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Textbook/Psychiatry/Confidentiality, information sharing and duty to protect
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Confidentiality, information sharing and duty to protect

Protect confidential psychiatric information while sharing proportionately with consent, under law or to prevent serious harm, distinguish receiving concerns from disclosing records, and document purpose, recipient, minimum content and patient communication.

29 min full readUK scopeSources checked 27 Aug 2026Clinical review pending
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Disclosure needed to prevent serious harm

A credible near-term threat to the patient, an identifiable person, a child or a vulnerable adult may make delay for ordinary consent unsafe.

Action: Clarify the threat, seek consent where practicable, consult senior, safeguarding, police or legal support according to urgency, and disclose only information needed by someone able to reduce the danger. Tell the patient before or after disclosure unless doing so would increase risk or frustrate protection, and record the full reasoning.

Open the sections you need. The overview is shown first.
01Purpose and principlesWhat the assessment is for and the core concepts behind it.

Confidentiality supports trust and access to care. At the start of assessment, explain that relevant information is normally shared within the healthcare team for direct care and that consent is sought for wider involvement. Discuss who the person wants included and which topics may be shared. Use professional interpreters under confidentiality arrangements. Capacity to consent to disclosure is decision specific; support communication before concluding that someone cannot decide.

Separate receiving from disclosing. A relative can provide information about weapon access, medication non-adherence or missing children even when the clinician cannot confirm that the person is a patient. Listen, obtain specific facts and explain that the information may be recorded and, where safe, discussed with the patient. Do not promise an informant that their identity will remain hidden if disclosure may be necessary for fairness or safety; consider the risk of revealing the source.

For direct care, relevant information is commonly shared on an implied-consent basis when patients understand and have a reasonable opportunity to object, subject to law and professional guidance. Disclosures for employment, insurance, media, research or family convenience usually require explicit authority or another clear basis. Verify identity and scope. A request from police does not automatically remove confidentiality; identify statutory requirement, court order, consent or public-interest justification and seek advice when uncertain.

Serious-harm disclosure is a structured balance. Clarify the threatened harm, evidence, immediacy, target and means; ask whether consent can safely be obtained and whether treatment, separation or another action can reduce danger without disclosure. GMC guidance supports disclosure where failure to share may expose others to a risk of death or serious harm. The recipient may be police, safeguarding service, the threatened person or another agency, depending on who can protect. Share facts needed for action and avoid diagnostic speculation not relevant to the purpose.

Record reasons whether disclosing or not. Include the information available, the patient's wishes and capacity, harms of disclosure, harms of silence, advice obtained, legal or public-interest basis, recipient and exact content. Tell the person in advance where practicable; if not, explain later when safe. Review access controls, correspondence addresses and contact methods when domestic abuse, stalking or family conflict makes routine communication dangerous.

Key points

  • Explain confidentiality and its limits early, including care-team sharing, safeguarding, legal requirements and prevention of death or serious harm.
  • Seek explicit consent for disclosures outside direct care, clarify recipient and purpose, and respect granular preferences where safe and lawful.
  • Within direct care, share relevant information with professionals who need it, while checking the person understands ordinary information flows whenever practicable.
  • Listen to family, employers or others who offer risk information without confirming diagnosis, attendance or treatment in return.
  • Without consent, ask whether disclosure is required by law or justified in the public interest because non-disclosure exposes someone to death or serious harm.
  • Assess specificity, imminence, severity, affected people, credibility, available alternatives and which recipient can actually reduce the danger.
  • Use the minimum necessary content, secure route and verified identity; protect third-party information and avoid forwarding whole notes by default.
  • Tell the person about disclosure unless that would increase danger, reveal a confidential source inappropriately or obstruct a lawful investigation.
  • Document consent, capacity, facts, advice, balancing, information shared, recipient, timing and plan for review or patient notification.
02Indications, selection and cautionsWhen it is useful, when urgency changes and important limitations.
Direct-care sharing

A clinician needs relevant information to provide treatment within an understood care pathway, subject to patient expectations, objection and applicable law.

Explicit-consent disclosure

The patient authorises a defined recipient and purpose, allowing only information within the agreed scope to be released.

Serious-harm justification

Credible evidence indicates that withholding relevant information may expose the patient or another person to death or serious harm.

Mandatory disclosure

A valid statutory requirement or court order compels specified information, requiring verification of scope rather than wholesale release.

Unsafe routine contact

Ordinary letters, texts or family updates could reveal care to a perpetrator, stalker or unsafe household and need restricted channels.

Red flags requiring action

  • A specific threat, target, method, access and timeframe requires active consideration of protection and cannot be managed by promising secrecy.
  • Children, partners, carers and employers do not gain automatic access to psychiatric information through relationship, concern or responsibility alone.
  • Refusing to hear information from a relative because consent is absent confuses receiving a concern with disclosing confidential patient details.
  • Sharing an entire record when a focused factual disclosure would meet the purpose breaches data minimisation and can expose unrelated trauma or third-party information.
  • There is no single universal UK Tarasoff-style formula; clinicians must apply GMC guidance, statutory duties, common law, safeguarding and jurisdiction-specific advice to the actual danger.
03Method and interpretationA systematic approach to the test and its findings.
Investigation order

Read from the initial assessment onwards. Tests may run in parallel in urgent care; first-line, preferred, confirmatory, definitive and gold-standard labels appear only when the chapter explicitly states them.

