Releasing medical records to the mentally ill: What about the carer?

To the Editor

According to the Health Records and Information Privacy Act 2002 (NSW Legislation, 2002), medical records should be released in a timely manner on request by a patient. Mentally ill patients are not discriminated against in this regard. There has been some discussion in the literature (Delbanco et al., 2010; Kung et al., 2013) regarding the risks to patient–doctor relations specific to psychiatric settings, but there has been little reference to patient–carer relations. In the process of gathering evidence to support the diagnosis of mental illness, a collaborative history is encouraged. Carers who may have observed symptoms of mental illness prior to a psychiatric admission can greatly assist the treating team in the process of assessing severity and levels of risk. In clinical practice, this information is recorded in the medical records with little thought or discussion regarding the possibility of a patient later accessing the record. Some carers may assume that any discussion with a doctor is confidential. According to one systematic review (Ross and Lin, 2003), the loss of confidentiality of ‘third party’ information has been identified as an issue that has not been addressed in studies thus far. The loss of this confidentiality can have a negative impact on the relationship between a patient and his or her carer and between the clinician and the carer. The patient may become hostile towards the carer and any persecutory delusions that might be held involving the carer could be reinforced (Roth et al., 1980). The carer may be less willing to provide collateral information to clinicians in the future if he or she knows that it will be available to the patient. Studies so far have not specifically reported any negative impact in relation to the release of third party information; however, in one case description (Roth et al., 1980), there is specific mention that aspects of a record were withheld to preserve the confidentiality of the parent’s communications.

In the absence of any clear policy regarding the release of third party information in medical records, the possibility of patients accessing information given by carers should be discussed with carers. This would also apply to other individuals providing information that may be accessed by the patient at a later date.