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When a patient says ‘I want to kill myself – don’t tell anyone’

Nurses need to know when the interests of the patient override the need for confidentiality.
when a patient says

Nurses need to know when the interests of the patient override the need for confidentiality, says RCN mental health adviser Ian Hulatt

As a general nursing student the question I dreaded hearing was am I dying nurse? Thankfully I cant recall being asked it, but like many of my peers I worried about situations such as this, for which I felt poorly prepared. As I moved into mental health nurse training, I became concerned about another tricky situation. Namely, when a person you are caring for asks can I tell you a secret?. This raises other concerns, and until I developed my standard answer, I think I probably used a lot of ums and aahs.

As the world

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Nurses need to know when the interests of the patient override the need for confidentiality, says RCN mental health adviser Ian Hulatt


Share necessary information with other healthcare professionals and agencies only when
the interests of patient safety and public protection override the need for confidentiality. Picture: iStock

As a general nursing student the question I dreaded hearing was ‘am I dying nurse?’ Thankfully I can’t recall being asked it, but like many of my peers I worried about situations such as this, for which I felt poorly prepared. As I moved into mental health nurse training, I became concerned about another tricky situation. Namely, when a person you are caring for asks ‘can I tell you a secret?’. This raises other concerns, and until I developed my standard answer, I think I probably used a lot of ‘ums’ and ‘aahs’.

As the world has developed and our practice scrutinised more than ever, it is understandable that this remains a difficult area in whatever field of nursing you work in, and even more so now that we are alert to the legal, moral and ethical issues involved.

There is no doubt that there are circumstances when we may be requested to keep to ourselves information that is difficult to do so. What if the information is ‘I have told everyone here in the emergency department that I am no longer a risk to myself, but now I am not so sure. Please don’t tell anyone’?

It is not possible in this short article to explore the many responses to a situation such as this, so perhaps the brevity of the NMC code will suffice: ‘Share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality’.

This issue of information sharing when people may have a wish to kill themselves, or have disclosed a wish to kill themselves, was the subject of a consensus statement published in 2014. The statement offers guidance to health professionals in such situations and I strongly recommend you read it. 


About the author 

Ian Hulatt is RCN mental health adviser

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