Understanding Confidentiality in Mental Health
The recent news cycle has been inundated with stories of late actor Sushant Singh Rajput’s death. From scrutinising every aspect of his life or new evidence that has come to light, the media has whipped up a frenzy.
Amidst this, a worrying trend has emerged: trivialising and misunderstanding mental health and mental healthcare regulations in India.
“The whole thing has become a mockery of mental health... there are terms being thrown around, there is uninformed commentary. This is not good for the mental health space.”Dr Kamna Chhibber, Clinical Psychologist, Head, Mental Health and Behavioral Sciences at Fortis Healthcare
Recently, Susan Walker, Sushant’s therapist came forward to publicly reveal details of his bipolar disorder diagnosis and mental health condition in an attempt to back his partner Rhea Chakroborty from the social media hounding.
And then emerged another question, one that worried many mental health professionals across the country: Was this ethical? Is breaking confidentiality for something like this alright?
FIT speaks to mental health professionals to get a better understanding of confidentiality, ethics and trust.
Dr Samir Parikh, a Psychiatrist from Fortis Hospital said, “It’s a mess how this conversation has unfolded.”
Dr Kamna Chhibber, Clinical Psychologist, Head, Mental Health and Behavioral Sciences at Fortis Healthcare, adds,
“There are guidelines under which you can break confidentiality - but those guidelines are only when there is a real threat or danger to the client or danger of the client harming someone else. In this case we don’t have the client. Then the question arises that can you speak on behalf of family members or loved ones. It’s a very grey area. Personally if you ask me, I’ll say you can’t break confidentiality.”
In an earlier video with FIT, Dr Soumitra Pathare spoke to me about the nuances of confidentiality and what India’s Mental Healthcare Act 2017 says. “It is patriarchal to assume the family gets to give consent after the client has passed away. The Act allows for the client to elect their own representative to consent.”
Ethics & Trust in Mental Healthcare
“I am greatly disappointed at how the conversation around mental health has unfolded - you would never talk like this if the patient had cancer, or stroke, or heart disease.”Dr Samir Parikh, a Psychiatrist from Fortis Hospital
Hvovi Bhagwagar, a clinical psychologist from Mumbai adds, “Ethically, this should not have been released in the public.” This case has been afforded a sort of ‘special status’ by the media and is a sensitive one and thus there needs to be an accompanying sensitive conversation on mental health. “This case has so many spokes attached to it, and we need to be more sensitive.”
Dr Parikh also says, “It is not for me to question another professional, but if it was me I would never do it, unless and until there were exceptional circumstances or in a court of law. These exceptional circumstances can be - can my patient cause self-harm? Or harm to someone else?”
One of the rare acceptable reasons to break confidentiality is under the clause of ‘third party harm’ wherein the patient is either at harm to themselves or others.
“The question here is - who was the patient? The actor and not the lady,” adds Dr Parikh. Dr Pathare adds, “To violate confidentiality, one has to be sure the patient is at risk themselves or can case risk to others.”
“It’s important to talk about ethics and confidentiality whenever anyone from the mental health fraternity makes a public statement.”Hvovi Bhagwagar, Clinical Psychologist
Consent is Paramount in Mental Healthcare
Does consent remain after death? Dr Pathare told me that while it has never been contested in court, if one reads the Mental Healthcare Act it does not imply that the rules of confidentiality cease to exist post-death. Dr Kamna adds, “If you are working with a client, it is not okay for you to come out and talk about that client, even if the client is no more.”
Dr Bhagwagar says that it would have been better if Walker had clarified she had the consent of the appointed person or had the permission of said partner, it would have given the statement more credence.
This case has been mired in many controversies, but Dr Bhagwagar says that it was not necessary to give the details of Sushant’s mental illnesses to the public.
“It's not like we don't get called to courts, but even what we reveal there is protected,” adds Dr Kamna.
Consent is vital in mental health, where clients trust their doctors with their deepest fears and secrets. Dr Kamna says that, “Even when we work with children we have to be very very careful about how we involve family members. These rules have been put in place to protect the privacy of the people who are dealing with mental health issues.
She adds, “As it is there is so much reluctance to go to mental health experts, people are scared of going to therapists and experts -- what if what I share gets exposed to someone. Something like this creates a situation where this gets amplified.”
The Importance of Boundaries
“I do agree with Ms Walker to say that his diagnosis is being blown out of proportion. People are conjecturing so perhaps she wanted to right that wrong. But to right one wrong, you cannot commit another.”Hvovi Bhagwagar, Clinical Psychologist
To be clear, the media treatment of Rhea has been misogynist and vile and all the doctors we spoke to attested to this. “I understand the urge to protect Rhea,” says Dr Bhagwagar, “and it must have been done from the best interests at heart, but it was an emotional decision.”
“It is not my role as a therapist to protect my client unless they are in legal danger and I have information that can save them, or from harm. In this case, it is too early to tell if Rhea’s life or mental health is in danger.”Hvovi Bhagwagar, Clinical Psychologist
Dr Pathare also said that at this point rather than a public statement, what could have helped was Rhea taking legal protections.
Dr Bhagwagar explains that first it needs to be seen if there was a need for the therapist to step up, and if so, is going to the media really the right platform?
“Therapists have to have very strong boundaries to operate.”
“We as therapists really respect and care for our clients. But we need to maintain certain boundaries. Was this protection needed? Was it called for? Did it have the required permissions from all concerned parties? If not, then why give it?”Hvovi Bhagwagar, Clinical Psychologist
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