Concerns about a sex offender
Dr Hosta is a psychiatrist who has been treating Mr Nixon, a child sex offender, during his custodial sentence. He has developed a very trusting professional relationship with Dr Hosta, which has been beneficial in his treatment.
Mr Nixon is about to be released, and will be required to register at the police station nearest to the hostel arranged for him by the probation service.
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 discusses with Dr Hosta his concerns about further attacks when he is released, especially in light of extensive press coverage of his case and proposals 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, 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.
What the doctor did
Dr Hosta first sought advice from a colleague before making a decision. She then explained to Mr Nixon why she considered it necessary to inform the relevant authority of her concerns and that those who know his whereabouts have a duty to keep it confidential.
Mr Nixon was not happy and though he did not give his consent, he understood that this was the action that Dr Hosta was going to take. Dr Hosta notified the relevant authority in the area about her concerns that Mr Nixon might be intending not to move into the designated hostel or notify the police of his address.
What the doctor had to consider.
- Trust is an essential part of the doctor- patient relationship and confidentiality is central to this. Patient’s may avoid seeking medical help, or may under- report symptoms, if they think their personal information will be disclosed by doctors without consent, or without the change to have some control over the timing or amount of information shared (Confidentiality, paragraph 1).
- The duty of confidentiality is not absolute, and there can be a public interest in disclosing information if the benefits to an individual or society outweigh both the public and the patient’s interest in keeping the information confidential. For example, disclosure may be justified to protect individuals or society from risks of serious harm, such as from serious communicable diseases or serious crime (Confidentiality, paragraph 22).
- A 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 should be made clear), but doctors should take account of any views expressed by the patient. 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 (Confidentiality, paragraphs 63 - 70).
- 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 (Confidentiality, paragraph 70).
- The relevant authority in England, Wales and Scotland is the Multi-Agency Public Protection Arrangements (MAPPA). In Northern Ireland it is the Public Protection Arrangements Northern Ireland (PPANI).
- The notification (registration) requirements of the Sexual Offences Act 2003, The Management of Offenders etc. (Scotland) Act 2005 and The Sexual Offences (Northern Ireland) Order 2008 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. They offer specific advice about participation in Multi-Agency Public Protection Arrangements (MAPPA) and panels, which manage the risks posed by convicted sex offenders and others.