Research into practice

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.