My rights: Confidentiality and privacy

Site: CAMH External Courses
Course: Youth Wellness Quest
Book: My rights: Confidentiality and privacy
Printed by: Guest user
Date: Friday, 26 November 2021, 9:15 PM

Consent

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Puzzle Pieces - What

Consent is a term used to talk about how decisions around your medical care are made. Consent means having choice and the ability to say yes or no to different treatment and service options. According to the Health Care Consent Act, a person of any age can agree to (or refuse) mental health treatment and choose the type of treatment they want, as long as they have capacity—which means they are considered capable of making this decision.

Consent must always be given willingly. That means the choice you make should be your own, and nobody should force you to make the decision.

You must be able to consent to your treatment. This means that you understand the information you are given about your medical care. If you don't understand, you are allowed to ask questions. You should be able to get answers in words that you understand, so you can make a decision you are comfortable with. You should also be able to understand the risks and benefits of making this decision.

Sometimes, you may not be able to choose or agree to your treatment, and you may be given treatment involuntarily. This can occur if you are unwell and unable to understand what is happening. In that case, your parents, caregivers, another family member, a doctor or a legal authority might make decisions for you. As your treatment continues and you get better, you may be able to give consent later. This is a changing process—and that is OK. When possible, you should always be involved in the decision making, even if you can’t make the final decision yourself.


Example

Korah is having mental health struggles. Her family doctor refers her to a mental health hospital. During her first appointment, her therapist asks if she is interested in cognitive behavioural therapy (CBT). Korah is unsure about using CBT because her friend did not have a good experience with it. Korah takes her mom to her next appointment. The therapist mentions CBT again, but Korah is still not sure. Korah’s mom now agrees with the therapist and pushes Korah toward starting CBT. Korah knows her rights and that her consent to treatment must be given willingly. Korah finds out more about CBT and how it works. She asks the therapist lots of questions and learns more about CBT. Korah is now able to make an informed decision about her care, knowing the risks and benefits. She decides she is willing to give CBT a try.

Example

Idris has been going to one-on-one counselling for his substance use. His counsellor suggests that he join a group at the agency, where many service users talk about their challenges with substance use. Idris agrees to try the group therapy. He joins the weekly group and fits right in. He enjoys sharing his experiences and listening to others who are facing similar challenges. After a couple of weeks, Idris starts feeling very anxious and uneasy when he thinks about the group. He is not sure why he feels this way. He talks to his counsellor and expresses his new feelings. He says he would like to take a break from the group. The counsellor agrees with Idris’s idea. Idris had previously given his consent to join a group and now he has changed his mind and is not consenting to group therapy anymore.



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Confidentiality and privacy

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Privacy

Different people have different comfort levels when it comes to sharing personal information. Some people don’t want others to know they are having mental health or substance use challenges or are seeking help. It’s important that your privacy is respected and that steps are taken to make you feel safe and secure.

In Canada, there are federal and provincial laws about privacy and personal health information. In general, service agencies must:

  • get your permission to collect and share your personal information
  • tell you why they are collecting your personal information
  • store your personal information safely
  • let you see your personal health information if you ask to see it.

To find out more about the Canadian laws on privacy, check out https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-canada/.

Confidentiality

What you tell a service provider usually stays between just you and the service provider—this is called “confidentiality.” You have the right to have the things you talk about with your care team kept confidential. That means that what you share with your care team stays between you and them, except in certain situations, which are outlined below. Every service provider should explain their policies on privacy and confidentiality. If you want more information, ask your service provider for a copy of their policy on privacy and confidentiality, or ask them to go through it with you.

There are times when an agency or service provider can legally share things you talked about WITHOUT your permission or awareness. They might even be required by law to report things you shared. Here are the three most common reasons this would happen:

  1. If you tell a service provider that you or a child (under age 18) is being physically, emotionally or sexually abused or neglected.
  2. If you’re at risk for seriously hurting yourself or someone else.
  3. If you’re involved with the law or legal system, the courts can ask your service provider for your personal health information.

If this is important to you, you may want to ask your service provider the following questions:

  • In what situations would you have to break confidentiality with me?
  • If you feel the need to break confidentiality, would you tell me?
  • How does the agency keep records? Who can access them? Am I allowed access?
  • Under what circumstances will guardians or other authorities be contacted? (This question applies if you are a minor—under age 18.)

