Mental health policy and practice across Europe: an overview

Carers and families 387
subject to general legislation concerning the neglect of a vulnerable adult. The
exceptions were Cyprus and Spain. In Cyprus, the family could be held legally
responsible for a relative on discharge or leave of absence from hospital. In
Spain, whoever was living with a person with a mental illness could be held
liable for that individual’s actions, whether or not they were the person’s official
guardian. Families were not always aware of this responsibility.
How does legislation allow information about the individual
with mental illness to be shared with families and carers?
Professionals may be reluctant to disclose confidential medical information to
relatives of an individual with a mental health problem, even though they may
be the primary caregiver(s). This is a complex issue as, on the one hand, there is
a need to uphold an individual’s rights to confidentiality, but at the same time
families may require a certain level of information to be able to provide effective
support. The extent to which information is shared will also be dependent on
local culture and custom. Ten countries responded to this survey question, the
majority raising legal issues surrounding confidentiality and many stating that
the law would only permit information to be shared with the consent of the
patient. However, the opposite situation exists in Greece where information is
routinely shared with families unless the patient expressly forbids it. In Italy,
in contrast, legislation made disclosure to family members more difficult, while
it was felt in Cyprus that information was largely shared with families when
medical staff wanted them to take on more responsibility. This was viewed
negatively as it often left families feeling guilty. Other responses noted that
this information might be shared ‘informally’ depending on the relationship
between the professional and the family, particularly in Belgium. English respondents
noted that medical personnel did not take account of the severity of
symptoms and how they may affect the individual when deciding whether to
share information with family members.
Empowerment of families – the role of family associations
The importance of empowering people with mental health problems to make
their own decisions about what services best meet their needs has already been
highlighted (see Chapter 3). Equally, the empowerment of family members is
essential. In addition to formal services, a critical role can be played by family
associations in empowering family caregivers by providing mutual support and
information both on the illness and on the availability of formal services, as well
as acting as advocates to protect the rights of both people with mental health
problems and family members. Family associations have now been established
in most European countries. While some associations have been in existence for
30 years, others have only been set up very recently. They have developed in
different ways. In the United Kingdom, for example, the family associations
Rethink, NSF (Scotland) and HAFAL (Wales) provide services for those with
mental illness in addition to providing support to families. In several countries,