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What if an adult patient may be at risk of suicide?

Assessing capacity

Adult patients (those age 16 or over) are presumed to have capacity to make decisions about sharing their information unless it is clear that, having been given all appropriate help and support, they cannot make that decision, or communicate their wishes. We give guidance on assessing capacity in our guidance Consent: patients and doctors making decisions together. We have also developed an online mental capacity decision tool, which you can find at www.gmc-uk.org/Mental_Capacity_flowchart.

If the patient has capacity to make the decision

If the patient has the capacity to make the decision and refuses permission for information about their health to be disclosed to others, then the doctor should explore with the patient their reasons for this. It may be appropriate to encourage the patient to re-consider that decision where sharing information may be beneficial to the patient’s care and wellbeing. The doctor should also talk through the possible negative effects of refusing to share the information. Ultimately, though, the doctor should usually respect the patient’s wishes if the patient has capacity to make the decision, unless failure to disclose the information may expose others to a risk of death or serious harm. See paragraphs 30, 31, 37 and 63 to 70 of Confidentiality.

If the patient lacks capacity to make the decision

Doctors may disclose personal information if it is of overall benefit to a patient who lacks the capacity to make the decision. It is important to support and encourage the individual to be involved, as far as they want and are able, in decisions about disclosure of their personal information. See the FAQ ‘what if the patient lacks capacity?’ and paragraphs 41 to 49 of Confidentiality.

If a person is considered to be at imminent risk of suicide they may reasonably be assessed as not having the mental capacity to make the decision about information disclosure at that particular time. This is an assessment that should be undertaken on a case by case basis in line with the requirements of mental capacity legislation. In the confidentiality guidance we have linked to the Department of Health’s consensus statement on information sharing and suicide prevention (pdf), and confirmed that it is consistent with the principles in our guidance.

Listening to those close to the patient

Confidentiality is not in itself a reason to refuse to listen to those close to the patient and doing so can be helpful to the patient’s care, for example by providing additional insights into a patient’s condition. See the FAQ ‘What can I tell those close to the patient?’ and paragraphs 35 to 40 of Confidentiality.

Sources of advice and support

You can find links to a range of helplines and sources of advice on the NHS Choices webpage.