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Copying letters to patients: Issues for child and adolescent mental health services

  • Fiona Subotsky (a1)
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Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Department of Health (2000) The NHS Plan. London: Department of Health.
Department of Health (2003) Copying Letters to Patients: Good Practice Guidelines. London: Department of Health.
Roy, D. (2004) Recording health care and sharing the information – more bureaucracy or a welcome change to prevailing practice? Psychiatric Bulletin, 28, 3335.
Steinberg, D. (2000) Letters from the Clinic: Letter Writing in Clinical Practice for Mental Health Professionals. London: Routledge.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Copying letters to patients: Issues for child and adolescent mental health services

  • Fiona Subotsky (a1)
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eLetters

Copying letters to patients in CAMHS

Anne E Thompson, Consultant Child and Adolesent psychiatrist
19 July 2005

We read with interest Dr Subotsky’s review of issues for CAMHS when copying letters to patients (Subotsky, 2005). A survey of our CAMHS service (66% response rate, 39 respondents) showed that many practitioners write to families as a matter of course.

Our survey indicates that 96% of the professionals have always copiedsome letters to patients. It also showed that 23% have recently changed their practice andsend more letters because of DOH and local service good practice guidelines. Some gave otherreasons for copying letters to families including sharing information in atransparent way with families and increasing the therapeutic alliance.

Most of our sample reported they adjust their writing style to suit the families; and they try not to use medical words. 59% indicated they write letters to the GP or referrer with a copy to the patient.

69% of professionals confirmed that they got feedback from their patients about their clinical letters. This feedback was largely positive, with only 8% statingthat patients were worried by something in the letter.

Interestingly, in a service which sees predominantly white British families, the professionals needed translators in 3 occasions for Chinese and Persian families.

In our service, the two most common reasons for not copying letters to patients were as cited by Subotsky, i.e. when practitioners had child protection concerns (46% of the whole sample) or when information was about a third party (41%).

Our survey also revealed a third potentially important exception (in 23% of the whole sample): practitioners may wish to communicate their clinical impressions or concerns to the referrer at an early stage of the assessment process, before the practitioner feels ready to discuss these views and their implications with the family. The most commonly cited example of this is if a practitioner has concerns that a young person might be psychotic.

Our colleagues sometimes resolve this dilemma by writing separate letters to referrers and to the family. While this may superficially address the need to balance communication with the family and professionals, this practice is not in keeping with the DOH guidelines. The DOH policy aims “to improve communications with patients to benefit their healthcare without jeopardising communication with other professionals” (Department of Health, 2003).

When worrying clinical information is apparent early in assessments, our service is considering whether no letter, an incomplete letter or a letter that is not shared with the patient is in the best interests of thechild.
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Conflict of interest: None Declared

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Copying letters to patients/parents

Rajesh S Aruna, Specialist Registrar in Child & Adolescent Psychiatry
05 July 2005

Copying letters to patients/parents:

We read with interest the editorial by Dr.Subotsky about the issues surrounding copying clinic letters in CAMHS settings (Psychiatric Bulletin, June ’05). We conducted a study to determine parents’ views on this policy. This was in a Specialist Tier 4 CAMHS Centre for children with complex developmental disorders and autistic spectrum disorders. The assessments done are multidisciplinary and elaborate. Copies of reports are sent to parents and they are subsequently invited to discuss the reports. All follow up letters are also copied to parents. This policy hasbeen in place since 1991.

In our study 87 families were surveyed with a 54% response rate (relatively low but typical of postal surveys). 95% of the parents supported the policy of receiving copy letters and wished to continue withthe practice. 93% of the responders felt that the information in the reports was accurate. 68% of the responders had highlighted the benefits of the copy reports in accessing help from other agencies namely Educationand Social Services. Many parents had commented that the written reports helped them to understand the child’s difficulties better.

Our study supports the idea that copying letters to parents is a useful initiative, particularly for parents managing children with complex developmental disorders with multi-agency involvement. The reports are a useful link between the agencies and play a key role in making long-term decisions. They are a permanent record of the consultation to be kept for future reference particularly for conditions that span a life-time. Written information also helps parents who themselves have communication difficulties to easily keep track of information.

This policy certainly works for our department and will continue in line with the Department of Health Guidelines. (Department of Health 2000 - The NHS Plan – London Stationery Office).
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Conflict of interest: None Declared

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