BOOKS

Confidentiality and mental health Edited by Christopher Cordess Jessica Kingsley Publishers 207 pages£15.95 paperback£47.50 hardback

It seems that everywhere we look there are debates about the need for professionals to keep information confidential.Yet there are equally passionate arguments for sharing it.

Granted, the tabloid press hardly promotes the debate as being about ethics and ethical considerations, but questions of 'who should have told, and why did they not tell' are commonly and very publicly aired. Inquiries into 'tragedies' in mental health and child protection put what has previously been seen as confidential information about patients, carers and workers in the full glare of publicity. On the other hand, complaints continue to surface that information patients believe they have given in confidence has been passed to relatives, friends and workers in other agencies.

This book considers both the theoretical and practical implications of confidentiality for those who work with people who have mental health problems. It also raises questions about the growing possibilities for service users, including young people, to become involved in the process of agreeing a shared understanding of confidentiality. There are discussions of the implications for forensic and community psychiatry, for child protection and for general social work.Mental health research and legal views are also raised.

Confidentiality comes up in every aspect of health and social care, but in no area is it more challenging than in mental health.

In their chapter concerning community psychiatry, George Szmukler and Frank Holloway talk of changes in the practice of mental healthcare that make traditional guidance 'look unrealistic'. Cordess argues for the need to develop the concept of diverse and different roles and consequent 'different expectations of disclosure'.

One issue highlighted is that users may refuse to disclose vital information if they believe it will be passed to others, with possible adverse implications for their treatment and care plans.Yet evolving practice in multidisciplinary and multi-agency teams means that information must be shared in order to develop an agreed way forward.

Information shared in the patients' interests can be difficult enough to agree, but the matter becomes more complex with the requirement to consider disclosure in relation to the potential for the risk of death or serious harm to others. Each author offers their perspective on developing ways of handling these questions.

This book is timely: even the recent passage of the Health and Social Care Act was delayed by arguments about the circumstances in which information may be passed on for research purposes. The book is accessible - possibly something of a challenge given the subject matter - and will be of interest to those concerned with professional and policy issues, even if they do not feel wellversed in bioethical argument. It is a helpful addition to the literature on confidentiality and the special considerations for mental health.