Doctors treating patients with severe mental health conditions, but who are mentally fit and taking their medication voluntarily, are bound by professional secrecy not to divulge information to relatives unless there is a relapse, according to Anton Grech, clinical chairman of the government’s Mental Health Services.
Grech noted how, just as with any other form of medical condition, a mental health patient has the right not to disclose information to others, including relatives.
The subject was raised by the wife and son of 55-year-old Nicolas Camilleri who was found dead earlier this week after having been reported missing. The family have spoken about how Nicholas, who was diagnosed with paranoid schizophrenia 18 years ago, was “failed by the system”.
He died by suicide months after his medication had been reduced without the family being informed.
Rita Camilleri and her son Daniel Nicholas described to Times of Malta how Nicholas lived a normal life for 15 years, during which time he was taking a monthly depot antipsychotic injection apart from daily pills. But things spiralled out of control some months after, at the end of last year, the depot injection was stopped, and they were not informed.
His wife learnt about this in January this year – a few days before Nicholas allegedly attacked her with a chisel in the garage of their home. He was charged with attempted murder and detained in preventive custody until April when he was granted bail.
When a patient takes medication voluntarily, then you have a person whose mental state is deemed fit to take responsibility for their own treatment
But due to the nature of the charges he could not return home as he had to stay away from his wife, as the victim. His sister Joanne Micallef said that, together with her sister Charmaine and brother Arthur, they took him under their wing.
They reported him missing on June 16. On June 21, his son found him in an abandoned building. He had ended his life.
Richmond Foundation, Malta’s leading mental health charity, described this as a “preventable tragedy”.
While stressing that he could not comment about the specific case of Nicholas Camilleri, Grech outlined how the system worked in such cases. He explained that treatment is changed for one of three reasons: when there is no response to medication, when there are adverse side effects or when the course of treatment is completed.
Decisions are taken via a therapeutic alliance between the doctor and the patient as involving the patient in decisions leads to better compliance.
When it comes to the taking of medication, some patients have to be administered their medication involuntarily in accordance with the Mental Health Act. A responsible carer is appointed to ensure the medication is taken.
“When a patient takes medication voluntarily, then you have a person whose mental state is deemed fit to take responsibility for their own treatment. In these cases, an adult has the right to confidentiality and may choose not to inform relatives about any changes. This is the same as any medical health issues where, for example, a patient may not want to inform others about an upcoming operation.
“Doctors are advised to try to convince the patient to involve their next-of-kin but, in the end of the day, they cannot breach confidentiality. Things change if a doctor notices a relapse, in which case they are morally obliged to inform relatives since this becomes a matter of the safety of others,” he said.