  1. 01
    Purpose and recipient definitionFirst step
    Why
    Identify why information is requested, who will receive it and what action the disclosure could enable.
    Interpretation and limitations
    Vague benefit or curiosity is insufficient. A clear purpose determines necessity, content and whether consent or another basis is needed.
  2. 02
    Consent and capacity assessment
    Why
    Establish the person's informed wishes about the specific disclosure after communication support.
    Interpretation and limitations
    Consent can be limited and withdrawn. If capacity is absent, apply the correct benefit or best-interests and legal framework rather than assuming family control.
  3. 03
    Serious-harm balance
    Why
    Assess severity, likelihood, immediacy, credibility, target, means and alternatives to disclosure.
    Interpretation and limitations
    Document why disclosure or non-disclosure is proportionate. Diagnostic category alone does not establish a public-interest basis.
  4. 04
    Legal-authority verification
    Why
    Check statute, court order, safeguarding duty, direct-care basis or other lawful requirement.
    Interpretation and limitations
    Confirm identity, jurisdiction and exact scope and seek Caldicott, legal or senior advice when the demand is unclear or contested.
  5. 05
    Minimum-necessary information review
    Why
    Select factual content needed for the recipient to achieve the protective or care purpose.
    Interpretation and limitations
    Exclude unrelated history and third-party information, use secure transfer and record exactly what was disclosed and when.
04Clinical next stepsHow the result changes management or prompts escalation.
01Consented sharingDefine scope and communicate securelyFirst stepThe patient wants a relative, employer, service or other recipient to receive information.
  1. 1Clarify purpose, recipient, content, duration and communication route and assess capacity when there is a genuine concern.
  2. 2Share accurate minimum necessary information within the authorised scope and distinguish fact, opinion and uncertainty.
  3. 3Record consent and disclosure and revisit permission when circumstances, recipient or purpose changes.
02Serious-harm disclosureBalance, protect and documentWithholding information may expose the patient or another person to death or serious harm.
  1. 1Clarify the scenario, seek consent where safe and consider treatment or protection alternatives and the person best able to act.
  2. 2Obtain urgent senior, safeguarding, police or legal advice as circumstances permit and disclose only relevant information on the justified basis.
  3. 3Tell the patient unless unsafe, document the reasoning and exact disclosure and review whether further protection or correction is needed.
03Third-party concernReceive without reciprocal disclosureA relative, employer or member of the public supplies information but has no authority to receive clinical details.
  1. 1Listen, establish identity and opportunity to know, obtain concrete facts and explain that urgent concerns may be recorded and acted upon.
  2. 2Do not confirm attendance, diagnosis or treatment unless consent or another lawful basis allows it.
  3. 3Verify material safety information, discuss it with the patient where safe and update the formulation and plan without treating allegation as proven fact.
05Risks, monitoring and follow-upComplications, safety checks and further assessment.
  • Review consent and contact permissions after relationship change, safeguarding disclosure, transfer or altered capacity.
  • Audit serious-harm disclosures for clear evidence, purpose, recipient, minimum content, advice and patient notification.
  • Correct information disclosed in error or later found materially inaccurate and inform affected recipients when necessary to prevent harm.
  • Check safe postal, telephone, portal and proxy-access arrangements for people experiencing domestic abuse, stalking or family conflict.
  • Ensure direct-care teams receive relevant risk and treatment information while unrelated sensitive history remains appropriately restricted.
06Special situationsVariants, exceptions and circumstances that change the usual approach.

Listening is not disclosure

A clinician can receive a relative's safety concern without confirming that the person attends or revealing any aspect of care.

Minimum is purposeful

The smallest useful disclosure contains enough factual detail for protection and omits material that cannot change the recipient's action.

Warning is contextual

Police, safeguarding services, healthcare teams or the potential victim may be appropriate recipients depending on immediacy, capability and jurisdictional advice.

Trust includes honesty

Explaining foreseeable confidentiality limits before crisis and informing patients of disclosures where safe reduces surprise and supports continuing care.

Non-disclosure needs reasons

When a serious concern is not shared, the record should show why the evidence or proportionality threshold was not met and what alternative action followed.

07Common pitfallsFrequent interpretation and management errors.
  1. 01

    Promising absolute confidentiality before asking about suicide, violence or abuse.

  2. 02

    Refusing to hear family information because the patient has not consented to discussion.

  3. 03

    Confirming diagnosis or attendance while receiving an unauthorised caller's concern.

  4. 04

    Assuming a police or employer request automatically compels disclosure.

  5. 05

    Sharing the complete psychiatric record when a limited factual summary meets the purpose.

  6. 06

    Using diagnosis alone to justify public-interest disclosure.

  7. 07

    Failing to tell the patient about disclosure when doing so would be safe and practicable.

Practice

Two practice questions

Question 1 of 20 correct
PsychiatryOriginal SBA

Specific threat disclosure

A patient describes a credible plan to kill a named neighbour tonight and has immediate weapon access, but refuses consent to share information. What is the most appropriate response?

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. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateComplete draftClinical stateAwaiting reviewJurisdictionUnited Kingdom