Quality statement 4: Involving family, carers or friends

Quality statement

Adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care and are made aware of the limits of confidentiality.

Rationale

Families, carers and friends can help to support a person who has suicidal thoughts or plans. They can also provide valuable input to an assessment of the person's needs to help keep them safe. Involving families, carers or friends can be complex so, providing the person has mental capacity, it is important for them to discuss who they would or would not like to be involved if there is a concern over suicide risk. The person should have the opportunity to discuss information sharing and their right to confidentiality so that they are aware of the circumstances in which confidential information may need to be disclosed to family, carers or friends.

Quality measures

Structure

a) Evidence of local arrangements to provide training on information sharing and confidentiality based on the Department of Health and Social Care's consensus statement on information sharing and suicide prevention to practitioners in contact with adults presenting to health or care services with suicidal thoughts or plans.

Data source: Local data collection, for example, staff training records.

b) Evidence of local processes to ensure that adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care.

Data source: Local data collection, for example, local service protocol.

c) Evidence of local processes to ensure that adults with suicidal thoughts or plans are made aware of the limits of confidentiality.

Data source: Local data collection, for example, local service protocol.

Process

a) Proportion of adults presenting with suicidal thoughts or plans who discuss whether they would like their family, carers or friends to be involved in their care.

Numerator – the number in the denominator who discuss whether they would like their family, carers or friends to be involved in their care.

Denominator – the number of adults presenting with suicidal thoughts or plans.

Data source: Local data collection, for example, audit of patient records.

b) Proportion of adults presenting with suicidal thoughts or plans who are made aware of the limits of confidentiality.

Numerator – the number in the denominator who are made aware of the limits of confidentiality.

Denominator – the number of adults presenting with suicidal thoughts or plans.

Data source: Local data collection, for example, audit of patient records.

Outcome

a) Proportion of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved, that involved family, carers or friends.

Numerator – the number in the denominator that involved family, carers or friends.

Denominator – the number of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved.

Data source: Local data collection, for example, audit of patient records.

b) Proportion of family members, carers or friends of adults who presented with suicidal thoughts or plans who are satisfied with information sharing about suicide risk.

Numerator – the number in the denominator who are satisfied with information sharing about suicide risk.

Denominator – the number of family members, carers or friends of adults who presented with suicidal thoughts or plans.

Data source: Local data collection, for example, survey of family members, carers or friends of adults who presented with suicidal thoughts or plans.

c) Suicide rate.

Data source: Public Health England's Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Service providers (such as general practices, hospitals, ambulance services, mental health trusts, prisons and social care providers) ensure that processes are in place for adults presenting with suicidal thoughts or plans to discuss whether they would like their family, carers or friends to be involved in their care, and to make them aware of the limits of confidentiality.

Providers ensure that if the person wants their family, carers or friends involved in their care, the nature of their involvement, including how and when information is shared with them, is agreed. Providers ensure that staff are trained and aware of the Department of Health and Social Care's consensus statement on information sharing and suicide prevention.

Health and social care practitioners (such as A&E practitioners, paramedics, first responders, GPs, nurses, social workers, mental health professionals and allied health professionals) discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality. If the person wants their family, carers or friends involved, health and social care practitioners ensure they agree how they will be involved and when information will be shared with them.

Commissioners (such as local authorities, clinical commissioning groups and NHS England) commission services that discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality.

Adults who contact a health or care service and feel suicidal discuss whether they would like their family, carers or friends to be involved in their care. If they want their family, carers or friends to be involved, they agree how they will be involved and when information will be shared with them. They are also told about confidentiality and when it may be necessary to share information with their family, carers or friends.

Source guidance

Definitions of terms used in this quality statement

Adults with suicidal thoughts or plans

Adults who disclose suicidal thoughts or plans when asked about suicide ideation and intent.

[Expert opinion]

Limits of confidentiality

If a person is at imminent risk of suicide, there may be sufficient doubts about their mental capacity to consent to information about their risk of suicide being shared. In these circumstances, a professional judgement will need to be made, based on an understanding of the person and what would be in their best interest. This should take into account the person's previously expressed wishes and views in relation to sharing information with their family, carers or friends.

The judgement may be that it is right to share critical information. If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is in the person's best interest to do so. Disclosure may also be in the public interest because of the far-reaching impact that a suicide can have on others.

[Department of Health and Social Care Information sharing and suicide prevention: consensus statement]

Equality and diversity considerations

Services that support adults with suicidal thoughts or plans should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can use the service. People should have access to an interpreter (including British Sign Language) or advocate if needed.

Health and social care practitioners should ensure that adults who temporarily lack mental capacity to consent to information sharing are asked if they want their family, carers or friends to be involved in their care as soon as they are able to give consent.