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Confidentiality vignette: reporting concerns about a sex offender

When should doctors report concerns about patients to the police?

Dr Hosta is a psychiatrist who has been treating Mr Nixon, a child sex offender who was transferred from prison during his custodial sentence. Mr Nixon is about to be released, when he will be required to register at the police station nearest to the hostel at which it has been arranged he will live.

Before he was imprisoned, Mr Nixon suffered harassment, including violence, from neighbours who found out about his activities; and he was attacked while in prison. He has developed a very trusting professional relationship with Dr Hosta, which has been beneficial in his treatment. He discusses with Dr Hosta his concerns about further attacks when he is discharged, especially in light of extensive press coverage of his case and plans he has read about to make child sex offenders’ whereabouts available to the public.

Dr Hosta is concerned that, when he is discharged, Mr Nixon might not go to the hostel the probation service have arranged for him to move into, and that he will not notify the police of his new address, so as to avoid being identified. She is confident that Mr Nixon has learned effective behaviours to avoid further offending, but is concerned about the risk he might pose if he does not continue with his treatment programme after his discharge from hospital.

Dr Hosta is however worried about undermining Mr Nixon’s trust in doctors and the health service, and the impact of breaching confidentiality might have on other patients.

Dr Hosta decides to notify the Multi-Agency Public Protection Panel (MAPPP) in the area about her concerns that Mr Nixon might be intending not to move into the designated hostel or notifying the police of his address, as he required to do by the Sexual Offences Act 2003. She first explains to Mr Nixon why she considers it necessary to inform the MAPPP of her concerns and that those members of the panel who know his whereabouts have a duty to keep it confidential.

GMC guidance

  • Confidentiality is central to trust between doctors and patients. Without it, patients might be reluctant to seek medical attention or to share information that their doctors need to provide safe, effective care (paragraph 6).
  • But the duty of confidentiality is not absolute, and personal information about patients may be disclosed without consent, and even if patients have refused consent, if the benefits to an individual or to society outweigh both the public and the patient’s interest in keeping the information confidential (paragraph 36).
  • Information about a patient may be disclosed without consent if failure to disclose may expose others to a risk of death or serious harm. Such a situation might arise, for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime, especially crimes against the person (paragraph 54).
  • Patient’s consent should still be sought for public interest disclosures. Seeking consent does not necessarily imply that a refusal will be respected (and that might be made clear), but doctors should consider seriously what patients have to say if they do refuse. If it is not practicable or safe to seek a patient’s consent or to notify them of an intention to disclose, or if that would undermine the purpose, doctors should disclose relevant information promptly to an appropriate person or authority (paragraphs 53 to 56).
  • Doctors should participate in procedures set up to protect the public from violent and sex offenders and cooperate with requests for relevant information about patients who may pose a risk of serious harm to others (paragraph 56).
  • The notification (registration) requirements of the Sexual Offences Act 2003 are to ensure that the information about sex offenders on the police national computer is kept fully up to date.
  • The Royal College of Psychiatrists publishes guidance for psychiatrists about sharing information in the context of public protection, including participation in Multi-Agency Public Protection Arrangements (MAPPA) and panels, which manage the risks posed by convicted sex offenders and others.