisions may have serious implications for both the individual practitioner and the mental health agency. The proposed workshop presents a model, including policy guidelines and consent form, that mental health providers may use to clarify confidentiality regarding the release of information to families. The model places a high priority on the protection of client’s rights and clearly states that the release of information from the client’s clinical record to family members requires client consent. The release form includes categories for the types of information that may be released. Workshop participants will learn strategies to adapt and integrate these procedures into their agency. Participants will also acquire skills and techniques for discussing the release of information with persons with mental illness and their families. Presenters will draw from their experience in implementing the model in two county mental health systems in Pennsylvania.
As part of a comprehensive research program on psychiatric
deinstitutionalization in Southwestern Ontario, we sought to determine whether
the frequency of contact between people with severe mental illness (SMI) and
police in the city of London was increasing. The London police maintain a
database of all contacts, in which individuals thought to have mental health
problems are identified, based primarily on the reporting officer’s opinion.
Having developed an algorithm to define those with “definite”,
“probable” and “possible” SMI, we proposed to check the “probable”
and “possible” against the first-hand knowledge of psychiatrists and other
health professionals, and against hospital records in order to confirm or delete
the SMI code from the database. However, legal opinions provided by counsel to
the London police and a university law professor indicated that such
verification was not permissible under the confidentiality provisions of the
Mental Health Act without the consent of the individuals in question. It is hard
to oppose prohibitions on the disclosure of mental health records, yet this case
indicates potential ethical drawbacks to a policy of blanket non-disclosure.
Among these drawbacks is the possible inhibition of research that could
demonstrate a costly and unjust shift of responsibility for the ‘care’ of
people with SMI from care providers and social service agencies to the police:
the phenomenon known as trans-institutionalization, which has become a major
concern in our overall research program. We outline the benefits of the proposed
research–emphasizing the combination of minimal risk and potential benefit to
a vulnerable population–and invite comments, critiques, and suggestions for an
alternate methodology.
There are numerous files, documents and other written material related to a patient’s medical health, social history, diagnosis, or treatment created or maintained by health care providers, hospitals, or other health facilities. These records may include doctors’ notes on the patient’s background, history, or condition, notes of medical observation obtained from examination of the patient, speculative diagnosis and the like. In various circumstances, a patient may wish to access these records, to check, for example, for inaccuracies, or even to seek support for an action against the health care provider. In these circumstances, important questions arise as to the circumstance in which a patient can insist upon obtaining access to their records. This paper examines Australian legislative case law, which has in some cases clarified and in others obscured the patient’s right to access.
The federal Personal Information and Privacy of Electronic Documents Act (PIPEDA), and the proposed Ontario Personal Health Information and Privacy Act (PHIPA) have significant implications for several groups of stakeholders in the mental health system: consumers, professional groups, other service providers, researchers, institutional ethics review boards, and health records/information managers in health care facilities.
This session will explore the policy dilemmas that are inherent in legislation that attempts to protect individual privacy at the same time as it facilitates communication among various actors in the health care system to ensure high quality patient care. Additional policy issues arise as governments and others responsible for the health system seek to make the best use of health information that is becoming more available in electronic form to analyze, evaluate and plan the system. The particular sensitivities of stakeholders in the mental health and addictions fields about use and disclosure of personal health information will be highlighted in this presentation.
Privacy of personal information is protected through constitutional guarantees, international legal instruments and statutes addressing different aspects of personal information, such as health information. This paper will discuss the philosophical underpinnings of the right to privacy, and the reasons why privacy protection is important in democratic societies. Specifically, this paper will examine why privacy protection is essential to enhance autonomy and dignity for each individual. Effective oversight is an integral part of any legislative scheme, and this paper will review possible models for a privacy commissioner or ombudsman.
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