The scene

'I am a GP and have been contacted by the Fixated Threat Assessment Centre. They have forwarded me letters that a patient has been sending to a public figure.

'These letters are not threatening but they do suggest the patient has an unnatural fixation and I can understand why there is concern about the content. I am aware the patient does have some mental health problems but I do not believe they are a physical danger to anyone. They appear to be sending these letters at least once a week. 

'The FTAC have asked me for information about the patient's mental health. In view of the nature of the letters and the importance of the recipient, am I obliged to disclose information without the patient's consent?'

MDU advice

The Fixated Threat Assessment Centre (FTAC) is a joint NHS and police unit based in London. Its role is to assess and manage risks that may be posed to prominent individuals, such as members of the royal family and politicians, by people who suffer from serious mental health conditions. Some of these people may not be known to medical services, and therefore one aim of the organisation is to help people get the care they need and in doing so, reduce the risk to others.

The trust between a doctor and patient is extremely important in order to establish an appropriate therapeutic relationship, however, there may be times when you have to consider breaching a patient's confidentiality. One of those times may be when it is in the public interest to do so. This may be to protect individuals or society from harm, such as serious crime.

You do not have an obligation to disclose sensitive information to the FTAC and you would need to be able to justify breaching the patient's confidentiality, if you did not have their consent. Unless it would put you or others at risk, you could arrange a consultation with the patient to discuss the contact you have had from the FTAC and explain their concerns whilst assessing the patient's clinical status and needs.

If the patient agrees, you could then let the FTAC know that you have had this consultation and what action you have taken as a result. If the patient refuses to consent to you disclosing their information, you could simply reassure the FTAC that matters are in hand.

If you do believe the patient poses a threat to any prominent individuals or the public in general and you can justify disclosure in the public interest, you do not need to ask for the patient's consent. However, unless there is a risk associated with doing so, you should let the patient know that you intend to disclose personal information about them and to whom. As always, document your discussion and any decisions you make carefully.