Example

Danil is experiencing mental health difficulties but he is unsure about using mental health services. He does not want his family and school to know about his struggles. Danil finds a mental health service close to his house and attends his first appointment. At the appointment, Danil is still unsure about talking to the therapist. The therapist explains what confidentiality is and gives Danil a form to read with the service’s policy on confidentiality and privacy. Danil is now aware of what would be kept confidential between him and his therapist. He is also aware of situations where his therapist may have to break the confidentiality agreement. Danil now understands confidentiality and feels more comfortable sharing his thoughts with his therapist.

"Through the process of seeking help as a young person, confidentiality feels like true empathy and support. It's having your mental health professional walk with you through the process and value the safe space you are sharing with them. Confidentiality is knowing you're safe, heard and seen."
—Vanessa, youth advisor

Click the tabs to view each section.

Anonymous services are a type of service where you don’t have to tell the service provider who you are. For example, many phone helplines and online mental health services are anonymous. People may want to use anonymous services for different reasons. For example, they may feel more comfortable being “unknown,” especially in a small town where everyone knows one another.

If this is important to you, you may want to ask your service provider the following questions:

  • Do you have anonymous services here? If so, what kind?
  • When I’m using an anonymous service, is there any way someone could find out who I am?
  • How do you make sure everything is kept confidential and anonymous?
  • If I choose to stay anonymous, how will you get a hold of me?

Many services will let you decide who you consider to be a part of your family. You might consider family members to be anyone in your circle who gives you emotional support and helps advocate for you when you don’t feel like you can advocate for yourself.

At different points throughout treatment, you can decide whether it could be helpful to involve family members so they can support you. You get to decide how much or how little your family is involved in your care.

If this is important to you, you may want to ask your service provider the following questions:

  • Can family members book my appointments for me, or do I have to do it myself?
  • Can I bring family members / close friends / partners to my appointments?
  • How will my family be involved in the treatment process?
  • Are there different ways my family can be involved?
  • I do not want my family involved. Are there any situations where they might be informed about my treatment?
  • I don’t want my family to come to my appointments, but I want to keep them informed. Can you give me short write-ups on my progress to give to them?

Example

August has begun counselling for her mental health, but she does not want her family to get too involved. She discusses her concerns with her psychologist. August explains what she would like to share with her family and what she would prefer to keep confidential with her psychologist. August decides that she does not want her family making decisions about her mental health without discussing it with her first. She also does not want her family to attend any of her appointments. But she would like her psychologist to give her short weekly write-ups/reports that she can share with her family to keep them informed about her progress.



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Feedback and complaints

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Sometimes, you may connect with service providers who are very supportive and understanding. It’s also possible that you may not feel heard or respected by some staff. This can be very upsetting. Many services have ways that you can share feedback about your experience, whether it’s positive or negative.


Tips on providing feedback or complaints

  • Speak directly to the doctor/service provider. Most professionals are willing to address your concerns directly or would love to hear positive feedback that you may have.
  • Speak to the manager to program lead. If you are not comfortable speaking to the person directly, speak to someone else in charge. You can also ask to remain anonymous.
  • See if there are programs already in place for you to provide feedback. Some agencies will have feedback surveys or programs that you can use to provide feedback.
  • Work with someone you trust. If you feel like you need some support, ask a friend or family member to come with you to meetings or to help you share your feedback.
  • Be clear. What happened? When did it happen? How has it affected you?
  • Decide what you would like to happen next. If you had a negative experience, how would you like things handled? Perhaps you want an apology, a meeting to discuss the problem or action to be taken to stop the situation from happening again.
  • Keep track of all the information. Write down the names and positions of the people involved, including those handling your complaint. Make sure you keep copies of any emails or letters you get; you may need to refer to them in the future.


Self-reflection activity

This is a self-reflection activity. As you do this activity, you can write down your thoughts on a piece of paper. If you have an account, you can click on the button below to write down your thoughts on a ‘Notes’ page that you can print or save.

Do you have any questions for your service provider regarding confidentiality, consent and privacy? You can also use this space to think about who you would like to involve or not involve in your care.



Key messages:

  • Learn about your rights when you begin treatment. You can do this by speaking directly to the service provider and asking them for information on confidentiality and privacy.
  • Consent is a term used to talk about how decisions around your medical care are made. Consent means having a choice and the ability to say “yes” or “no” to different treatments and service options.
  • What you tell a service provider usually stays between you and the service provider—this is called confidentiality.

Quest Marker

Play the Quest: Optional Activity


How to play:

Read the five sections: What, Who, How, My Rights and Self-help. At the end of each module, a word will be shown.

To finish the quest:

At the end, combine the words you’ve discovered to reveal a final message.

  Create an account to write notes in your journal.