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Previous research about confidentiality showed practitioners were more likely to breach than maintain confidentiality, even when contrary to clients’ expressed wishes.¹ Disclosure was justified through conflicting loyalties, often motivated by desire to obtain "good results". Since then the Data Protection Act 1998 has been implemented and the General Social Care Council has published draft codes of practice.² These changes are intended to improve standards. My interest was whether decision-making about confidentiality had changed.

My original research used low-risk case studies to focus interviews with qualified and unqualified experienced mental health workers. The case studies featured "Cathy" and "Jim". Cathy, a young woman suffering from multiple bereavements, is depressed and homeless. Additional information suggests some risk of self-harm.

Jim has schizophrenia. He lives in the community in stable circumstances on medication. Recently he has become agitated about people around him. Additional information suggests potential for anti-social behaviour.

These two case studies are now used for teaching students on undertaking the diploma in social work. In 2002 student responses were compared with original findings.

Most experienced workers and students eventually disclosed (95 per cent for Cathy; 91 per cent for Jim). However, students disclosed more quickly than practitioners four years ago. In Cathy’s case 70 per cent of students breached confidentiality in stage one, against 24 per cent of experienced practitioners. In Jim’s case, 60 per cent of students disclosed at stage one compared with 38 per cent of experienced practitioners. One reason for this could be that the students were not experienced in mental health cases. Experienced workers may better determine when they can maintain confidentiality. However, in defence of the students, good practice increasingly demands information sharing.³

So, to whom might workers disclose information? With Cathy, more opted to disclose to a GP (36 per cent students, 19 per cent experienced workers) and residential staff (32 per cent and 22 per cent respectively), but there was no majority choice. There was even less agreement with Jim.

Professional loyalty was the most common reason for disclosure (39 per cent students, 42 per cent experienced workers). Responsibilities to third parties (28 per cent students, 26 per cent experienced workers) and client best interest (28 per cent students, 25 per cent experienced workers) were about equal. Self-interest was relatively low (5 per cent students, 7 per cent experienced workers). The minimal difference is striking despite intervening years and debates about ethics and accountability.

The GSCC draft codes and the Data Protection Act 1998 suggest that consent is needed for routine discussion, and without this, confidentiality should be breached only exceptionally. However, this research shows that information sharing is common and confidentiality is routinely breached.

Practitioners were acutely aware that there are others who "need to know", others for whom some "duty of care" is required, that sometimes their clients are "at risk" and that they themselves run risks. But sharing information is the norm and risk cannot be determined without it.

¹ F Watson "Overstepping Our Boundaries", Professional Social Work, 1999

² General Social Care Council, Draft Codes of Practice for Social Care Workers and Employers, 2002

³ Department of Health, National Service Framework for Mental Health, The Stationery Office, 1999

Florence Watson is lecturer in social work at Norwich City College and is course leader for the diploma in social work.