Handbook of Forensic Psychiatric Practice in Capital Cases


A good psychiatrist must be able to consider the ethical implications of treatment and clinical management regimes. Te principles of fairness, respect, equality, dignity and autonomy are considered fundamental to good ethical psychiatric practice. A good psychiatrist will take these issues into account when making decisions, and will need to pay particular attention to issues concerning boundaries and the vulnerability of individual patients. A good psychiatrist will not enter into a relationship with a patient or with someone who has been a patient…


Good Psychiatric Practice: Confidentiality and Information-Sharing


• Express consent should be sought where sharing of information outside the healthcare team is anticipated


• Competent refusals made before death should be respected after death, unless there are overriding circumstances


• Information should not be shared within inter-agency teams without consent


• At CPA meetings, the psychiatrist’s duty of confidentiality must be acknowledged and respected if information is to be shared


• If non-team members are to be involved in your patient’s care (including attending team meetings), you should discuss it with the patient


• If you attend a meeting arranged by an outside agency, consider and record your decisions about disclosure to them. Remember, the agency to which you disclose information may apply


standards of confidentiality different from your own


• In situations with dual obligations you must be clear in explaining your role to your patient, and in seeking consent


• For court proceedings, you do not have to disclose in the absence of a court order unless you have consent or there are grounds to override refusal


• It is sometimes justifiable for a psychiatrist to pass on patient information without consent or statutory authority. Such situations include:


• Where death or serious harm may occur to a third party, whether or not a criminal offence (e.g. disclosure of threat of serious harm to a named person, on the expectation that this would prevent the harm)


• When a disclosure may assist in the prevention, detection or prosecution of a serious crime, especially crimes against the person; or conversely in situations where it is necessary to the defence of a case to ensure that there is no miscarriage of justice


• Where the patient is a health professional and the psychiatrist has concerns over that person’s fitness to practise


• Where a psychiatrist has concerns over a patient’s fitness to drive • Where a psychiatrist has concerns over a patient’s fitness to hold a firearms licence


• When deciding to disclose, you must take a wide range of factors into account. You must communicate with your patient; it is advisable to discuss the proposed disclosure with


appropriate colleagues or organisations


• You have a duty to cooperate with MAPPA. You do not have an obligation to disclose. Public interest will be an important factor for your consideration


• You should normally seek written consent before drafting a report. However, where there is a statutory obligation or there are overriding considerations, consent is not required. Remember


to make your role clear to the patient when seeking consent, and disclose only the necessary information


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