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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Collateral history and longitudinal course

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Urgent information despite incomplete consent

Credible information about imminent serious harm, a missing dependent, dangerous access to means or acute incapacity may require prompt verification and proportionate sharing before ordinary consent discussions can be completed.

Action: Address immediate safety, seek the person's agreement where practicable, share only information necessary with those able to reduce the danger, and record the public-interest, safeguarding or best-interests rationale. Continue to listen to information offered by others even when confidentiality prevents disclosing patient details in return.

Synopsis

Use consented and, when justified, proportionate collateral information to establish baseline, chronology, function, treatment response and risk while protecting confidentiality, documenting source reliability and preserving the person's own account.

  • Ask the person's permission to contact named supporters and explain what questions will be asked, what may be shared and why the information could help.
  • Collateral history is especially valuable for baseline function, onset, fluctuation, previous episodes, treatment response, adherence, substance use, risk behaviour and the effect on dependants.
  • Create a dated longitudinal timeline rather than averaging episodes into a static label; include recovery periods, interventions, medicine changes and social transitions.
  • Record the source's identity, relationship, opportunity to observe, exact material information and any possible conflict or limitation.
  • Receiving information does not require disclosing confidential clinical details; thank the informant, clarify safety facts and explain what you can and cannot discuss.
  • When a patient refuses contact, explore concerns and capacity, offer narrower choices and respect refusal unless a legal, safeguarding or public-interest justification supports proportionate action.
  • Interview the patient alone for part of the assessment when coercion, abuse, exploitation or inhibited disclosure may be present.
  • Triangulate records, dispensing data, previous clinicians and direct observation where material discrepancies affect diagnosis or safety.
  • Tell the patient about significant information and sharing decisions unless doing so would create serious risk or frustrate a lawful safeguarding process.

Key red flags

A sudden departure from baseline sleep, speech, spending, self-care, cognition or behaviour can reveal mania, delirium, intoxication or relapse that is not apparent in one calm interview.

A witness report of weapon access, rehearsed suicide plans, escalating threats, missing children or severe self-neglect requires direct verification and same-day risk action.

Conflicting accounts may reflect memory, perspective, fear, coercion or abuse; choosing one narrator without exploration can compound harm.

A relative who insists on speaking for a capable person, monitors answers or prevents private contact may signal coercive control or exploitation.

Information obtained secretly without a defensible safety or legal reason can damage autonomy, therapeutic trust and the reliability of future care.

Investigation priorities

01
Consent and scope discussionFirst step

Agree who may be contacted, topics that may be discussed and information that may be returned.

Management branches

Routine collateralAgree contact and obtain specific evidence

Longitudinal or functional information would materially improve assessment or care.

  1. Explain the value of collateral, identify suitable sources and agree the scope of contact with the person.
  2. Ask for dated observable changes, baseline, treatments, risks and strengths rather than inviting a global character judgement.
  3. Compare the account with the patient's history and records, discuss discrepancies where safe and update the formulation transparently.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • GMC confidentiality guidanceConsent, disclosure, public interest and information about risk of serious harm.
  • GMC decision making and consentSupported involvement, capacity and communication with those close to the patient.
  • NICE CG136 service user experience recommendationsCollaborative assessment and involvement of families and carers.
  • NICE NG225 self-harm recommendationsCollateral information and psychosocial assessment following self-harm.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom