Post 8 - Abuse, Ignorance or Arrogance? - No "Medical In Confidence" for Anyone Previously Detained in the UK!

Many people claim they fight for the marginalised, the stigmatised, the voiceless people within societies around the world and they are admired by me for their efforts.  However this particular episode is startling for me as it has occurred here in the UK, where we know better.  We understand as a Nation all about Institutional Conditions regarding stigma, bullying, marginalisation and how these issues and their effects can create victims to the extent it has sometimes led to suicide. 

This is a factual account of one recent experience brought to our attention, it raises so many questions it is difficult to know where to start, so I suppose the best place is the beginning of the issue at hand and you can form your own views?  

It involves a person living their life on Life licence in the community for a crime many years ago who had occasion to attend their doctor.  The client has regular quarterly meetings with the probation services who obviously are aware of all life events and in particular the client had been discussing matters with them regarding Mental Health and well being etc, so no secrets and an open transparent relationship was in place.

This is not an "oh woe me" story on behalf of our client so the details of why they were ill and what events transpired within their family resulting in this situation are in the main irrelevant to the implications of this account.

During their attendance at the appointment with the doctor, they engaged in a completely frank and candid manner during the conversation with their doctor, to the extent they explained about their past and all connected events.  The doctor diagnosed Depression, in fact he was of the view the client had been depressed for many years and expressed surprise that Depression had not been identified during incarceration and that help had not been offered previously.   It cannot be stressed enough the sense of relief and hope felt by the client regarding the situation now that the Doctor had intervened.

The doctor concluded the client was in 'crisis' and following thorough assessments offered a treatment programme involving medication, however the client preferred to try 'Talking Therapy' with the CMHT (Community Mental Health Team) before opting for medication.  The doctor agreed it was a viable option and the client was referred as an emergency.

The process involved a telephone call that afternoon to the client from the CMHT who conducted an hour long 'Triage' interview on the telephone where again the client was open and candid about their past history, they agreed 'Talking Therapy' was an option and told the client the case would be passed to a psychologist who would telephone and arrange an appointment for the client to go in and have a face to face meeting with the psychologists who were also the facilitators.  A few days passed, a time which the client endured (and possibly survived) only with the compassion and active intervention of close friends.

The first "bombshell"!         

I should say at this point that fortunately all telephone calls to and from CMHT are recorded.

The client received a further telephone call from the CMHT, in fact the same person who had conducted the 'Triage' interview for over an hour, they asked if permission could be granted for the Psychologist to approach the clients probation officer!  The client asked why that was necessary when the current situation was directly relevant to other issues and not to an event many years ago, the client also asked why the psychologist could not discuss matters with them in person when they met.  The response was in our view absolutely shocking.

The client was told access to 'Talking Therapy' (thus NHS services) would ONLY be granted in circumstances whereby consent was given for the psychologist to approach the probation officer for discussions prior to meeting with the client (don't forget this is someone diagnosed to be in crisis and in need of support).  Needless to say the client felt this was outrageous as Lifers are already a marginalised group (as there conviction is never spent so will always appear on a Criminal Records Bureau (CRB) check (now known as DRB Disclosure and Barring check), and felt this was also an example of blatant discrimination.   Permission was expressly withheld by the client without any opportunity for misunderstanding or ambiguity, the call was terminated with the client in tears and distressed. The impact on the client at this point was devastating and brought back overwhelming feelings of helplessness, isolation, loneliness and desperation - and again it may be that it was only due to the intervention of close friends that the client survived this period.

The second "bombshell"!                    

The client went along to a regular quarterly meeting with the probation services, within minutes to the complete shock of the client the probation officer raised the subject of the appointment at the doctor and the subsequent decision to opt for 'Talking Therapy'.  Before expanding in response to the question the client asked how the probation officer knew he had been to the doctor and what had been discussed, and in response was told the Psychologist from CMHT had telephoned probation to ask questions regarding the client etc.  The probation officer was quick to point out that he had asked for a copy of the consent form the client had signed to be emailed or faxed over and when the CMHT psychologist stated they did not have one the probation officer claims they terminated the call.

The client then pointed out that an element of investigation must have taken place on the part of the Psychologist because at no time were the CMHT or the doctor made aware of which probation area/office/officer was responsible for their supervision in the community, and that by engaging in conversation at any level the probation officer had essentially confirmed collateral data which was a breach of their confidentiality, and clearly others associated with probation had done likewise for the Psychologist to have eventually got through to the supervising office/officer.  The only circumstances where such discussions could take place with complete disregard to patient confidentiality were in circumstances where there was a public risk issue, and both parties have since AGREED that did not apply.  It was made clear to the probation officer by the client that permission/consent had not been given to discuss these issues, and that in fact had the Psychologist suggested in an interview that a tri-party meeting would be useful from their perspective it was highly likely the client would have agreed, however that had not occurred.

So not only had the CMHT in the form of the Psychologist breached the medical in confidence of the patient (client), but the probation service had also breached the clients confidentiality ergo the DPA 1998 and this was a cause for concern.  Needless to say a heated discussion took place about stigmatisation, professional standards, bias, prejudice, discrimination, public perception of ex-offenders, medical codes of practice, patient confidentiality, rights to privacy etc and the Lifer shared the experience with us.

An approach was made initially by telephone to the CMHT to raise a complaint, their head of complaints is involved and in communication and meetings are underway to address the issue.

The third "bombshell"!              

Despite all of the above currently being investigated the CMHT Psychologist failing to learn his mistake has since emailed the probation officer to "ask one simple question" which according to the client who spoke with his probation officer on the telephone was "is the patient 'safe' to be alone in a room with us"?  

Do people know we have a Rehabilitation of Offenders Act or the Data protection Act 1998 or The Mental Health Act and that everyone except in very specific circumstances has a right to have their medical history protected? Probation have expressed their support of the client in his complaint, but what does this say about the perception of people regardless of their profession regarding anyone with a Mental Health concern who approaches their doctor, and especially so if they happen to be an ex-prisoner or detainee?   

Do they in fact regain any rights upon release, are they actually free, do they have any level of autonomy in their life outside or is the truth they are permanently marginalised with the stigma which ignorance bestows upon them?  In this case was it abuse?  Was it ignorance?  Or despite being in knowledge the third time Is it arrogance?

You tell us, please comment below by clicking on 'comments'. Please raise the debate, discuss this over dinner, talk with colleagues and friends, or post on our website.