In this reflection practice, I will talk about client confidentiality. Last week, I met a patient at Scarborough General hospital who was admitted for attempting to commit suicide. He was a young man aged 26 years and he has experienced a difficult life. His problems started 8-9 years ago when he was diagnosed with schizophrenia. However, he was able to cope and was doing well in school. Recently, he started experiencing depression that worsened and led him to attempt to take his own life by drinking bleach. The patient who I will call Jack was a brilliant young man who had great potential according to his parents. He had earlier graduated from college with a diploma and he was doing so well while in college. Jack’s parents shared that he had friends who supported him and spent time with him. However, the symptoms of depression started showing after he graduated from college. He no longer visited his friends and eventually, he lost contact with them.
Jack became depressed when he failed to get a job after graduating from college. He started expressing suicidal thoughts since he could not get a job. He was less social even at home and he relied on his family for support. His parents sought help at CAMH where he received support from psychiatrists, social workers, and caseworkers. Nonetheless, Jack did not get better. Instead, the support from the CAMH seemed to overwhelm him and he chose to cease seeking help. Jack also stopped taking his medication and turned to other drugs such as marijuana to deal with his mental health problems. This affected his father who has been asking the psychiatrists to help him in any way they can. However, they said there is nothing they can do since Jack had voluntarily decided to discontinue his medication and start using other dangerous drugs. His depression became severe leading him to try to take away his life. Jack’s father was also worried that he might try to end his life again.
When I checked Jack’s chart, I realized that he had been admitted several times in the hospital under the Mental Health Act. It was common for him to be admitted and then return home only to be readmitted again. I advised jack’s parent to seek the help of LHIN in assisting him to feed after he gets discharged from the hospital. I did not see any need for them to ask for social worker help since they had all the information for crisis health and mental health. When jack was discharged, I referred him to LHIN home care services to receive G-tube feed support and management. LHIN would also provide resources for crisis lines and offer employment support. Jack’s case weighed heavily on my heart and I asked myself several questions. Is it really true that the psychiatrist from whom Jack’s father sought help could not help? Although it is important to respect a client’s self-autonomy, aren’t there other avenues we can exploit to ensure that the patient does not stop seeking treatment or taking medication?
When I first saw Jack, his case got me sad and I had to talk to my husband to share my feelings and find relief. However, I did not share any personal information about Jack but instead, I explained to him that I find it challenging to offer assistance and I was also worried about the patient. To my surprise, my husband said that he knows Jack. Jack was a cousin to my husband’s friend who had informed him how jack had attempted to commit suicide. Although I had not told my husband the name of the client or his location, he automatically knew that I was talking about Jack. I asked my husband to ask his friend to keep checking on his cousin because he requires constant support.
The Canadian Association of Social Workers (CASW) has established ethical guidelines that must be adhered to by all Canadian social workers. CASW also talks about the value of confidentiality. According to this value, a social worker should not disclose the client’s information without his/her consent or unless the information is within the confidentiality limits (Canadian Association of workers, 2005). I can’t really tell if I breached confidentiality by telling my husband about Jack but I hope that he will talk with his friend and ask him to keep supporting his cousin because he needs help. This case is my first ethical situation and I feel that it forms the foundation for the ethical dilemmas that I may encounter. It has also helped me create boundaries on my principles and value when confronted by an ethical dilemma. I can’t stop wondering if there is any way I can help Jack to cope and overcome his challenges. I do not intend to breach the client’s confidentiality or act unethically in a way that compromises my career. Therefore, I will be cautious when talking about my challenges to avoid breaching confidentiality.
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