Last reviewed 4 April 2022

In this feature, Christine Grey looks at the guidance drawn up to help practitioners decide whether they should consider informing family, carers or friends where there is serious concern over suicide risk.

In recent years, when families who have been bereaved by suicide have been encouraged to share their experiences with services, issues with confidentiality have become a recurring theme. Healthcare professionals will, at times, need to consider whether they should inform a patient’s family about aspects of risk if this may prevent harm or prevent a patient from taking their own life. There is an inherent tension between this real need and data protection law and professional guidelines by which staff are bound in order to protect individuals’ confidential information.

Issues with information sharing

The Zero Suicide Alliance (ZSA), a collaboration of NHS Trusts, charities and businesses, recognises that “consent, confidentiality and the sharing of information, both between agencies and with families and carers, is one of the most complex yet vitally important aspects of mental healthcare”. And yet both routine and best practice is “all too frequently overlooked or poorly applied” according to ZSA co-founder, a father bereaved by suicide, Steve Mallen.

Evidence of the problem is in the NHS Resolution’s Learning from Suicide Related Claims, which documented recurring failures to share information in deaths by suicide.

GPs have also told advisory groups that they don’t always feel adequately trained and equipped to seek consent and share information as a “core, positive procedure” in patient care, especially in cases of potential suicide, and they believe greater understanding and good practice would produce better outcomes and potentially avert serious incidents.

These concerns follow “repeated” accounts from families that there seems to be a reluctance in clinicians and practitioners to engage with families, to share information and signpost them to resources that are relevant to mental illness and suicide risk.

The Consensus Statement

In response to challenges facing patients, families and professionals, the Government updated an Information Sharing and Suicide Prevention Consensus Statement, which applies to adults in England. This was republished in August 2021 in collaboration with multiple organisations and the National Suicide Prevention Strategy Advisory Group.

It reflects the current legal position, including implementation of the UK General Data Protection Regulation (UK GDPR), which sits alongside an amended version of the Data Protection Act 2018 (DPA), as well as improving information for families who are concerned about a relative who may be at risk of suicide.

The Statement recognises, where the common law duty of confidentiality applies, that “practitioners will usually be under a duty to respect a person’s refusal to consent to disclosure of their suicide risk, if the person has the relevant capacity and they do not pose a risk to anyone but themselves”. The Statement doesn’t change this legal duty but aims to “promote greater sharing of information within the context of the relevant law” and clarifies that “this is a matter of professional judgement” for an individual practitioner providing care to an individual person.

In brief, the Statement:

  • supports practitioners working closely with families

  • supports obtaining information from and listening to concerns of families to determine risk

  • recognises some people do not wish to share information about themselves or their care.

It says practitioners should:

  • discuss with people how they wish information to be shared and with whom

  • wherever possible discuss what should happen if there is serious concern over suicide risk

  • use professional judgement to determine what is in the person’s best interests, in accordance with the Mental Capacity Act 2005 (MCA), if a person lacks capacity to make a decision to share information on suicide risk.

Practitioners may:

  • disclose without consent where there is a legal power to share and it is necessary for reasons of substantial public interest.

Practitioners must:

  • record their decision about sharing information on each occasion they do so together with their justification.

The Statement adds that, where a person wishes for particular information not to be shared, this does not prevent practitioners from listening to the views of family members or providing them with general information.

ZSA guidance

Expanding on and enhancing the updated Consensus Statement, the ZSA’s new SHARE Guide End the Silence, End Suicide, provides good practice checklists that operate within the limitations of the appropriate legislation, rules and regulations, together with clinical scenarios to help decision making around "when and how to share information” about patients, where this may help prevent suicide.

This advice says practitioners should routinely and frequently confirm whether and how a person wishes their family, friends or carers to be involved in their care.

Seeking consent

It may be very important to “create a channel of communication for both giving and receiving information” that will help keep a person safe, according to the Statement. And it says “seeking consent” to involve another person to share appropriate information about the patient’s general care and risks is “a crucial consideration” in situations of suicide risk, and this should happen as early as possible in the interaction between service user and practitioner.

Capacity to consent

The MCA says a person must be assumed to have capacity unless it is established that they lack capacity. If a person is at imminent risk of suicide, however, there may be enough reason to doubt their mental capacity at that time, and it may be in the person’s best interests to share critical information.

The ZSA’s guide adds that, when decisions are made to share information based on capacity and best interest, it is important to:

  • document the decision making process clearly

  • record any consultation sought and rationale for actions taken

  • consider the nature and type of information shared

  • keep shared information to a minimum, limited to what is necessary.

The law

In addition to a legal power to share information, and a justification for breaching confidentiality where that applies, you will need to ensure that there is a fair and lawful basis for sharing under the UK GDPR. There is more information on this within the Statement and on the information page of the Information Commissioner’s Office website.

Any health data shared would be classed as “special category data”. The Statement explains what this means in terms of meeting additional conditions and safeguards set out in Schedule 1 of the DPA.

This includes the condition of “substantial public interest”, which allows for disclosure of special category data in limited circumstances without the consent of a person, if that person is considered to be at risk of neglect or physical, mental or emotional harm. It says it is likely that there would be a substantial public interest in sharing data concerning the suicide risk of an individual.

To rely on this condition, however, there should be an appropriate policy document in place in your organisation, containing compliance measures, procedures and retention policies.

Emergency situation

It is clear that the law does not prevent the sharing of personal data in an emergency situation, including to protect a person from serious harm or to prevent the loss of human life. In such situations, data should be shared as is necessary and proportionate.

Views of others

The consensus is that the duty of confidentiality is not a justification for not listening to the views of family members and friends who may help provide additional insights that can help with a patient’s care.

Good practice also includes providing families with non-person-specific information, such as how to get support for carers and access services in a crisis.

It is also possible to consider discussing cases with colleagues or seeking advice from legal teams, a professional association or regulatory body if you are unsure whether information should be shared.

Supporting document

The Quality Statement 4, contained in NICE’s Suicide Prevention Quality Standard QS 189, covers the involvement of families, carers or friends when adults present with suicidal thoughts.