The EPA recently published a policy paper on the ethical aspects of communication with patients and their families1. This paper was also endorsed by EUFAMI (the European Federation of Association of Families of people with Mental Illness) and GAMIAN (the Global Alliance of Mental Illness Advocacy Networks).
Different areas of communication
Communication plays a fundamental role in establishing a therapeutic relationship with patients, their families and caregivers. It may also be considered a therapeutic tool in itself, since good communication is associated with improved patient outcomes. Therefore, it is a key aspect of care for patients in mental-health settings.
Dr Carpiniello discussed the ethics of communicating about different aspects of psychiatric disorders:
- the diagnosis
- disease risk or prodromal stages
- treatment options
- involuntary treatment
Diagnosis and risk status
Take a patient-led approach to information-giving
Communication about a diagnosis or prodromal disease for a severe mental disorder can be extremely challenging, particularly as the disorder is likely to have stigma attached to it, and may have a poor prognosis2,3. So clinicians will need to take a patient-led approach:
- What do and don’t patients want to know?
- Do patients want family and caregivers to have this information?
- What is the balance of advantages and disadvantages in knowing about prodromal disease or their risk status?
Treatment – voluntary and involuntary
Informed consent must be the key consideration
When communicating about treatment options, informed consent must be the key consideration; and the patient needs to be competent to give their consent4. Patients need to know about the nature of the treatments, their risks and benefits, the time needed for efficacy and treatment duration. Families and caregivers will also usually be informed, unless this is expressly prohibited by the patient.
Good communication is a basic ethical requirement in the management of patients with mental-health disorders
When mandating involuntary treatment, psychiatrists are required to use great sensitivity, balancing the risks and benefits of such a step, and respecting the patient’s decision-making capacity as much as possible. Communication of the reasons for using such an intervention, the patient’s legal rights, and regular reviews of the treatment are all aimed at obtaining informed consent and stopping involuntary treatment in a timely way.
Overall, Dr Carpiniello reminded us, good communication is a basic ethical requirement in the management of patients with mental-health disorders.