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Counsellors reluctant to disclose clients’ suicide risk to GPs

Counsellors ‘massively under-report’ clients at risk of harming themselves
woman in counselling

There is massive under-reporting by counsellors of their clients being at risk of harming themselves, a suicide prevention conference heard.

University of Salford senior lecturer in counselling and psychotherapy Mark Widdowson said most counsellors have a clause in their contract that confidentiality can be breached if the counsellor believes their client is at risk of harm.

Some will refer the person to their GP, while others will contact mental health crisis teams or follow local NHS procedures.

Breach of confidentiality

But Dr Widdowson said counsellors have to weigh up the risk of irreparably damaging the relationship with their client if confidentiality is broken, and the risk of the person dying by suicide.

It is not just a straightforward thing of picking up the telephone and telling the GP, he told

There is ‘massive’ under-reporting by counsellors of their clients being at risk of harming themselves, a suicide prevention conference heard. 


Counsellors feel conflicted about reporting harm risk, says academic  Photo: iStock

University of Salford senior lecturer in counselling and psychotherapy Mark Widdowson said most counsellors have a clause in their contract that confidentiality can be breached if the counsellor believes their client is at risk of harm.

Some will refer the person to their GP, while others will contact mental health crisis teams or follow local NHS procedures. 

Breach of confidentiality

But Dr Widdowson said counsellors have to weigh up the risk of irreparably damaging the relationship with their client if confidentiality is broken, and the risk of the person dying by suicide. 

‘It is not just a straightforward thing of picking up the telephone and telling the GP,’ he told the University of Salford conference on 17 January.

'You have to think about the impact on the relationship of disclosing that. It is worthwhile but you have to manage that.’

Dr Widdowson said that, anecdotally, counsellors end up not telling GPs and then managing the situation themselves, resulting in ‘massive under-reporting of it’.

Long-term psychotheraphy

He highlighted a 2016 meta-analysis by Calati and Courtet that found patients who receive psychotherapy were less likely to attempt suicide during a follow-up period. 

It also reported that longer-term psychotherapy was more effective than short-term therapy in reducing the likelihood of a patient dying by suicide, and intensive psychotherapy (more than one session per week) was associated with a greater reduction in suicide attempts.

He said the ‘typical’ offer of eight sessions of therapy under the Improving Access to Psychological Therapies programme, was not enough.


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