Sharing information/ disclosure

As I so often read the ‘yellow’ journal or the Bulletin, I wanted to know why children are excluded from the issues discussed. In child and adolescent psychiatry, the issues of access to records and copying of letters to patients have quite different dimensions. Children, as well as adults, have rights.

The additional dimensions are:

1. 1. The child is our patient. What rights have the parents? This is obviously complex and often age or development-dependent, but children tend to be ignored. Children as young as 8 can be consulted, even if their views are overruled, as to whether they want clinical information disclosed to their parents.

2. 2. Letters sent to referrers can be copied to children and adolescents. Younger children cannot read and, in most households, parents control the correspondence so the child may not receive the letter. Should children and parents be copied separately? Should clinics arrange to read out letters about the child to the child or adolescent?

3. 3. There is the problem of possible harm to the child by copying clinical correspondence to his or her parents. Are letters to be worded to be most child- or parent-friendly? How is our duty to the child and to the parents balanced? For example, when we know a letter is to be copied, we may omit negative opinions about a parent and his/her care. From the child's perspective, should this be included? Looking at this the other way round, including an opinion about the possible detrimental effect of, say, the parent's negative approach to the child might increase the hostility.

I realise there are answers of a sort to all these questions - from human rights, legal and therapeutic perspectives - but I wanted to raise awareness of children in such discussions and raise the profile of children and their rights in psychiatric practice.