Joshua Brown

From Rt Hon Norman Lamb MP

| RAS 2 Minister of State for Care and Support
/
| Department Department of Health
/ of Health Richmond House
79 Whitehall
London SW1A 2NS
Ms R Cobb
Senior Coroner 21 OCT 2044

Coroner's Office, Kent County Council
St Peters House

Dane Valley Road

St Peters

Broadstairs

Kent

CT10 3FD

Dens (ts Che,

Thank you for your letter following the inquest into the death of Joshua Brown. In
your report you state that Mr Brown took his own life while suffering from depression,
the clinical cause of death being from multiple injuries sustained after falling from the
top of a cliff.

Mr Brown had a history of self-harm and suicidal thoughts and in 2011 had verbally
indicated his intention to take his own life. He had been diagnosed with moderate
depression and maladaptive personality traits and was in the care of the Community
Health Team (CHT).

| was sorry to read of Mr Brown's death and wish to extend my sincere sympathies to
his family.

Your main concerns appear to arise from the fact that Mr Brown did not wish his
personal information to be shared with his family. In particular, you raise the
following points:

e Mr Brown lived at home with his parents and although they were his primary
support they were not his carers. Mr Brown did not wish information about
himself to be shared and so the CHT were not able to involve his parents
formally. His parents therefore did not receive information that might have
alerted them to when Mr Brown was particularly vulnerable, and equally
information which might have been of assistance to the CHT caring for him
was not passed on.

Department
of Health

e twas not the practice of the CHT to confirm the accuracy of notes they had
made with family members with the consequence that inaccuracies or
misunderstanding may have arisen in some of the notes. There was therefore
no provision for these notes to be signed as accurate by the relevant family
members.

e Family members were not made aware of how to obtain information through
the Kent and Medway NHS Trust about ways they could best support Mr
Brown and themselves.

e There were limitations for engagement by the CHT with family members,
particularly because Mr Brown did not wish his information to be shared — this
worked to his disadvantage.

Current legislation provides that, where a clinician believes that a patient is at risk of
suicide, and that patient refuses to provide consent for information to be shared with
family members or any other third party, and, in the judgement of the clinician, the
patient has full mental capacity to understand the risks, then disclosure of that
patient's confidential information is not warranted.

In such circumstances the clinician needs to consider the risks to his or her own
relationship with the patient — the patient may withdraw from treatment if he or she
does not believe the clinician will respect confidentiality. Breaking patient
confidentiality could also create a risk that future patients will fail to seek treatment
because they do not trust the NHS to provide a confidential service.

The Department has received feedback from a number of families bereaved by
suicide about their experiences with services. Issues of confidentiality have been a
recurring theme. The public has repeatedly raised concerns that practitioners can
seem reluctant to use information from families and friends or provide families with
information about a person’s suicide risk. Several Prevention of Future Deaths
reports from Coroners have also drawn attention to this situation.

The Department has therefore facilitated a consensus statement on confidentiality,
Information sharing and suicide prevention: consensus statement, which was

published in January 2014 alongside the first annual report on the suicide prevention
strategy.

Both of these documents are published on the Government website:

https://www.gov.uk/government/publications/suicide-prevention-report

The consensus statement says:

“We strongly support working closely with families. Obtaining information from and
listening to the concerns of families are key factors in determining risk. We recognise
however that some people do not wish to share information about themselves or

From Rt Hon Norman Lamb MP
Minister of State for Care and Support

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their care. Practitioners should therefore discuss with people how they wish
information to be shared, and with whom. Wherever possible, this should include
what should happen if there is serious concern over suicide risk.”

To expand on this, the consensus statement advises that there are times in dealing
with a patient at risk of suicide when practitioners will need to consider informing the
family and friends about aspects of risk and may need to create a channel of
communication for both giving and receiving information that will help keep the
person safe.

The statement recommends that practitioners routinely discuss and confirm with
patients whether they wish their family and friends to be involved in their care
generally, and whether they wish for information about themselves to be shared. The
patient's view on who should be involved (and potentially, who should not be
involved), should there be serious concern over suicide risk, needs to be discussed,
considered and recorded.

In cases where these discussions have not happened in advance, a practitioner may
need to assess whether the patient, at least at that time, lacks the capacity to
consent to information about a suicide risk being shared. The Mental Capacity Act
makes it clear that persons must be assumed to have capacity unless it is
established that they lack capacity, and that people are not to be treated as unable
to make a decision merely because they make unwise decisions. However, if a
person is at imminent risk of suicide there may well be sufficient doubts about mental
capacity at that time.

In these circumstances, a professional judgement will need to be made, based on an
understanding of the patient and what would be in the patient’s best interest. This
should take into account the patient's previously expressed wishes and views in
relation to sharing information with family, and, where practical, include consultation
with colleagues. The judgement may be that it is right to share critical information. If
the purpose of the disclosure is to protect a person who lacks capacity from serious
harm, there is an expectation that practitioners will disclose relevant confidential
information, where it is considered to be in the person’s best interest to do so.

This work was supported by our National Suicide Prevention Strategy Advisory
Group. The consensus statement will be discussed again at the next meeting of this
group in November 2014.

i

Department
of Health

| hope that this response is helpful and | am grateful to you for bringing the
circumstances of Mr Brown's death to my attention.

NORMAN LAMB

ae