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Greater openness for friends and family when a loved one suffers mental illness

Adam Lamb, solicitor at Leigh Day, discusses the need for greater transparency to enable family and friends to do what's best for those affected by mental illness.

Adam is a solicitor working in the clinical negligence department. He has worked on many cases representing families at inquests where close relatives have died as a result of negligent medical care.
Leading mental health research charity, MQ estimates that 1 in 4 adults will experience mental illness at some point each year in the UK.  This can range from anxiety and depression to substance misuse and psychosis.  

Be it a member of your family, a friend, work colleague or neighbour, the chance is that we all know somebody who is affected by mental illness. The problem is also growing. Since the early 1990s, the NHS has reported a steady increase in patients suffering with mental health problems. 
While 23% of all NHS activity is taken up by treating mental illness, only 11% of the NHS budget has been allocated to mental health services in recent years. Despite the Government promising in 2014 to inject an extra £1.4 billion pounds into mental health services, there is still a severe shortage of funds  for acute and community frontline services.
With services being stretched to breaking point and the numbers suffering mental illnes  increasing, it seems to me that more and more responsibility is being put on the friends and families of those who are suffering mental illness to support them.

It is being left to them to try their best to look after their loved one and to decide when to seek medical help. Having attended a number of inquests involving the deaths of patients suffering with mental health problems and having worked with the families of those who have died I have seen first-hand how difficult this is for families, especially when they are often not aware of all of the circumstances of their loved one’s illness.

I have worked on cases where families were not advised of their relative’s diagnosis, how serious it was, what ‘red flags’ to look out for or what action to take if they were concerned. Yet, they were the ones left in charge of their relative’s day to day care and when things went wrong they were the ones left feeling responsible – wondering if they could have saved their child, partner, sibling or friend if only they had done something different. This just causes more distress to the already bereaved. 
To try to avoid this I would like to see mental health professionals engaging the patient’s family members and/or close friends in the patient’s treatment more. I think it would be useful for family or friends to understand their loved one’s treatment plans and to be advised of what warning signs to look out for and what action to take.
One obstacle to this is, of course, patient confidentiality, which restricts the patient’s mental health team from being able to share information with the patient’s family or close friends.  Where a patient over the age of 16 has been assessed as having capacity to make treatment decisions, then unless there is a risk of harm to themselves or somebody else, their personal health information can only be disclosed if consent is expressly given. 

If a clinician assesses a patient as not having the mental capacity to make decisions relating to their treatment and is convinced that it is essential and in the patient’s best interests, then they can disclose the information to an appropriate person or authority. 
Whilst it goes without saying the duty of confidentiality is vital for patients, if families are to be left to care for their mentally ill relatives, then I believe their treating professionals need to focus on encouraging and persuading their patients to disclose details of their illness to their loved ones.

In my view mental health professionals must be given the time with their patients and, if necessary, training to encourage disclosure and explain the benefits of them doing so.

When a patient is being cared for in the community, in my experience the bulk of that care will fall to families or friends.   They will only ever be able to provide the right level of support if they are armed with the correct information on the patient’s treatment and care. That must surely  be not only in the patient’s best interests but also in the best interests of those who are given the responsibility of  caring their mentally ill friend or relative.

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