TORONTO - It's a struggle experts say is an ongoing and familiar one for counsellors: balancing between respecting obligations of privacy, confidentiality and trust with the patient while recognizing the frustration of families concerned for their child's welfare.
The issue came to the fore this week as the parents of late Carleton University student Nadia Kajouji blamed the institution for failing to do enough to inform them of the 18-year-old's depression or prevent her suicide.
Suzanne Blanchard, Carleton's vice-president of student services, said counsellors were bound by confidentiality law from telling Kajouji's parents details of her depression, and that students won't trust counsellors if they start telling parents of their problems.
Even if a counsellor was able to go to a client's parents, it wouldn't necessarily guarantee a cure, said Donna Hansplant, vice-president of counselling services for Kids Help Phone.
"I think there's a sense in society you can intervene, then you can save the child and everything will be all right afterwards - and that's not true and we know that," she said from Montreal.
"(For) the person who's experiencing the depression or the suicidal ideations, it's them who are in control, and the best you can do as a counsellor or a mental health agency or a parent is put in place the best supports that you can to help them make the decision to not want to kill themselves or not want to go there."
In 2007, Kids Help Phone helped children in need more than two million times on the phone and online, with clients ranging in age from five to 20 years old. Twelve per cent of the contacts received were about mental health concerns.
Hansplant said they do hear from parents on occasion who want to inquire about their child, but the anonymous, confidential service doesn't disclose details to parents - although it does recognize their frustration.
"Parents care deeply about their kids and they want the best for them and the hard thing for parents is when they can't help their kids through a difficult situation and it makes them feel very vulnerable and at a loss for what to do."
Dr. Gary Chaimowitz, chair of the Canadian Psychiatric Association's standing committee on professional standards and practice, said the ability to treat patients would be "quite curtailed" if they felt the information disclosed wasn't confidential.
"The problem is, the person in therapy may not want that information revealed to spouses, parents or children and that obviously is the confidentiality that has to be respected," he said from Hamilton.
However, if there is a concern someone is at risk, there are "all sorts of obligations to breach confidentiality," he said.
In the case of a child at risk up to the age of 16, a therapist has an obligation to inform the Children's Aid Society.
When it comes to a patient with suicidal ideas, be it child or adult, if a physician believes the patient could hurt themselves, the doctor should act in a way that gets that person treatment, which could involve hospitalization, he said.
That's not to say family members are completely powerless, Chaimowitz said. There's nothing to stop concerned relatives from contacting the health professional to share their views, he said.
